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Marrow Disorders


Ovid: Musculoskeletal Imaging Companion

Editors: Berquist, Thomas H.
Title: Musculoskeletal Imaging Companion, 2nd Edition
> Table of Contents > Chapter 12 – Marrow Disorders

Chapter 12
Marrow Disorders
Thomas H. Berquist
Protocols
Suggested Reading
Mirowitz
SA, Apicella P, Reinus WR, et al. MR imaging of bone marrow lesions:
Relative conspicuousness on T1-weighted, fat suppressed T2-weighted,
and STIR images. AJR Am J Roentgenol 1994;162:215–221.
Schellinger
D, Lin CS, Fertikh D, et al. Normal lumbar vertebrae: Anatomic, age,
sex variance in subjects at proton MR spectroscopy-initial experience. Radiology 2000;215:910–916.

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Normal Marrow: Basic Concepts

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FIGURE 12-1 Marrow patterns. T1-weighted images of the pelvis (A), knee (B), shoulder (C), and spine (D). The marrow in the pelvis (A) is predominantly fatty in this adult except for small areas of red marrow in the acetabular regions (arrows). There is also fatty high signal intensity marrow in the knee (B) in an older adult and epiphysis of the shoulder (C)
in this 20-year-old patient. There is red marrow in the humeral shaft
and glenoid. The sagittal spine image shows predominantly yellow marrow
with areas of low signal intensity because of multiple metastases.
Suggested Reading
Vogler JB, Murphy WA. Bone marrow imaging. Radiology 1988;168:679–693.

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Marrow Reconversion

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FIGURE 12-2 Marrow hyperplasia in a long-distance runner. Coronal (A) and sagittal (B)
T1-weighted images showing low intensity marrow in the femoral
diaphysis and metaphysis with a focal area of hyperplasia in the tibia.
Cortical bone is normal, and there are no soft tissue abnormalities.
Suggested Reading
Shellock
FG, Morris E, Deutsch AL, et al. Hemopoietic marrow hyperplasia: High
prevalence on MR images of the knee in asymptomatic marathon runners. AJR Am J Roentgenol 1992;158:335–338.
Vande
Berg BC, Levouvet FE, Moyson P, et al. MR assessment of red marrow
distribution and composition in the proximal femur: Correlation with
clinical and laboratory parameters. Skel Radiol 1997;26:589–596.

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Myeloid Depletion
FIGURE 12-3
Radiation therapy. Axial T1-weighted image showing a malignant soft
tissue mass with fatty marrow in the femur. Compare with normal lower
signal intensity red marrow in the opposite femur.

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FIGURE 12-4 Radiation changes with fatty marrow in the upper thoracic spine seen on T1-weighted magnetic resonance (MR) image.
Suggested Reading
Cavenagh
EC, Weinberger E, Shal DW, et al. Hemopoietic marrow reconversion in
pediatric patients undergoing spinal irradiation. MR depiction. AJNR Am J Neuroradiol 1995;16:461–467.

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Marrow Ischemia
FIGURE 12-5 Avascular necrosis of the hip. Coronal (A) and sagittal (B) T1-weighted MR images showing avascular necrosis, which is more extensive on the left.

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FIGURE 12-6 Bone infarction. (A) Standing radiographs of the knees show serpiginous marginal calcifications characteristic of bone infarction in both knees. (B) Coronal T1-weighted images of the knees demonstrate the areas of infarction and subchondral avascular necrosis.
Suggested Reading
Deely DM, Schweitzer ME. MR imaging of bone marrow disorders. Radiol Clin North Am 1997;35:193–212.

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Marrow Infiltration: Basic Concepts
TABLE 12-1 INFILTRATIVE MARROW DISORDERS
Neoplasms
Myeloma
Leukemia
Lymphoma
Myelofibrosis
Lipidosis
  Gaucher disease
  Niemann-Pick disease
  Fabry disease
  Gangliosidosis
Histiocytosis
  Langerhans cell histiocytosis
  Erdheim Chester disease
Hyperlipoproteinemias
Suggested Reading
Resnick D. Lipidosis, histiocytosis, and hyperlipoproteinemias. In: Resnick D, ed. Diagnosis of bone and joint disorders, 4th ed. Philadelphia: WB Saunders; 2002:2233–2290.

