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Edema-like marrow signal intensity (ELMSI) associated with nonossifying fibroma (NOF) on MRI: an uncommon finding in a common bone lesion



To investigate the association between nonossifying fibroma (NOF) and perilesional edema-like marrow signal intensity (ELMSI) on MRI and discuss the clinical and diagnostic implications of this finding.

Materials and methods

A retrospective search for “nonossifying fibroma” and “NOF” on knee MRI reports of patients up to 20 years of age over a 5-year period was performed. A total of 77 patients (34 males, 43 females, ages 11–20) were identified, and each MRI was reviewed to evaluate for ELMSI associated with the NOF. Statistical analysis was performed to determine if there was a correlation with the presence of perilesional ELMSI and age, gender, lesion size, or signal characteristics.


Twelve patients out of 77 (16%) had ELMSI associated with a NOF. Excluding patients who had additional findings of pathologic fracture (n = 2), a known potential complication of NOFs, and edema related to an adjacent osteoid osteoma (n = 1), a total of 9 patients (12%) had otherwise unexplained perilesional ELMSI. There was no statistically significant difference between patients with vs. without perilesional ELMSI with respect to age (p = 0.08), gender (p = 0.28), lesion size (p = 0.52), or appearance on fluid-sensitive sequences (p = 0.81).


ELMSI can be seen about NOFs encountered around the knee joint on MRI, which may represent active healing and/or involutional change of this “do not touch” lesion in cases where no other explanation is identified.

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Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.


  1. Błaż M, Palczewski P, Swiątkowski J, Gołębiowski M. Cortical fibrous defects and non-ossifying fibromas in children and young adults: the analysis of radiological features in 28 cases and a review of literature. Pol J Radiol. 2011;76(4):32–9.

    PubMed  PubMed Central  Google Scholar 

  2. Kumar R, Madewell JE, Lindell MM, Swischuk LE. Fibrous lesions of bones. Radiographics. 1990;10(2):237–56.

    Article  CAS  PubMed  Google Scholar 

  3. Ritschl P, Karnel F. Zur Pathogenese des fibrösen Kortikalisdefektes und nicht ossifizierenden Knochenfibromes [Pathogenesis of fibrous cortical defect and non-ossifying bone fibroma]. Z Orthop Ihre Grenzgeb. 1986;124(6):682–7.

    Article  CAS  PubMed  Google Scholar 

  4. Ritschl P, Karnel F, Hajek P. Fibrous metaphyseal defects–determination of their origin and natural history using a radiomorphological study. Skeletal Radiol. 1988;17(1):8–15.

    Article  CAS  PubMed  Google Scholar 

  5. Jee WH, Choe BY, Kang HS, et al. Nonossifying fibroma: characteristics at MR imaging with pathologic correlation. Radiology. 1998;209(1):197–202.

    Article  CAS  PubMed  Google Scholar 

  6. Dumitriu DI, Menten R, Clapuyt P. Pitfalls in the diagnosis of common benign bone tumours in children. Insights Imaging. 2014;5(6):645–55.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Stacy GS, Dixon LB. Pitfalls in MR image interpretation prompting referrals to an orthopedic oncology clinic. Radiographics. 2007;27(3):805–26 (discussion 827-8).

    Article  PubMed  Google Scholar 

  8. Sakamoto A, Tanaka K, Yoshida T, Iwamoto Y. Nonossifying fibroma accompanied by pathological fracture in a 12-year-old runner. J Orthop Sports Phys Ther. 2008;38(7):434–8.

    Article  PubMed  Google Scholar 

  9. Shimal A, Davies AM, James SL, Grimer RJ. Fatigue-type stress fractures of the lower limb associated with fibrous cortical defects/non-ossifying fibromas in the skeletally immature. Clin Radiol. 2010;65(5):382–6.

    Article  CAS  PubMed  Google Scholar 

  10. Robertson M, Gilley J, Nicholas R. Stress fractures of the distal femur involving small nonossifying fibromas in young athletes. Orthopedics. 2016;39(6):e1197–200.

    Article  PubMed  Google Scholar 

  11. Herget GW, Mauer D, KrauB T, El Tayeh A, Uhl M, Südkamp NP, Hauschild O. Non-ossifying fibroma: natural history with an emphasis on a stage-related growth, fracture risk and the need for follow-up. BMC Musculoskelet Disord. 2016;5(17):147.

    Article  Google Scholar 

  12. Easley ME, Kneisl JS. Pathologic fractures through nonossifying fibromas: is prophylactic treatment warranted? J Pediatr Orthop. 1997;17(6):808–13.

    Article  CAS  PubMed  Google Scholar 

  13. Goldin A, Muzykewicz DA, Dwek J, Mubarak SJ. The aetiology of the non-ossifying fibroma of the distal femur and its relationship to the surrounding soft tissues. J Child Orthop. 2017;11(5):373–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Muzykewicz DA, Goldin A, Lopreiato N, et al. Nonossifying fibromas of the distal tibia: possible etiologic relationship to the interosseous membrane. J Child Orthop. 2016;10(4):353–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Baumhoer D, Kovac M, Sperveslage J, et al. Activating mutations in the MAP-kinase pathway define non-ossifying fibroma of bone. J Pathol. 2019;248(1):116–22.

    Article  CAS  PubMed  Google Scholar 

  16. Gomes CC, Gomez RS. MAPK pathway-activating mutations drive giant cell lesions of the jaws and non-ossifying fibromas of bone. J Pathol. 2019;248(1):123–4.

    Article  PubMed  Google Scholar 

  17. Bovée JV, Hogendoorn PC. Non-ossifying fibroma: a RAS-MAPK driven benign bone neoplasm. J Pathol. 2019;248(2):127–30.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gao S, Zhou R, Xu Q, Chen H. Edema surrounding benign tumors and tumor-like lesions. Biomed Res Int. 2019;29(2019):8206913.

    Google Scholar 

  19. Maraghelli D, Brandi ML, MatucciCerinic M, et al. Edema-like marrow signal intensity: a narrative review with a pictorial essay. Skeletal Radiol. 2021;50(4):645–63.

    Article  PubMed  Google Scholar 

  20. Zbojniewicz AM, Laor T. Focal Periphyseal Edema (FOPE) Zone on MRI of the adolescent knee: a potentially painful manifestation of physiologic physeal fusion? Am J Roentgenol. 2011;197:4, 998–1004.

    Article  Google Scholar 

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Correspondence to Mobeen Farooq.

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Farooq, M., Belair, J.A. Edema-like marrow signal intensity (ELMSI) associated with nonossifying fibroma (NOF) on MRI: an uncommon finding in a common bone lesion. Skeletal Radiol 52, 1511–1518 (2023).

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