Öz
Özet
Amaç: Kemik iliği ödemi tanım olarak kemik medullasında sıvının anormal bir şekilde artmasına denir. Etyolojide travmatik ve non-travmatik birçok faktör rol almaktadır. Bu çalışmada travmatik olgularda tespit edilen kemik iliği ödemi ve kontüzyonu kavramına dikkat çekmek ve adli tıp yaklaşımında sonuç belirlemek amaçlanmıştır.
Yöntem: Ocak 2020 ile Mayıs 2021 tarihleri arasında bir sağlık kuruluşunun radyoloji kliniğine manyetik rezonans görüntüleme (MRG) çekilmek için başvuran hastalardan, kas-iskelet sistemi için çekimi olan görüntüler retrospektif olarak incelendi. İncelemede travma tanılı olgular dikkate alınarak kemik iliği ödemi ve kontüzyonu varlığı- yokluğu şeklinde kategorize edildi. Görüntüleme işlemi 1,5 Tesla Simens Magnetom Aera cihazı ile yapıldı.
Bulgular: Travma öyküsü ile gelen ancak belirgin bir osteopatoloji tespit edilmeyen 153 olgudan 74 (% 48,4) tanesinde kemik iliği ödemi saptandı. Bu olguların tamamında künt travma öyküsü mevcuttu. Olguların 40’ı (%54,0) kadın, 34’ü (%46,0) erkek idi. Kemik iliği ödemi saptanan 74 olgunun 39’unda (% 52,8) kemik kontüzyonu tespit edildi.
Sonuç: Son olarak Haziran 2019’da güncellenen “Türk Ceza Kanunu’nda Tanımlanan Yaralama Suçlarının Adli Tıp Açısından Değerlendirilmesi Rehberinde” travmatik kemik iliği ödemi ve kontüzyonu kavramının yer almadığını görmekteyiz. İlerleyen dönemlerde adli tıp rehberlerinde bir yaralanma kriteri olarak yer alması gerektiği düşüncesindeyiz. Ayrıca vücut üzerine etkisi göz önüne alındığında; “Basit bir tıbbi müdahale ile giderilebilecek ölçüde hafif olmadığı” olarak skorlanmasının uygun olduğu kanaatindeyiz.
Anahtar Kelimeler
Travma Kemik İliği Ödemi Adli Tıp Manyetik Rezonans Görüntüleme
Teşekkür
Teşekkür: 6 Şubat 2023 Malatya Depreminde yaşamını yitiren ve bu yazıda emeği bulunan Dr.Nusret AYAZ’ı saygı ile anmaktayız.
Kaynakça
- 1. Eraslan A, Ülkar B, Çelebi M. Derleme: kemik ezilmesi". Spor Hekimliği Dergisi 42.3,2007; 105-18.
- 2. Patel S. Primary bone marrow oedema syndromes. Rheumatology (Oxford). 2014 May;53(5):785-92.
- 3. https://www.md-health.com/Bone-Bruise.html. Erişim tarihi 10 Aralık 2022.
- 4. Johnson DL, Urban WP Jr, Caborn DN, Vanarthos WJ, Carlson CS. Articular cartilage changes seen with magnetic resonance imaging-detected bone bruises associated with acute anterior cruciate ligament rupture. Am J Sports Med. 1998 May-Jun;26(3):409-14.
- 5. Gürbeden B, Özkan DS, Özdemir MH. Kemik berelenmesi medikolegal süreçte kırık olarak değerlendirilmeli mi? Olgu sunumu. The Bulletin of Legal Medicine 2016;21:47-49.
- 6. Graf BK, Cook DA, De Smet AA, Keene JS. "Bone bruises" on magnetic resonance imaging evaluation of anterior cruciate ligament injuries. Am J Sports Med. 1993 Mar-Apr;21(2):220-3.
- 7. Miller MD, Osborne JR, Gordon WT, Hinkin DT, Brinker MR. The natural history of bone bruises. A prospective study of magnetic resonance imaging-detected trabecular microfractures in patients with isolated medial collateral ligament injuries. Am J Sports Med. 1998 Jan-Feb;26(1):15-9.
