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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

Frontal radiograph shows patchy marrow sclerosis and mass (arrow). Sagittal T1W (B) and coronal STIR (C) images show patchy marrow replacement with epiphyseal involvement of the proximal humerus. Associated subcutaneous soft tissue mass shows marked T2 hyperintensity and intense enhancement (arrows) on post-contrast subtracted 3D T1W image (D). Restricted diffusion was seen in the acromion and soft tissue mass, reflecting high cellularity (arrow in E), and there was >20% signal loss on the out-of-phase (F,G) image. Bone marrow lesions category III
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Figure 4: Frontal radiograph shows patchy marrow sclerosis and mass (arrow). Sagittal T1W (B) and coronal STIR (C) images show patchy marrow replacement with epiphyseal involvement of the proximal humerus. Associated subcutaneous soft tissue mass shows marked T2 hyperintensity and intense enhancement (arrows) on post-contrast subtracted 3D T1W image (D). Restricted diffusion was seen in the acromion and soft tissue mass, reflecting high cellularity (arrow in E), and there was >20% signal loss on the out-of-phase (F,G) image. Bone marrow lesions category III

Mentions: Category III lesions show complex and more heterogeneous alterations of density on conventional radiography and signal intensity on T1W and T2W MR images. There may be associated focal lesions, but usually there are no associated soft tissue masses and/or fluid collections, except areas of extramedullary hematopoesis, which can be seen in hematopoetic disorders [Figure 4A–G]. This category encompasses pathologies such as, metabolic/hematopoietic disorders including Gaucher's disease, thalassemia, and sickle cell disease, in which marrow MR signal alterations are frequently complicated by aseptic necrosis/infections/blood transfusion related blood product deposition. Other conditions include infiltrative malignancy treated by chemo-radiation/bone marrow transplant, Paget's disease in acute-subacute phases, and serous marrow lesions observed in HIV-infected patients having lipodystrophy syndrome treated with highly active antiretroviral therapy.[575859] These conditions can be highly heterogeneous and difficult to distinguish from active malignancy. However, there are usually small islands of microscopic fatty marrow in successfully treated lesions.[58] Therefore, imaging findings should be correlated with clinical findings and other available biochemical results, and problem-solving techniques such as CSI [Figure 4F–G] and DWI [Figure 4E] should be frequently employed in these cases for exclusion of malignancy. Additionally, DWI may also be used to assess treatment response in tumors, as increasing ADC values (reflecting necrosis/apoptosis) usually correlate with good treatment response.[60] Finally, a unique pattern of diffusely hypointense marrow on all MR imaging sequences may be observed in a limited number of conditions such as hemosiderosis, sclerotic bone conditions such as renal osteodystrophy/osteopetrosis/pyknodysostosis/fluorosis, and myelofibrosis. MR imaging is helpful in finding superimposed complications such as infection/stress reaction/fracture by demonstrating T2-hyperintense edema and/or enhancement at the respective site (s) of insult.


Bone marrow lesions: A systematic diagnostic approach.

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

Frontal radiograph shows patchy marrow sclerosis and mass (arrow). Sagittal T1W (B) and coronal STIR (C) images show patchy marrow replacement with epiphyseal involvement of the proximal humerus. Associated subcutaneous soft tissue mass shows marked T2 hyperintensity and intense enhancement (arrows) on post-contrast subtracted 3D T1W image (D). Restricted diffusion was seen in the acromion and soft tissue mass, reflecting high cellularity (arrow in E), and there was >20% signal loss on the out-of-phase (F,G) image. Bone marrow lesions category III
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4126144&req=5

Figure 4: Frontal radiograph shows patchy marrow sclerosis and mass (arrow). Sagittal T1W (B) and coronal STIR (C) images show patchy marrow replacement with epiphyseal involvement of the proximal humerus. Associated subcutaneous soft tissue mass shows marked T2 hyperintensity and intense enhancement (arrows) on post-contrast subtracted 3D T1W image (D). Restricted diffusion was seen in the acromion and soft tissue mass, reflecting high cellularity (arrow in E), and there was >20% signal loss on the out-of-phase (F,G) image. Bone marrow lesions category III
Mentions: Category III lesions show complex and more heterogeneous alterations of density on conventional radiography and signal intensity on T1W and T2W MR images. There may be associated focal lesions, but usually there are no associated soft tissue masses and/or fluid collections, except areas of extramedullary hematopoesis, which can be seen in hematopoetic disorders [Figure 4A–G]. This category encompasses pathologies such as, metabolic/hematopoietic disorders including Gaucher's disease, thalassemia, and sickle cell disease, in which marrow MR signal alterations are frequently complicated by aseptic necrosis/infections/blood transfusion related blood product deposition. Other conditions include infiltrative malignancy treated by chemo-radiation/bone marrow transplant, Paget's disease in acute-subacute phases, and serous marrow lesions observed in HIV-infected patients having lipodystrophy syndrome treated with highly active antiretroviral therapy.[575859] These conditions can be highly heterogeneous and difficult to distinguish from active malignancy. However, there are usually small islands of microscopic fatty marrow in successfully treated lesions.[58] Therefore, imaging findings should be correlated with clinical findings and other available biochemical results, and problem-solving techniques such as CSI [Figure 4F–G] and DWI [Figure 4E] should be frequently employed in these cases for exclusion of malignancy. Additionally, DWI may also be used to assess treatment response in tumors, as increasing ADC values (reflecting necrosis/apoptosis) usually correlate with good treatment response.[60] Finally, a unique pattern of diffusely hypointense marrow on all MR imaging sequences may be observed in a limited number of conditions such as hemosiderosis, sclerotic bone conditions such as renal osteodystrophy/osteopetrosis/pyknodysostosis/fluorosis, and myelofibrosis. MR imaging is helpful in finding superimposed complications such as infection/stress reaction/fracture by demonstrating T2-hyperintense edema and/or enhancement at the respective site (s) of insult.

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