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Bone marrow lesions: A systematic diagnostic approach.

Del Grande F, Farahani SJ, Carrino JA, Chhabra A - Indian J Radiol Imaging (2014)

Bottom Line: Bone marrow lesions on magnetic resonance (MR) imaging are common and may be seen with various pathologies.The authors outline a systematic diagnostic approach with proposed categorization of various etiologies of bone marrow lesions.Utilization of typical imaging features on conventional MR imaging techniques and other problem-solving techniques, such as chemical shift imaging and diffusion-weighted imaging (DWI), to achieve accurate final diagnosis has been highlighted.

View Article: PubMed Central - PubMed

Affiliation: The Russell H. Morgan Departments of Radiology and Radiology Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA.

ABSTRACT
Bone marrow lesions on magnetic resonance (MR) imaging are common and may be seen with various pathologies. The authors outline a systematic diagnostic approach with proposed categorization of various etiologies of bone marrow lesions. Utilization of typical imaging features on conventional MR imaging techniques and other problem-solving techniques, such as chemical shift imaging and diffusion-weighted imaging (DWI), to achieve accurate final diagnosis has been highlighted.

No MeSH data available.


Related in: MedlinePlus

Axial T1W (A) and STIR (B) images at the level of the mid-tibia. There is homogenous ill-defined bone marrow lesion, appearing mildly hyperintense to muscle on T1W and moderately hyperintense on STIR images (arrows). Associated fascial and periosteal edema is also present. Chemical shift imaging (CSI) shows more than 20% loss of signal intensity (SI) on the out-of-phase image (C) compared to the in-phase image (D). Bone marrow lesions category I (stress reaction)
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Figure 1: Axial T1W (A) and STIR (B) images at the level of the mid-tibia. There is homogenous ill-defined bone marrow lesion, appearing mildly hyperintense to muscle on T1W and moderately hyperintense on STIR images (arrows). Associated fascial and periosteal edema is also present. Chemical shift imaging (CSI) shows more than 20% loss of signal intensity (SI) on the out-of-phase image (C) compared to the in-phase image (D). Bone marrow lesions category I (stress reaction)

Mentions: Probably, the most common pattern in this category is acute or chronic traumatic injury, which may range from bone contusion, sometimes referred as “bone bruises,” to a real fracture. Histologically, the traumatic bone marrow lesion is the result of hemorrhage and inter-trabecular microfractures.[10] MR imaging plays an important role in the assessment of stress injuries/fractures [Figure 1A–D] due to the relative low sensitivity of radiographs, ranging from 15-35% on initial examination to 30-70% on follow-up examination.[11] Stress fractures are of two types, fatigue and insufficiency. Fatigue fractures are the result of abnormal stress on normal bone structure, whereas insufficiency fractures are the result of a normal stress on an abnormal bone, such as in osteoporosis and osteomalacia. The former are more common in young athletes and military recruits and the latter in older patients.[1112] Stress injuries were classified by Fredericson et al. into four grades based on the conventional MR imaging characteristics. Grade I injury represents periosteal edema, Grade II represents mild bone marrow edema visible only on fsT2-W sequence but not on T1W sequence, Grade III (inter-trabecular fracture) represents extensive edema visible on all sequences (however, it is much more pronounced on fluid-sensitive sequence), and Grade IV represents a clear fracture line (which may be incomplete/complete and may be displaced/non-displaced).[13] Grade I/II injuries reflect stress response/reaction and Grade III/IV injuries represent fractures. The fracture line is commonly visible as a linear, solid or broken T1 and T2 hypointensity surrounded by a cloud of edema. Several reports on stress fracture in athletes are available and virtually every bone can be involved depending on the type of activity. Typical location for stress fractures are the pelvis with lesser trochanter, femoral neck, tibia, and sacrum from running; and shoulder in athletes involved in throwing and lifting, such as in baseball players.[141516] Rarer locations are: rib fractures in weightlifters, olecranon in baseball players, hook of the hamate in golf players, tennis players, or baseball players, and proximal ulna in throwing athletes.[17181920]


Bone marrow lesions: A systematic diagnostic approach.

