MRI of Spinal Bone Marrow

Articles being reviewed:

  1. MRI of Spinal Bone Marrow: Part 1, Techniques and Normal Age-Related Appearances http://www.ajronline.org/content/197/6/1298.abstract
  2. MRI of Spinal Bone Marrow: Part 2, T1-Weighted Imaging-Based Differential Diagnosis http://www.ajronline.org/content/197/6/1309.abstract

Reviewed by:
Timothy V. Myers, MD

CME offered: Yes

Authors:
Lubdha M. Shah1
Christopher J. Hanrahan

Disclosures: None

Abstract:
1. OBJECTIVE. This article reviews MRI protocols, including routine and nonroutine pulse sequences as well as the normal MRI appearance of spinal marrow and expected age-related changes.

CONCLUSION. Routine MRI of the spine provides useful evaluation of the spinal bone marrow, but nonroutine MRI pulse sequences are increasingly being used to evaluate bone marrow pathology. An understanding of MRI pulse sequences and the normal and age-related appearances of bone marrow is important for the practicing radiologist.

2. OBJECTIVE. The purpose of this article is to review the structure of bone marrow and the differential diagnosis of bone marrow pathology on the basis of T1-weighted MRI patterns.

CONCLUSION: Bone marrow is an organ that is evaluated routinely during MRI of the spine, particularly lumbar spine evaluation. Thus, it is one of the most commonly performed MRI examinations. T1-weighted MRI is a fundamental sequence in evaluating spinal marrow, and an understanding of T1-weighted MR signal abnormalities is important for the practicing radiologist.

Discussion: These 2 articles review the MRI findings in a variety of spinal conditions.  They review the MRI imaging characteristics seen with multiple different imaging techniques.  There are good representative images and a very nice table of differential diagnosis, see below.

Representative images:

STIR image displays no abnormal signal intensity in upper thoracic vertebral bodies to suggest edema related to marrow process. Edema and superior endplate deformities of lower thoracic vertebral bodies (arrows) are compatible with acute compression fractures.

A, Sagittal fast spin-echo T2-weighted MR image illustrates few heterogeneously hypointense metastatic lesions in lumbar spine. In particular, T12 lesion has epidural component compressing conus medullaris (arrow).

Recommendation:
Article (1-5):   5
1. Reads poorly and difficult to understand 2. Adequate, could have been better. 3. Average readability 4. Understandable and adequately readable. 5. Readable and interesting with information presented very well.

Images (1-5):  5
1. Not enough images, images not well done 2. The images could have been better or more of them 3. Average images and image number 4. The images were good and there were a reasonable number of images 5. Excellent images demonstrating the areas of interest presented in the article.

Overall (1-5):  5
1. Not recommended 2. Recommended somewhat 3. Average article, read if of specific interest 4. Recommended article 5. Absolutely recommended.

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