Not osteonecrosis (Kümmell disease)
Imaging
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Well-defined, geographic signal abnormality, which tends to involve anterior 1/3 to 1/2 of vertebral body
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T2WI shows increased signal in multiple bodies, with abrupt transition to normal marrow signal
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T1WI C+ shows markedly diminished enhancement of affected vertebral body areas
No associated epidural or paravertebral soft tissue
Rare to involve posterior elements
Top Differential Diagnoses
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Infarction secondary to underlying systemic disease
Sickle cell
Acute leukemia (ALL or AML)
SLE
Lymphoma
Transplantation with graft vs. host disease
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Infarction secondary to aortic disease
Dissection
Abdominal aortic surgery
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Metastatic disease marrow infiltration
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Leukemia or lymphoma marrow tumor infiltration
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Granulomatous or fungal infection
Diagnostic Checklist
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Infarction as sign of systemic illness or malignancy, such as leukemia
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Associated with spinal cord infarction; useful as a confirmatory sign that nonspecific T2 hyperintensity in cord reflects infarction
TERMINOLOGY
Synonyms
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Immature bone infarct, bone marrow infarction
Definitions
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Infarction of vertebral body cancellous bone and marrow secondary to systemic disease or aortic pathology
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Not osteonecrosis (Kümmell disease)