Bone Infarction

 Not osteonecrosis (Kümmell disease)






Imaging




• Well-defined, geographic signal abnormality, which tends to involve anterior 1/3 to 1/2 of vertebral body

• T2WI shows increased signal in multiple bodies, with abrupt transition to normal marrow signal

• T1WI C+ shows markedly diminished enhancement of affected vertebral body areas
image No associated epidural or paravertebral soft tissue

image Rare to involve posterior elements


Top Differential Diagnoses




• Infarction secondary to underlying systemic disease
image Sickle cell

image Acute leukemia (ALL or AML)

image SLE

image Lymphoma

image Transplantation with graft vs. host disease

• Infarction secondary to aortic disease
image Dissection

image Abdominal aortic surgery

• Metastatic disease marrow infiltration

• Leukemia or lymphoma marrow tumor infiltration

• Granulomatous or fungal infection


Diagnostic Checklist




• Infarction as sign of systemic illness or malignancy, such as leukemia

• Associated with spinal cord infarction; useful as a confirmatory sign that nonspecific T2 hyperintensity in cord reflects infarction

image
(Left) Sagittal T1WI C+ MR in a patient with a new diagnosis of lymphocytic leukemia shows multiple well-defined, geographic foci of diminished enhancement image in multiple vertebral bodies, with a rim of increased enhancement. There is no associated soft tissue mass and no disc involvement.


image
(Right) Axial T1WI C+ MR in a patient with multiple vertebral infarcts and a new diagnosis of ALL shows sharply marginated lesions in both right and left sides of the vertebral body image with mild peripheral enhancement.

image
(Left) Sagittal T1WI MR shows multiple infarcts in a patient with ALL status post chemotherapy. Note well-defined low signal present in the anterior 1/2 of multiple vertebral bodies. (Courtesy M. Pathria, MD.)


image
(Right) Sagittal T2WI FS MR in a patient with ALL status post chemotherapy shows focal, well-defined hyperintensity in the anterior 1/2 of multiple vertebral bodies, which also involves the sacrum. (Courtesy M. Pathria, MD.)


TERMINOLOGY


Synonyms




• Immature bone infarct, bone marrow infarction


Definitions




• Infarction of vertebral body cancellous bone and marrow secondary to systemic disease or aortic pathology

• Not osteonecrosis (Kümmell disease)


IMAGING


General Features




• Best diagnostic clue
image Geographic T2 hyperintensity of multiple vertebral bodies with diminished enhancement in setting of systemic disease

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Oct 5, 2016 | Posted by in NEUROLOGICAL IMAGING | Comments Off on Bone Infarction
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