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Marrow Infiltration: Lipidosis

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FIGURE 12-7 Gaucher disease. Coronal T1-weighted images of the knees (A) and sagittal T1-weighted images of the spine (B) showing low signal intensity throughout the marrow.
Suggested Reading
Resnick D. Lipidosis, histiocytosis, and hyperlipoproteinemias. In: Resnick D, ed. Diagnosis of bone and joint disorders, 4th ed. Philadelphia: WB Saunders; 2002:2233–2290.

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Langerhans Cell Histiocytosis

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FIGURE 12-8 Eosinophilic granuloma. (A) AP radiograph of the femur showing a lytic lesion with endosteal scalloping and periosteal reaction. AP (B) and lateral (C) radiographs of the spine with marked compression (vertebra plana) of T6.

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FIGURE 12-9 Erdheim-Chester disease. (A) Radionuclide bone scan showing increased tracer in both femora and tibiae. AP (B,C) and lateral (D,E) radiographs of the tibiae showing sclerotic areas with prominent trabeculae.

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Suggested Reading
Resnick D. Lipidosis, histiocytosis, and hyperlipoproteinemias. In: Resnick D, ed. Diagnosis of bone and joint disorders, 4th ed. Philadelphia: WB Saunders; 2002:2233–2290.

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Hyperlipoproteinemias

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FIGURE 12-10 Osseous xanthomas (Type IV hyperlipoproteinemia). (A,B) Routine radiographs showing a poorly defined lytic lesion in the distal femur (arrowheads). Coronal T1-weighted (C) and sagittal T2-weighted (D) MR images showing a poorly defined lesion that has fatty intensity on T1-weighted image (C) and areas of increased intensity on T2-weighted image (D).
Suggested Reading
Resnick D. Lipidosis, histiocytosis, and hyperlipoproteinemias. In: Resnick D, ed. Diagnosis of bone and joint disorders, 4th ed. Philadelphia: WB Saunders; 2002:2233–2290.

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Myelofibrosis

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FIGURE 12-11 Myelofibrosis. (A) Chest radiograph showing increased bone density and marked splenomegaly. (B) AP radiograph of the pelvis showing scattered bone sclerosis. AP (C) and lateral (D) radiographs showing increased bone density.

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FIGURE 12-12 Myelofibrosis. T1-weighted MR image of the femora showing low signal intensity, except distally.
Suggested Reading
Lanir A, Aghai E, Simon JS, et al. MR imaging in myelofibrosis. J Comput Assist Tomogr 1986;10:634–636.

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Compression Fractures: Benign versus Malignant
FIGURE 12-13 Steroid-induced osteoporosis in a 75-year-old man. (A) Sagittal T2-weighted nondiffusion image showing vertebral compression with mixed decreased and increased signal intensity. (B) Diffusion-weighted spin-echo image showing an area of increased intensity (arrow) caused by lung metastasis. (From

Spuentriep
E, Buecher A, Adam G, et al. Diffusion-weighted MR imaging for
differentiation of benign fracture edema and tumor infiltration of the
vertebral body. AJR Am J Roentgenol 2001;176:351–358, with permission.

)

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Suggested Reading
Rahmouni
A, Montazel JL, Divine M, et al. Bone marrow with diffuse tumor
infiltration in patients with lymphoproliferative diseases: Dynamic
gadolinium-enhanced MR imaging. Radiology 2003;229:710–717.
Spuentriep
E, Buecher A, Adam G, et al. Diffusion-weighted MR imaging for
differentiation of benign fracture edema and tumor infiltration of the
vertebral body. AJR Am J Roentgenol 2001;176:351–358.

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