title: Fatty marrow conversion of the proximal femoral metaphysis in transient bone marrow edema syndrome.
abstract: BACKGROUND
  In the proximal femoral metaphysis, hematopoietic marrow is predominant during the adult stage of life. The conversion of hematopoietic marrow to fatty marrow in the proximal femoral metaphysis has been suggested as an etiologic factor of ischemia in the pathogenesis of femoral head osteonecrosis. To determine whether the chronology of fatty marrow conversion of the proximal femoral metaphysis is related to transient bone marrow edema syndrome of the hip, a case control study was conducted on 10 patients with the disease.
  
  
  METHODS
  There were 8 men and 2 women with a mean age of 33 years (range 19-45 years). The 10 patients were matched with 20 controls for gender and age (5-year range). T1-weighted MRI scans of their hips were reviewed. Marrow of the greater trochanter becomes fatty before puberty, and thus, the greater trochanter can be used as a built-in control. The signal intensity of the proximal femoral metaphysis was compared to that of the greater trochanter.
  
  
  RESULTS
  In all patients, the signal intensity of the proximal femoral metaphysis was isointense (fatty marrow) relative to that of the greater trochanter. In control subjects, the signal intensity was isointense in 8 (40%) and hypointense (hematopoietic marrow) in 12 (60%) (p < 0.05).
  
  
  CONCLUSIONS
  The current study shows that the proximal femoral metaphysis is predominantly fatty in transient bone marrow edema syndrome. The conversion of hematopoietic to fatty marrow is known to correlate with decreases in intramedullary blood flow. Thus, the current study suggests that an ischemia of the proximal femur secondary to fatty marrow conversion of the proximal femoral metaphysis might be a cause of transient bone marrow edema syndrome of the hip.
authors.affiliation: Department of Orthopaedic Surgery, Kyungpook National University College of Medicine, 50 Samduk-2 ga, Daegu 700-721, South Korea.
authors.forename: Shin-Yoon
authors.initials: SY
authors.lastname: Kim
authors.forename: Kyung-Hoi
authors.initials: KH
authors.lastname: Koo
authors.forename: Kuen-Tak
authors.initials: KT
authors.lastname: Suh
authors.forename: Yong-Sik
authors.initials: YS
authors.lastname: Kim
authors.forename: Yoon-Je
authors.initials: YJ
authors.lastname: Cho
authors.forename: Byung-Woo
authors.initials: BW
authors.lastname: Min
authors.forename: Yong-Chan
authors.initials: YC
authors.lastname: Ha
authors.forename: Jung-Ah
authors.initials: JA
authors.lastname: Choi
mesh_terms: D000328:Adult; D001853:Bone Marrow / Q000098:blood supply / Q000503:physiopathology*; D001855:Bone Marrow Diseases / Q000209:etiology*; D016022:Case-Control Studies; D004487:Edema / Q000209:etiology*; D005260:Female; D005269:Femur / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged