Advanced MR imaging of bone marrow: quantification of signal alterations on T1-weighted Dixon and T2-weighted Dixon sequences in red marrow, yellow marrow, and pathologic marrow lesions

Abstract Background: Aplastic anemia (AA), paroxysmal nocturnal hemoglobinuria (PNH) and myelodysplastic syndrome (MDS) are the heterogeneous group of bone marrow failure syndrome (BMFs). AS they often show profound hypocellular marrow, the diagnosis is often difficult by bone marrow and laboratory examination alone. Red to yellow marrow conversion occurs with age in the appendicular skeleton (AS), where red marrow is converted to yellow marrow until the age of early 20s. Although abnormal distribution of red marrow in appendicular skeleton were previously reported in small series of patients with MDS, leukemia and lymphoma by MRI, no further study has published so far. Here, we examined distribution of red marrow in AS by low-dose multi-detector CT (MDCT) in BMFs patients, and analyzed the relationship between the abnormal medullary pattern in AS and laboratory variables. The relationship between the MDCT pattern and subsequent development of leukemic transformation on survivals was analyzed in patients with BMFs. Patients: We retrospectively reviewed the medical records of 138 untreated patients (AA n=36, PNH n=5, and MDS n=97) with BMFs diagnosed in the Department of Hematology/Oncology at Kameda Medical Center, Kamogawa, Japan, from July 2008 to June 2014. Follow-up MDCTs were evaluated in 28 MDS patients when they were diagnosed as overt AML (MDS/tAML). Retrospective review of clinical and laboratory features including complete blood count, % of bone marrow blast, chromosomal analysis, and International Prognostic Scoring System (IPSS) at diagnosis was performed. WHO classification of patients with MDS was as follows: RCUD (n=21), RARS (n=2), RCMD (n=26), RAEB (n=43), and, MDS unclassified (MDS-U) (n=5). Leukemia-free survival (LFS) and overall survival (OS) were analyzed in 73 patients with MDS who were ≥65 years of age and ineligible for allogeneic stem cell transplantation (allo SCT) by the Kaplan-Meier. CT image acquisition and Image analysis: Non-enhanced CT examinations were performed from the skull to the knees by MDCT scanner (Aquilion 64, Tohshiba, Tokyo, Japan). Bony canal of humeral and femoral bone were visualized by coronal and sagittal axis image reconstruction. Medullary CT density of humerus and femurs were measured and the results were expressed as Hounsfield unit (HU). As the normal adult bone marrow was composed of rich adipocytes and called yellow marrow, it is represented by low density CT value between -30 to -100 HU. The value above -30 HU observed in long bony canals was considered as high density. Medullary pattern of AS were categorized as follows: (1) fatty pattern; showing a low signal density marrow (2) focal pattern; showing abnormally focal high density lesions (3) diffuse pattern; showing uniformly high density marrow. Results: All 36 patients with AA showed a fatty (n=13, 36.1%) or focal (n=23, 63.9%) pattern in medullary AS on MDCT, and none of them showed diffuse pattern. Five patients with PNH showed as follows: fatty/focal/diffuse, 1/3/1. Ninety-seven patients with MDS showed as follows: fatty/focal/diffuse, 24/46/27. Patients with MDS who showed diffuse pattern had a significantly low hemoglobin concentration compared to those with fatty or focal pattern (p=0.03). Among the patients with MDS, most of the patients with RCUD (n=21), RARS (n=2), RCMD (n=26), MDS-U (n=5) showed the fatty or focal pattern (fatty or focal/diffuse pattern; RCUD (18/3), RARS (2/0), RCMD (21/5), MDS-U (5/0)), but approximately half (46%) of patients with RAEB showed diffuse pattern (fatty/focal/diffuse pattern; 7/17/19). In addition, patients with transformed to MDS/tAML showed either focal (n=10, 35.7%) or diffuse (n=18, 64.3%) pattern and none of them showed fatty pattern. In 73 patients with MDS who were ≥65 years of age and ineligible for allo SCT, the group with focal or diffuse pattern had significantly shorter LFS and OS compared to the group with fatty pattern (p=0.01, p=0.05, respectively). Patients with focal pattern in AS showed longer LFS than those with diffuse pattern (p=0.05), but difference was not statistically significant in OS (p=0.22). Conclusions: This study showed that MDCT imaging of the appendicular skeletons provided important information for the diagnosis and prognosis of patients with BM. In patients with MDS, focal or diffuse pattern on MDCT showed negative prognostic impact on LFS and OS, and these patterns appeared to reflect the status of disease. Figure 2. Figure 2. Figure 3. Figure 3. Disclosures No relevant conflicts of interest to declare.