- 8. Roemer FW, Bohndorf K. Long-term osseous sequelae after acute trauma of the knee joint evaluated by MRI. Skeletal Radiol. 2002 Nov;31(11):615-23.
- 9. Blebea JS, Houseni M, Torigian DA, et al. Structural and functional imaging of normal bone marrow and evaluation of its age-related changes. Semin Nucl Med. 2007;37(3):185-194. doi:10.1053/j.semnuclmed.2007.01.002
- 10. Horga LM, Hirschmann AC, Henckel J, Fotiadou A, Di Laura A, Torlasco C, et al. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol. 2020 Jul;49(7):1099-1107.
- 11. Sahoo K, Garg A, Saha P, Dodia JV, Raj VR, Bhairagond SJ. Study of imaging pattern in bone marrow oedema in MRI in recent knee injuries and its correlation with type of knee injury. J Clin Diagn Res. 2016 Apr;10(4):TC06-11.
- 12. Zhang Y, Shu D, Yao W, et al. MRI study of changes in knee bone marrow edema-like signal in asymptomatic amateur marathon runners before and after half-marathon running. Clin Imaging. 2021;80:150-157. doi:10.1016/j.clinimag.2021.05.005.
- 13. Hofmann S. The painful bone marrow edema syndrome of the hip joint. Wien Klin Wochenschr. 2005;117(4):111-120. doi:10.1007/s00508-005-0322-2
- 14. Palmer W, Bancroft L, Bonar F, Choi JA, Cotten A, Griffith JF, et al. Glossary of terms for musculoskeletal radiology. Skeletal Radiol. 2020 Jul;49(Suppl 1):1-33.
- 15. Hagglund M, Walden M, Zwerver J, Ekstrand J. Epidemiology of patellar tendon injury in elite male soccer players. Br J Sports Med. 2011;39(9):1906–11.
- 16. Malliaras P, Cook JL, Kent PM. Anthropometric risk factors for patellar tendon injury among volleyball players. Br J Sports Med. 2007;41(4):259–63.
- 17. Matiotti SB, Soder RB, Becker RG, Santos FS, Baldisserotto M. MRI of the knees in asymptomatic adolescent soccer players: a case–control study. J Magn Reson Imaging. 2017;45(1):59–65.
- 18. Sadineni RT, Pasumarthy A, Bellapa NC, Velicheti S. Imaging Patterns in MRI in Recent Bone Injuries Following Negative or Inconclusive Plain Radiographs. J Clin Diagn Res. 2015 Oct;9(10):TC10-3.
- 19. Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2018.
- 20. Terzidis IP, Christodoulou AG, Ploumis AL, Metsovitis SR, Koimtzis M, Givissis P. The appearance of kissing contusion in the acutely injured knee in the athletes. Br J Sports Med. 2004;38:592–96.
- 21. Vincken PW, Ter Braak BP, van Erkel AR, Coerkamp EG, Mallens WM, Bloem JL: Clinical consequences of bone bruise around the knee. Eur Radiol 16: 97-107, 2006.
- 22. Mankin HJ. The response of articular cartilage to mechanical injury. J BoneJoint Surg (Am) 1982;64:460–6.
- 23. Türk Ceza Kanunu’nda Tanımlanan Yaralama Suçlarının Adli Tıp Açısından Değerlendirilmesi Rehberi, 2019.
- 24. Aktaş EÖ, Kaya A. Yaralama Suçlarının Adli Tıbbi Değerlendirilmesinde Kullanılan Kılavuza Bakış. The Bulletin of Legal Medicine 2017;22:45-53.
- 25. Meral O, Ayaz N. Psikiyatri Konsültasyonlarının Adli Rapor Düzenleme Sürecine Etkisi. The Bulletin of Legal Medicine 2020;25:161-6.
- 26. Summers P, Saia G, Colombo A, Pricolo P, Zugni F, Alessi S, et al. Whole-body magnetic resonance imaging: technique, guidelines and key applications. Ecancer medical science. 2021(7);15:1164.
