Bone Marrow Patterns

10.1055/b-0034-87943

Bone Marrow Patterns

**Table 5.88 Bone marrow: foci of increased T2-weighted signal intensity**
Diagnosis	Findings	Comments
Normal variation in residual red marrow and/or vascular channels Fig. 5.170a, b Fig. 5.171a, b	Foci of decreased T1- and increased T2-weighted signal intensity distributed throughout fatty marrow.	The pattern typically seen at the hands and feet usually resolves around 15 y of age, although various patterns may also be seen in adults.56,57
Rebound or stimulated hematopoietic marrow Fig. 5.172a, b	Foci of decreased T1- and increased T2-weighted signal intensity distributed throughout fatty marrow.	After initiation of hematopoietic stimulating therapy or on cessation of therapies toxic to red marrow.
Chronic repetitive trauma		Presumably from trabecular microfractures.
Juvenile rheumatoid arthritis Fig. 5.106, p. 567	Foci of bone marrow edema adjacent to joints seen on MRI.	Bone marrow edema (osteitis) has been correlated with future erosions.58
Reflex sympathetic dystrophy	Bone marrow edema tends to be larger, more focal, and confluent.	Often accompanied by osteopenia and soft-tissue atrophy in the appropriate clinical setting.
AVN Fig. 5.173a, b, p. 614 Fig. 5.174, p. 614 Fig. 5.175, p. 614	Early: occult on radiographs with diffuse bone marrow edema on MRI and increased activity on bone scan. Middisease: alternating serpiginous bands of alternating low and high signal intensity on MRI ± characteristic findings of osteonecrosis on radiography.21
Transient osteoporosis	Radiographs may show bone demineralization.
Osteoid osteoma and osteoblastoma	Intense bone marrow edema on MRI.	The bone marrow edema tends to extend well beyond the nidus.
Metastatic disease Fig. 5.132, p. 586 Fig. 5.136, p. 589	More confluent edema ± soft-tissue mass or bone destruction.

Fig. 5.170a, b Normal variation in red marrow. (a, b) Speckled appearance of biopsy-proven normocellular red marrow on T1 and postgadolinium T1-weighted fat-saturated MRI.

Fig. 5.171a, b Normal variation in red marrow. (a, b) Speckled increased T2-weighted signal intensity in the marrow of a 3-year-old (arrow in b).

Fig. 5.172a, b Biopsy-proven red marrow. (a, b) Foci of increased T2-weighted signal intensity (arrows) may mimic a neoplastic process in this patient in remission from acute lymphoblastic leukemia.

Fig. 5.173a, b Avascular necrosis. (a, b) Osteonecrosis of the middle and hind foot on MRI with a vertical fracture through the talus that extends to the posterior facet (arrow in b).

Fig. 5.174 Acute avascular necrosis with bone marrow edema in the right proximal femoral epiphysis. Note the bone infarcts in the ilium and femoral diaphysis. Also, the anemia decreases T2-weighted signal intensity in the regions of the pelvis unaffected by osteonecrosis.

Fig. 5.175 Avascular necrosis. Sickle cell disease with acute bone infarct in the proximal radius with adjacent muscle necrosis on STIR MRI.

**Table 5.89 Bone marrow: diffuse alteration in marrow**
Diagnosis	Findings	Comments
Overproduction of hematopoietic marrow	Diffusely decreased T1- and increased T2-weighted marrow signal intensity on MRI.	DD: sickle cell disease, thalassemia, and other hemoglobinopathies.
Hematologic malignancy Fig. 5.176a, b	MRI marrow changes may be accompanied by lucent metaphyseal bands on radiographs.
Inflammation	Diffusely decreased T1- and increased T2-weighted marrow signal intensity on MRI may be accompanied by periosteal reaction.
Infection	Similar findings as with inflammation.
Rebound following bone marrow stem cell transplantation

Fig. 5.176a, b Hematological malignancy. Diffuse marrow infiltration from acute megakaryocytic leukemia with replacement of marrow fat in the epiphyses (a) and diffuse periosteal reaction and marrow enhancement in the diaphyses (b).

**Table 5.90 Alterations in the apophysis and sesamoid bones**
Diagnosis	Findings	Comments
Apophysitis	Increased fluid signal intensity in the apophysis ± increased fluid signal intensity in the synchondrosis.	Common locations: patella (bipartite patella), ankle (os trigonum), shoulder (os acromiale).
Avulsion	Large gap in the expected location of the synchondrosis suggests avulsion.
Pseudofracture	Synchondrosis may simulate a fracture.	Bipartite patella.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Tags: 5 The Skeleton and Soft Tissues, Differential Diagnosis in Pediatric Imaging, Pediatric & Neonatal Medicine, Radiology (incl. Interventional Radiology)

Jul 12, 2020 | Posted by drzezo in PEDIATRIC IMAGING | Comments Off

Full access? Get Clinical Tree

Get Clinical Tree app for offline access

Get Clinical Tree app for offline access