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MR Imaging of Bone Marrow in Patients with Musculoskeletal Tumors

Sarcoma ◽

10.1080/13577149977857 ◽

1999 ◽

Vol 3 (1) ◽

pp. 37-41 ◽

Cited By ~ 7

Author(s):

David M. Panicek ◽

Lawrence H. Schwartz

Keyword(s):

Bone Marrow ◽

Radiation Therapy ◽

Mr Imaging ◽

Imaging Techniques ◽

Normal Bone Marrow ◽

Normal Bone ◽

Musculoskeletal Tumors ◽

Red Marrow ◽

Bone Marrow Metastases

Knowledge of the appearances of normal bone marrow, metastases involving marrow, and therapy-related marrow changes shown by MR imaging is necessary in order to avoid misdiagnosis. This article reviews MR imaging techniques and the findings that allow distinction of normal yellow (fatty) marrow and red marrow from tumor in marrow, as well as the identification of marrow changes resulting from radiation therapy or treatment with marrow-stimulating drugs in patients with musculoskeletal tumors.

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Volume and Cellular Constitution of Bone Marrow in Guinea Pigs Hypoxic from Birth

Blood ◽

10.1182/blood.v16.2.1199.1199 ◽

1960 ◽

Vol 16 (2) ◽

pp. 1199-1204 ◽

Cited By ~ 4

Author(s):

G. HUDSON

Keyword(s):

Bone Marrow ◽

Guinea Pigs ◽

Total Population ◽

Erythroid Cells ◽

Simulated Altitude ◽

Absolute Increase ◽

Red Marrow ◽

Yellow Marrow ◽

Experimental Group ◽

Normal Controls

Abstract A quantitative study of the volume and cellular constitution of the bone marrow was carried out in 10 guinea pigs of approximately 400 Gm. body weight, which had been born and reared at a simulated altitude of 14,000 feet, and in 10 normal controls. The hemopoietic marrow of the experimental group was more cellular and showed a marked increase in the number of erythroid cells per unit volume. No significant changes were demonstrated in the absolute counts of other cells, but fat vacuoles appeared less numerous. The fatty (yellow) marrow occupied its normal centrifugal position in the skeletons of both groups. No absolute increase in the volume of bone marrow was detected in the experimental group, but the red marrow volume formed a significantly greater proportion both of the volume of the skeleton containing it and of the total marrow volume. It was concluded that the marrow of the hypoxic animals had a total population of erythroid cells about 40 to 50 per cent greater than normal; this increase was largely accommodated by closer packing of cells in the red marrow.

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Prognostic Significance of Magnetic Resonance Imaging (MRI) of Bone Marrow (BM) in Patients with Multiple Myeloma (MM) Undergoing Treatment with High-Dose Melphalan (HDM) and Autologous Stem Cell Transplantation (ASCT).

Blood ◽

10.1182/blood.v108.11.3095.3095 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3095-3095

Author(s):

Athanasios Anagnostopoulos ◽

Lia A. Moulopoulos ◽

Maria Roussou ◽

Efstathios Kastritis ◽

Dimitra Gika ◽

...

Keyword(s):

Bone Marrow ◽

Intensive Therapy ◽

Bone Marrow Involvement ◽

Prognostic Significance ◽

Intervertebral Discs ◽

High Dose ◽

Normal Pattern ◽

Red Marrow ◽

Yellow Marrow ◽

Focal Pattern

Abstract Purpose: We have previously reported that diffuse pattern of bone marrow involvement as determined by MRI imaging of the spine, in newly diagnosed patients with MM is associated with features of advanced disease and with shorter survival compared to patients with normal, focal or variegated pattern of BM involvment. Purpose of the study was to determine the prognostic value of spinal bone MRI in the outcome of MM patients undergoing treatment with HDM and ASCT. Materials and methods: Between October 1995 and June 2006, 63 MM patients for whom a MRI of the spine before first line therapy was available, received treatment with HDM (200mg/m2 iv) and ASCT, in our Department. Four patterns of BM involvement in MRI were identified: normal pattern which required no evidence of abnormal signal, focal pattern, which consists of localized areas of abnormal marrow (on T1-weighted images, focal lesions are darker than yellow marrow and slightly darker or isointense to red marrow; on T2-weighted images they are brighter than both red and yellow marrow), diffuse pattern of abnormal marrow, where the normal bone marrow is completely replaced by the abnormal process and the intervertebral discs appear brighter or are isointense to the diseased marrow, and variegated pattern, which consists of innumerable small foci of disease on a background of intact marrow. MRI pattern of BM involvement and multiple clinical and laboratory parameters were evaluated for their possible correlation with progression free survival (PFS) after HDM. Results: Patients’ median age was 55years (range: 23 to 74 years), 60% of patients had ISS 2 or 3 before initial treatment, 54% of patients were transplanted during remission and 46% of patients had active myeloma at the time of HDM (primary refractory: 34%, resistant relapse: 12%). Nine patients (14%) had a normal MRI pattern, 33 (53%) had focal, 4 (6%) variegated and 17 (27%) diffuse MRI pattern of BM involvement. The median PFS for all patients was 20 months. Significant adverse prognostic factors for PFS included elevated creatinine and LDH serum levels, and ISS stage 3 at diagnosis. Furthermore the pattern of BM involvement by MRI correlated strongly with PFS: median PFS of 72 months for normal pattern, 20 months for focal pattern, 16 months for variegated and 9 months for diffuse pattern (p=0.016). Patients with both ISS stage 3 and diffuse MRI pattern had a median PFS of only 6 months. Conclusion: MRI of the spine before treatment provides prognostic information for the outcome of MM patients with myeloma after HDM and ASCT. Diffuse marrow replacement on MRI of the spine identifies patients with advanced MM who have a poor prognosis even after intensive therapy. Such patients are candidates for innovative treatments.

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Bone Marrow Imaging of Appendicular Skeleton by Multi-Detector Computed Tomography in Patients with Aplastic Anemia and Hypoplastic MDS.

Blood ◽

10.1182/blood.v120.21.2817.2817 ◽

2012 ◽

Vol 120 (21) ◽

pp. 2817-2817

Author(s):

Tomotaka Ugai ◽

Hiroki Sugihara ◽

Yuki Nishida ◽

Masayuki Yamakura ◽

Masami Takeuchi ◽

...

Keyword(s):

Bone Marrow ◽

Who Classification ◽

Low Dose ◽

High Density ◽

Whole Body ◽

Appendicular Skeleton ◽

Bone Marrow Blast ◽

Red Marrow ◽

Yellow Marrow ◽

Focal Pattern

Abstract Abstract 2817 Background: Myelodysplastic syndrome (MDS) and aplastic anemia (AA) are the heterogeneous group of bone marrow failure disorders. AS both shows profound hypocellular marrow without minimal morphologic atypia, differentiation of MDS and AA is often difficult by bone marrow and laboratory examination alone. Red to yellow marrow conversion is occurs with age in the appendicular skeleton (AS), where red marrow is converted to yellow marrow until the age of early 20s. Although abnormal distribution of red marrow in appendicular skeleton has previously reported in small series of patients with MDS, leukemia and lymphoma by MRI, no further study has published so far. Here, we examined distribution of red marrow in AS by low-dose multi-detector CT (MDCT) in AA and MDS. We analyzed the relationship between the abnormal medullary pattern in AS with laboratory variables, subsequent development of leukemic transformation and survivals MDS patients. Patients: We performed a low-dose MDCT of humerus and femurs in 64 untreated adult patients with AA (N=15) and MDS (N=49). Retrospective review of clinical and laboratory features including complete blood count, % of bone marrow blast, chromosomal analysis, and International Prognostic Scoring System (IPSS) was performed. WHO classification of MDS patients was as follows: RA (N=17), RARS (N=2), RCMD (N=9), RAEB (N=19) and MDS unclassified (N=2). Overall survival (OS) and leukemia-free survival (LFS) were analyzed in 49 MDS patients by the Kaplan-Meier and differences between curves were calculated by two-sided log-rank test. Multivariate analysis was Used to assess the effects of prognostic factors - hemoglobin, platelet, bone marrow blast, cytogenetic abnormalities, IPSS score, WHO classification, and MDCT patterns. CT image acquisition and Image analysis: Non-enhanced CT examinations were performed from the base of skull down to the knee joint by MS-CT scanner (AQUILION 64, Tohshiba, Tokyo, Japan). Bony canal of humeral and femoral bone were visualized by coronal and sagittal axis image reconstruction. The effective radiation dose associated with whole body MD-CT was 10.1 mSv. (ICRP 26). The dose was comparable to whole body CT (2.4 mSv.). Medullary CT density of humerus and femurs were measured and the results were expressed as Hounsfield unit (HU). As the normal adult bone marrow was composed of rich adipocytes and called yellow marrow, it is represented by low density CT value between −30 to −100 HU. The value above −30 HU observed in long bony canals was considered as high density lesions. Medullary pattern of appendicular skeletons were categorized as follows: (1) fatty; showing a low signal density marrow (2) focal; showing abnormally focal high density lesions: (3) diffuse; showing uniformly high density marrow. Results: All 15 patients with AA showed a fatty (N=10, 66%) or focal (N=5, 33%) pattern in medullary AS on MDCT and none of them showed diffuse pattern. Conversion from fatty to focal marrow was observed in 9 of 15 AA patients after successful immunosuppressive treatment. Among the 49 patients with MDS, 15 (31%) had fatty pattern, 21 (43%) had focal pattern, and 13 (27%) had diffuse pattern. Patients with diffuse infiltration pattern on MDCT had a significantly low hemoglobin concentration (p<0.01) and shorter OS (p<0.01) compared to those with fatty or focal medullary pattern. The characteristics of the patients with diffuse pattern did not differ significantly in terms of sex, age, WBC count or karyotype from those of the patients with fatty or focal pattern. Among 13 MDS patients with diffuse pattern, 6 developed AML during their follow-up periods (median, 17 months; range, 2 to 38 months). LFS and OS of 13 patients with diffuse patterns were significantly shorter than that of the 36 patients with fatty and focal patterns (74% vs 19% at 3 years; p<0.01 and 79% vs 40% at 3 years; p<0.01, respectively). On multivariable analysis, diffuse pattern on MDCT was emerged as independently negative prognostic impact on LFS and OS in patients with MDS. Conclusions: This study showed that MDCT imaging of the appendicular skeletons provided important information for the diagnosis and prognosis of patients with MDS and AA. Disclosures: No relevant conflicts of interest to declare.