- 27. Fischer T, Baz YE, Waelti S, Wildermuth S, Leschka S, Güsewell S, Dietrich TJ. Short tau inversion recovery (STIR) after intravenous contrast agent administration obscures bone marrow edema-like signal on forefoot MRI. Skeletal Radiol. 2022;51(3):573-9.
- 28. Li J, Zhou H, Zhang X, Song F, Pang X, Wei Z. A two-way comparison of whole-body 18FDG PET-CT and whole-body contrast-enhanced MRI for distant metastasis staging in patients with malignant tumors: a meta-analysis of 13 prospective studies. Ann Palliat Med. 2020;9(2):247-255. doi:10.21037/apm.2020.02.30
Öz
Aim: Traumatic and non-traumatic many factors play a role in the etiology of bone marrow edema. In this study, it is aimed to draw attention to the term of bone marrow edema and contusion detected in traumatic cases and to determine a result in the medico-legal approach.
Methods: The musculoskeletal images of patients who applied to the radiology clinic of a health institution for magnetic resonance imaging (MRI) between January 2020 and May 2021 were analyzed retrospectively. Imaging was performed with a 1.5 Tesla Simens Magnetom Aera device.
Results: Bone marrow edema was detected in 74 (48.4%) of the 153 patients who presented with a history of trauma but no obvious osteopathology was detected. All of these cases had a history of blunt trauma. Forty (%54.0) of the cases were female and 34 (%46.0) were male. Bone marrow contusion was detected in 39 (52.8%) of 74 cases.
Conclusion: We see that the term of traumatic bone marrow oedema and contusion is not included in the "Guidelines for Forensic Evaluation of Injury Crimes Defined in the Turkish Penal Code" updated in June 2019. In addition, considering the effect on the body; We believe that it is appropriate to score it as "not mild enough to be remedied with a simple medical intervention".
Anahtar Kelimeler
Trauma Bone Marrow Edema Forensic Medicine Magnetic Resonance Imaging
Kaynakça
- 1. Eraslan A, Ülkar B, Çelebi M. Derleme: kemik ezilmesi". Spor Hekimliği Dergisi 42.3,2007; 105-18.
- 2. Patel S. Primary bone marrow oedema syndromes. Rheumatology (Oxford). 2014 May;53(5):785-92.
- 3. https://www.md-health.com/Bone-Bruise.html. Erişim tarihi 10 Aralık 2022.
- 4. Johnson DL, Urban WP Jr, Caborn DN, Vanarthos WJ, Carlson CS. Articular cartilage changes seen with magnetic resonance imaging-detected bone bruises associated with acute anterior cruciate ligament rupture. Am J Sports Med. 1998 May-Jun;26(3):409-14.
- 5. Gürbeden B, Özkan DS, Özdemir MH. Kemik berelenmesi medikolegal süreçte kırık olarak değerlendirilmeli mi? Olgu sunumu. The Bulletin of Legal Medicine 2016;21:47-49.
- 6. Graf BK, Cook DA, De Smet AA, Keene JS. "Bone bruises" on magnetic resonance imaging evaluation of anterior cruciate ligament injuries. Am J Sports Med. 1993 Mar-Apr;21(2):220-3.
- 7. Miller MD, Osborne JR, Gordon WT, Hinkin DT, Brinker MR. The natural history of bone bruises. A prospective study of magnetic resonance imaging-detected trabecular microfractures in patients with isolated medial collateral ligament injuries. Am J Sports Med. 1998 Jan-Feb;26(1):15-9.
- 8. Roemer FW, Bohndorf K. Long-term osseous sequelae after acute trauma of the knee joint evaluated by MRI. Skeletal Radiol. 2002 Nov;31(11):615-23.
- 9. Blebea JS, Houseni M, Torigian DA, et al. Structural and functional imaging of normal bone marrow and evaluation of its age-related changes. Semin Nucl Med. 2007;37(3):185-194. doi:10.1053/j.semnuclmed.2007.01.002
- 10. Horga LM, Hirschmann AC, Henckel J, Fotiadou A, Di Laura A, Torlasco C, et al. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol. 2020 Jul;49(7):1099-1107.
