en.Wedoany.com Reported - A study led by Thomas Beyer at the Rostock University Medical Center, based on data from the German Study of Health in Pomerania-Trend-0 cohort, evaluated the prevalence and associated factors of parasymphyseal bone marrow edema (BME) and pubic disc cleft sign on pelvic MRI in the general population.
The study randomly selected 1,000 participants (mean age 51.5 years, 52% female) from a population-based study conducted between 2008 and 2012. All participants underwent standardized pelvic MRI using a 1.5 Tesla scanner with coronal turbo inversion recovery magnitude (TIRM) sequences; after excluding 14 non-diagnostic examinations, 986 participants were included in the final analysis. The study assessed the presence, laterality, extent (maximum transverse distance from the pubic symphysis cleft, in millimeters), and signal intensity ratio of parasymphyseal BME, and classified the cleft sign as present or absent.
Among the 986 participants, parasymphyseal BME was detected in 109 (overall prevalence 11.1%; 95% CI, 9.2%-13.2%), with bilateral distribution in 5.5%, left-sided in 2.5%, and right-sided in 3.0%; in 99.1% of cases, edema extended to the immediate vicinity of the pubic symphysis cleft. The cleft sign was present in 59 participants (overall prevalence 6.0%; 95% CI, 4.7%-7.6%). Observations indicated a significant association between BME and the cleft sign (P < .01), with 18.3% of participants with BME having the cleft sign compared to 4.4% of those without BME.
In association analyses, the number of pregnancies showed a borderline exploratory association with BME, with each pregnancy increasing the odds of BME by 23.8% (odds ratio 1.238; 95% CI, 1.008-1.521; P = .042); the cleft sign was more common in women than in men (7.9% vs 4.0%; P = .015). The study found no significant associations between BME or the cleft sign and lower abdominal pain, leg pain, physical activity, occupation, age, or BMI; neither the extent nor the signal intensity ratio of BME was related to pain variables.
The authors noted that the prevalence of parasymphyseal bone marrow edema and pubic disc cleft sign on pelvic MRI in the general population was 11.1% and 6.0%, respectively. No associations were detected with self-reported pain, physical activity, or occupational variables; however, given the non-specific pain assessment and exploratory analyses, these findings should be interpreted with caution. They added that pregnancy history had a borderline association with BME, while the cleft sign was more common in women, and these background prevalence rates should be considered when evaluating suspected osteitis pubis and correlating it with clinical presentation.
The study was published online on May 21, 2026, in the European Journal of Radiology. Study limitations include: indirect assessment of groin pain using lower abdominal and leg pain variables within a 7-day symptom window; cross-sectional design; use of only a single coronal TIRM sequence without T1-weighted or multiplanar high-resolution imaging. Other limitations include a 5 mm slice thickness, moderate to fair reader agreement, exploratory and univariate statistical analyses without correction for multiple comparisons, and a cohort confined to a single geographic region in northeastern Germany. The study received no specific grant from any public, commercial, or non-profit funding agency, and the authors report no conflicts of interest.
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