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A Bizarre Presentation of Bilateral Mandibular Osteoporotic Bone Marrow Defect (A Case Report)

European Journal of Dental and Oral Health ◽

10.24018/ejdent.2020.1.2.4 ◽

2020 ◽

Vol 1 (2) ◽

Author(s):

Abbas Al-Ramzi ◽

Maysoun Kasem ◽

Karim Ahmed

Keyword(s):

Bone Marrow ◽

Case Report ◽

Dental Implants ◽

Radiographic Examination ◽

Osteoporotic Bone ◽

Red Marrow ◽

Yellow Marrow ◽

Healthy Female ◽

Uncommon Case

BACKGROUND: Osteoporotic bone marrow defect of the jaw is an uncommon localized radiolucency that consists of hematopoietic red marrow with varying amounts of fatty yellow marrow. The lesion is usually asymptomatic and accidentally discovered during a routine radiographic examination; however, some studies showed different results. CASE REPORT: This is an uncommon case of bilateral mandibular osteoporotic bone marrow defect in a 40-year- old healthy female. One of the defects reoccurred, and it involves dental implants. PLAN OF TREATMENT: Lesion was managed by curettage and the patient was followed up after 1,6,12 months. CONCLUSIONS: in order to diagnose FOBMD and differentiate it from other lesions, further researches are needed to help fully understand it, since the exact incident and etiology are not established yet.

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Clinical and Prognostic Significance of Bone Marrow Imaging of Appendicular Skeletons By Low-Dose Multi-Detector Computed Tomography in Patients with Aplastic Anemia and Myelodysplastic Syndorme

Blood ◽

10.1182/blood.v124.21.5602.5602 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5602-5602

Author(s):

Manabu Fujisawa ◽

Tomotaka Ugai ◽

Yasuhito Suehara ◽

Keisuke Seike ◽

Kota Fukumoto ◽

...

Keyword(s):