- 11. Sahoo K, Garg A, Saha P, Dodia JV, Raj VR, Bhairagond SJ. Study of imaging pattern in bone marrow oedema in MRI in recent knee injuries and its correlation with type of knee injury. J Clin Diagn Res. 2016 Apr;10(4):TC06-11.
- 12. Zhang Y, Shu D, Yao W, et al. MRI study of changes in knee bone marrow edema-like signal in asymptomatic amateur marathon runners before and after half-marathon running. Clin Imaging. 2021;80:150-157. doi:10.1016/j.clinimag.2021.05.005.
- 13. Hofmann S. The painful bone marrow edema syndrome of the hip joint. Wien Klin Wochenschr. 2005;117(4):111-120. doi:10.1007/s00508-005-0322-2
- 14. Palmer W, Bancroft L, Bonar F, Choi JA, Cotten A, Griffith JF, et al. Glossary of terms for musculoskeletal radiology. Skeletal Radiol. 2020 Jul;49(Suppl 1):1-33.
- 15. Hagglund M, Walden M, Zwerver J, Ekstrand J. Epidemiology of patellar tendon injury in elite male soccer players. Br J Sports Med. 2011;39(9):1906–11.
- 16. Malliaras P, Cook JL, Kent PM. Anthropometric risk factors for patellar tendon injury among volleyball players. Br J Sports Med. 2007;41(4):259–63.
- 17. Matiotti SB, Soder RB, Becker RG, Santos FS, Baldisserotto M. MRI of the knees in asymptomatic adolescent soccer players: a case–control study. J Magn Reson Imaging. 2017;45(1):59–65.
- 18. Sadineni RT, Pasumarthy A, Bellapa NC, Velicheti S. Imaging Patterns in MRI in Recent Bone Injuries Following Negative or Inconclusive Plain Radiographs. J Clin Diagn Res. 2015 Oct;9(10):TC10-3.
- 19. Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2018.
- 20. Terzidis IP, Christodoulou AG, Ploumis AL, Metsovitis SR, Koimtzis M, Givissis P. The appearance of kissing contusion in the acutely injured knee in the athletes. Br J Sports Med. 2004;38:592–96.
- 21. Vincken PW, Ter Braak BP, van Erkel AR, Coerkamp EG, Mallens WM, Bloem JL: Clinical consequences of bone bruise around the knee. Eur Radiol 16: 97-107, 2006.
- 22. Mankin HJ. The response of articular cartilage to mechanical injury. J BoneJoint Surg (Am) 1982;64:460–6.
- 23. Türk Ceza Kanunu’nda Tanımlanan Yaralama Suçlarının Adli Tıp Açısından Değerlendirilmesi Rehberi, 2019.
- 24. Aktaş EÖ, Kaya A. Yaralama Suçlarının Adli Tıbbi Değerlendirilmesinde Kullanılan Kılavuza Bakış. The Bulletin of Legal Medicine 2017;22:45-53.
- 25. Meral O, Ayaz N. Psikiyatri Konsültasyonlarının Adli Rapor Düzenleme Sürecine Etkisi. The Bulletin of Legal Medicine 2020;25:161-6.
- 26. Summers P, Saia G, Colombo A, Pricolo P, Zugni F, Alessi S, et al. Whole-body magnetic resonance imaging: technique, guidelines and key applications. Ecancer medical science. 2021(7);15:1164.
- 27. Fischer T, Baz YE, Waelti S, Wildermuth S, Leschka S, Güsewell S, Dietrich TJ. Short tau inversion recovery (STIR) after intravenous contrast agent administration obscures bone marrow edema-like signal on forefoot MRI. Skeletal Radiol. 2022;51(3):573-9.
- 28. Li J, Zhou H, Zhang X, Song F, Pang X, Wei Z. A two-way comparison of whole-body 18FDG PET-CT and whole-body contrast-enhanced MRI for distant metastasis staging in patients with malignant tumors: a meta-analysis of 13 prospective studies. Ann Palliat Med. 2020;9(2):247-255. doi:10.21037/apm.2020.02.30
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2023 |
| Gönderilme Tarihi | 28 Mart 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 3 Sayı: 3 |