Del Grande F, Farahani SJ, Carrino JA, Chhabra A - Indian J Radiol Imaging (2014)

Axial T1W (A) and STIR (B) images at the level of the mid-tibia. There is homogenous ill-defined bone marrow lesion, appearing mildly hyperintense to muscle on T1W and moderately hyperintense on STIR images (arrows). Associated fascial and periosteal edema is also present. Chemical shift imaging (CSI) shows more than 20% loss of signal intensity (SI) on the out-of-phase image (C) compared to the in-phase image (D). Bone marrow lesions category I (stress reaction)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC4126144&req=5

Figure 1: Axial T1W (A) and STIR (B) images at the level of the mid-tibia. There is homogenous ill-defined bone marrow lesion, appearing mildly hyperintense to muscle on T1W and moderately hyperintense on STIR images (arrows). Associated fascial and periosteal edema is also present. Chemical shift imaging (CSI) shows more than 20% loss of signal intensity (SI) on the out-of-phase image (C) compared to the in-phase image (D). Bone marrow lesions category I (stress reaction)
Mentions: Probably, the most common pattern in this category is acute or chronic traumatic injury, which may range from bone contusion, sometimes referred as “bone bruises,” to a real fracture. Histologically, the traumatic bone marrow lesion is the result of hemorrhage and inter-trabecular microfractures.[10] MR imaging plays an important role in the assessment of stress injuries/fractures [Figure 1A–D] due to the relative low sensitivity of radiographs, ranging from 15-35% on initial examination to 30-70% on follow-up examination.[11] Stress fractures are of two types, fatigue and insufficiency. Fatigue fractures are the result of abnormal stress on normal bone structure, whereas insufficiency fractures are the result of a normal stress on an abnormal bone, such as in osteoporosis and osteomalacia. The former are more common in young athletes and military recruits and the latter in older patients.[1112] Stress injuries were classified by Fredericson et al. into four grades based on the conventional MR imaging characteristics. Grade I injury represents periosteal edema, Grade II represents mild bone marrow edema visible only on fsT2-W sequence but not on T1W sequence, Grade III (inter-trabecular fracture) represents extensive edema visible on all sequences (however, it is much more pronounced on fluid-sensitive sequence), and Grade IV represents a clear fracture line (which may be incomplete/complete and may be displaced/non-displaced).[13] Grade I/II injuries reflect stress response/reaction and Grade III/IV injuries represent fractures. The fracture line is commonly visible as a linear, solid or broken T1 and T2 hypointensity surrounded by a cloud of edema. Several reports on stress fracture in athletes are available and virtually every bone can be involved depending on the type of activity. Typical location for stress fractures are the pelvis with lesser trochanter, femoral neck, tibia, and sacrum from running; and shoulder in athletes involved in throwing and lifting, such as in baseball players.[141516] Rarer locations are: rib fractures in weightlifters, olecranon in baseball players, hook of the hamate in golf players, tennis players, or baseball players, and proximal ulna in throwing athletes.[17181920]

Bottom Line: Bone marrow lesions on magnetic resonance (MR) imaging are common and may be seen with various pathologies.The authors outline a systematic diagnostic approach with proposed categorization of various etiologies of bone marrow lesions.Utilization of typical imaging features on conventional MR imaging techniques and other problem-solving techniques, such as chemical shift imaging and diffusion-weighted imaging (DWI), to achieve accurate final diagnosis has been highlighted.

View Article: PubMed Central - PubMed

Affiliation: The Russell H. Morgan Departments of Radiology and Radiology Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA.

ABSTRACT
Bone marrow lesions on magnetic resonance (MR) imaging are common and may be seen with various pathologies. The authors outline a systematic diagnostic approach with proposed categorization of various etiologies of bone marrow lesions. Utilization of typical imaging features on conventional MR imaging techniques and other problem-solving techniques, such as chemical shift imaging and diffusion-weighted imaging (DWI), to achieve accurate final diagnosis has been highlighted.

No MeSH data available.


Related in: MedlinePlus