Bone Marrow ◽

Aplastic Anemia ◽

Low Dose ◽

High Density ◽

Whole Body ◽

Appendicular Skeleton ◽

Diffuse Infiltration ◽

Red Marrow ◽

Yellow Marrow ◽

Focal Pattern

Abstract Background: Myelodysplastic syndrome (MDS) and aplastic anemia (AA) comprise a heterogeneous group of bone marrow failure disorders. As both show profound hypocellular marrow with minimal morphological atypia, differentiation of MDS and AA is often difficult by bone marrow and laboratory examination alone. Red to yellow marrow conversion occurs with age in the appendicular skeleton (AS), where red marrow is converted to yellow marrow until the early 20s. Although an abnormal distribution of red marrow in AS has previously been reported in small numbers of patients with MDS, along with leukemia and lymphoma by MRI, there have been no further reports to date. Here, we examined the distribution of red marrow in AS by low-dose multi-detector CT (MDCT) in AA and MDS. We analyzed the relationships between the abnormal medullary pattern in AS and laboratory variables, subsequent development of leukemic transformation, and survival in MDS patients. Patients: We performed low-dose MDCT of the humerus and femur in 103 untreated adult patients with AA (n = 32) and MDS (n = 71). We retrospectively reviewed the medical records of patients with AA and MDS diagnosed in the Department of Hematology/Oncology at Kameda Medical Center, Kamogawa, Japan, from July 2008 to June 2014. A retrospective review of clinical and laboratory features, including complete blood count, % bone marrow blasts, chromosomal analysis, and International Prognostic Scoring System (IPSS), was performed. WHO classification of MDS patients was as follows: RA (n = 22), RARS (n = 2), RCMD (n = 17), RAEB 1 (n = 18), RAEB 2 (n = 11), and MDS unclassified (n = 1). Overall survival (OS) and leukemia-free survival (LFS) were analyzed in 71 MDS patients by the Kaplan–Meier method and differences between curves were calculated by two-sided log-rank test. CT image acquisition and image analysis: Non-enhanced CT examinations were performed from the base of the skull down to the knee joint with an MS-CT scanner (AQUILION 64; Toshiba, Tokyo, Japan). The bony canals of the humeral and femoral bones were visualized by coronal and sagittal axis image reconstruction. The effective radiation dose associated with whole-body MD-CT was 10.1 mSv (ICRP 26). The dose was comparable to whole-body CT (2.4 mSv). Medullary CT density of the humerus and femur were measured and the results are expressed in Hounsfield units (HU). As the normal adult bone marrow was composed of rich adipocytes and called yellow marrow, it is represented by a low-density CT value between –30 and –100 HU. A value above –30 HU observed in long bony canals was considered to indicate a high-density lesion. The medullary pattern of the appendicular skeleton was categorized as follows: (1) fatty, showing a low signal density marrow; (2) focal, showing abnormally focal high-density lesions; (3) diffuse, showing uniformly high-density marrow. Results: All 15 patients with AA showed a fatty (n = 12, 37.5%) or focal (n = 20, 62.5%) pattern in medullary AS on MDCT, and none showed a diffuse pattern. Among the 71 patients with MDS, 22 (30.9%) had a fatty pattern, 32 (45.1%) had a focal pattern, and 17 (23.9%) had a diffuse pattern. Seventeen patients with diffuse infiltration pattern on MDCT had significantly shorter LFS (P < 0.01, P = 0.02) compared to 23 patients with fatty pattern and 32 patients with focal medullary pattern (median LFS: 18 months vs. not reached vs. not reached, respectively). Seventeen patients with a diffuse infiltration pattern on MDCT had significantly shorter OS (P = 0.04) compared to 23 patients with a fatty pattern, but the difference was no significant compared to 32 with a focal medullary pattern (P = 0.15) (median OS: 22 months vs. not reached vs. not reached, respectively). The characteristics of the patients with diffuse pattern did not differ significantly in terms of sex, age, WBC count, platelet count, karyotype, WT1, or IPSS classification from those of patients with a fatty or focal pattern, but patients with a diffuse infiltration pattern on MDCT had a significantly low hemoglobin concentration compared to those with a fatty or focal medullary pattern (P = 0.03). Conclusions: This study showed that MDCT imaging of the appendicular skeleton provided important information for the diagnosis and prognosis of patients with MDS and AA. In patients with MDS, a diffuse pattern on MDCT emerged as an independent negative prognostic indicator on LFS and OS. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

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Ectopic extramedullary hematopoiesis: evaluation and treatment of a rare and benign paraspinal/epidural tumor

Journal of Neurosurgery Spine ◽

10.3171/2012.12.spine12720 ◽

2013 ◽

Vol 18 (3) ◽

pp. 236-242 ◽

Cited By ~ 9

Author(s):

Tobias A. Mattei ◽

Michael Higgins ◽

Flynn Joseph ◽

Ehud Mendel

Keyword(s):

