Improving the interpretation of bone marrow imaging in cancer patients

Abstract

Magnetic resonance imaging (MRI) is the best technique for bone marrow imaging. The MRI signal of bone marrow depends on the quantity of fat it contains and on its cellularity. Evaluation of marrow of patients treated for cancer is complicated by age and osseous site related changes in the distribution of normal haematopoietic (red) and fatty (yellow) marrow and by the changes induced by treatments: decrease in pathological cellularity, increase in fat proportion, conversion of red marrow to fatty marrow or, conversely, reconversion of fatty marrow in normal haematopoietic red marrow. The treatments used in oncology modify pathological marrow but also normal marrow and may sometimes lead to complications. These modifications may be focal or diffuse, homogeneous or patchy and symmetrical or asymmetric. The knowledge of bone marrow physiological status and post-therapeutic patterns is important for the interpretation of marrow disorders and effects of therapy and to avoid false-positive diagnosis of marrow metastases and tumour progression. The aim of this paper is to recall the MRI patterns of normal bone marrow and normal variations and to show the effects of treatments on bone tissue and normal bone marrow and treatment-related modifications on pathological marrow.

Bone complications after pelvic radiation therapy: Evaluation with MRI

“…Radiation may cause changes in the skeletal system, depending on the age and health of the patient, absorbed dose, size of the radiation field, beam energy and fractionation . Radiation‐induced changes and complications in bone may include vascular congestion, oedema, loss of cellularity, areas of haemorrhage, fatty transformation, focal bone marrow changes, haematopoietic marrow regeneration, osteitis, osteolysis of symphysis pubis or sacroiliac joints, insufficiency fractures, avascular necrosis, osteoradionecrosis and radiation‐induced neoplasms . The importance of understanding bone complications after pelvic radiotherapy lies in the potential for their misdiagnosis as bony metastases, especially in the case of insufficiency fractures.…”

“…1 Radiation-induced changes and complications in bone may include vascular congestion, oedema, loss of cellularity, areas of haemorrhage, fatty transformation, focal bone marrow changes, haematopoietic marrow regeneration, osteitis, osteolysis of symphysis pubis or sacroiliac joints, insufficiency fractures, avascular necrosis, osteoradionecrosis and radiation-induced neoplasms. [2][3][4] The importance of understanding bone complications after pelvic radiotherapy lies in the potential for their misdiagnosis as bony metastases, especially in the case of insufficiency fractures. Insufficiency fractures are among the types of stress fractures and occur as a result of normal physiological stress on bones with decreased mineralisation and deficient elastic resistance; they were first described in 1982 by Lourie.…”

Radiological Reasoning: Bone Marrow Changes on MRI

“…Red bone marrow reconversion refers to the process of mature yellow marrow being replaced by hematopoietic red marrow. This reconversion has many causes, including physiologic stress, smoking, marrow-stimulating medications, and high-altitude living [13][14][15][16].…”

Female Pelvis: Genital Organs

“…On out-of-phase GE images, one can see a drop in signal intensity from normal hematopoietic marrow and no change in signal from malignant cells (van Kaick and Delorme 2008 ;Ollivier et al 2006 ). Posttreatment changes occur frequently, and knowledge of signal patterns is essential to avoid misinterpretation.…”

“…Marrow hyperplasia is also associated with cardiac insuffi ciency and with obesity (Shellock (Ollivier et al 2006 ) (Fig. 2 ).…”