Bone Marrow ◽

Blood Cells ◽

Extramedullary Hematopoiesis ◽

The Body ◽

Cytotoxic Agents ◽

Ct Guided ◽

Extensive Evaluation ◽

Red Marrow ◽

Yellow Marrow ◽

Hematological Disorder

Ectopic extramedullary hematopoiesis (EMH), defined as the formation of blood cells outside the bone marrow, usually occurs in a scenario of chronic anemia when, even after conversion of the bony yellow marrow to red marrow, the body is still unable to meet the demand for red blood cells. Ectopic extramedullary hematopoiesis most commonly occurs in the liver and spleen but may, in fact, occur almost anywhere in the body. Although previous reports have documented EMH presenting as paraspinal masses, such lesions have almost always been associated with a predisposing hematological disorder such as hemolytic anemia, myelofibrosis or myelodysplastic syndromes, thalassemia, polycythemia vera, leukemia, or lymphoma. The authors of this report describe the first reported instance of EMH in a patient presenting with a symptomatic epidural and paraspinal cervical lesion arising from the posterior spinal elements and no known predisposing hematological disease. Initial radiographs revealed a bony lesion arising posteriorly from the C2–3 laminae and spinous processes. Subsequent imaging suggested the diagnosis, which was confirmed by CT-guided biopsy, peripheral blood smears, and bone marrow aspirate. Despite epidural compression and slight displacement of the cervical cord and thecal sac, the patient's symptoms were limited to pain and diminished cervical range of motion. Therefore, surgery was deferred in favor of nonsurgical therapy. Several alternative modalities for the treatment of EMH have been suggested in the literature, including cytotoxic agents and radiotherapy. The authors opted for an approach utilizing directed low-dose radiotherapy of a total of 25 Gy divided in 2.5-Gy fractions. At the 3-month follow-up, the patient continued to be asymptomatic, and MRI demonstrated a significant reduction in the dimensions of the lesion. Extramedullary hematopoiesis with spinal cord compression in the absence of a preexisting hematological disorder has not been described in the context of clinical neurosurgical practice. Recognizing that EMH may present as an epidural or paraspinal lesion is important since chemotherapy and radiotherapy are effective therapeutic options in the majority of patients who suffer few if any symptoms. Extensive evaluation for underlying hematological disorders is necessary before undertaking directed therapy. Inadvertent resection of these highly vascularized masses may risk catastrophic intraoperative hemorrhage with no proven benefit as compared with medical treatment, which usually provides excellent long-term outcomes.

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Vertebral Bone Marrow and Endplate Assessment on MR Imaging for the Differentiation of Modic Type 1 Endplate Changes and Infectious Spondylodiscitis

Journal of Clinical Medicine ◽

10.3390/jcm9030826 ◽

2020 ◽

Vol 9 (3) ◽

pp. 826 ◽

Cited By ~ 1

Author(s):

Ursula Schwarz-Nemec ◽

Klaus M. Friedrich ◽

Christoph Stihsen ◽

Felix K. Schwarz ◽

Siegfried Trattnig ◽

...

Keyword(s):

Bone Marrow ◽

Mr Imaging ◽

Diagnostic Accuracy ◽

Characteristic Analysis ◽

Vertebral Bone ◽

Endplate Changes ◽

Modic Type ◽

Infectious Spondylodiscitis ◽

Vertebral Bone Marrow

On magnetic resonance (MR) imaging, Modic type 1 (MT1) endplate changes and infectious spondylodiscitis share similar findings. Therefore, this study investigated vertebral bone marrow and endplate changes to enable their differentiation. The lumbar spine MR examinations of 91 adult patients were retrospectively included: 39 with MT1; 19 with early spondylodiscitis without abscess; and 33 with advanced spondylodiscitis with abscess. The assessment included percentage of bone marrow edema on sagittal short tau inversion recovery images, and the signal ratio of edema to unaffected bone and endplate contour (normal; irregular, yet intact; blurred; destructive) on sagittal unenhanced T1-weighted images. Differences were tested for statistical significance by Chi-square test and mixed model analysis of variance. The MR diagnostic accuracy in differentiating MT1 and spondylodiscitis was assessed by cross-tabulation and receiver-operating characteristic analysis. The endplate contours, edema extents, and T1-signal ratios of MT1 (extent, 31.96%; ratio, 0.83) were significantly different (p < 0.001) from early spondylodiscitis (56.42%; 0.60), and advanced spondylodiscitis (91.84%; 0.61). The highest diagnostic accuracy (sensitivity, 94.87%; specificity, 94.23%; accuracy, 94.51%) in identifying MT1 was provided by an irregular, yet intact endplate contour. This may be a useful MR feature for the differentiation between MT1 and spondylodiscitis, particularly in its early stage.

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