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Flashcards in Bone & Spine Deck (11)
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1

Normal red marrow MRI signal characteristics ( contains small amounts of fat)

T1 - slightly hyper - iso to muscle / disc
STIR - hyper to FAT ( compare with T2)
In/out MRI- signal decrease

Abnormal marrow may not be darker when early or haemorrhage.

Compare T2 with STIR to assess suppression - abnormal does not suppress

2

Normal marrow red --> fat conversion order sequence

appendicular> axial
distal > proximal
Epiphyses and apophyses > diaphyses> distal metaphyses> proximal metaphyses

Reversed order in reconversion.

Epiphyses usually not involved in reconversion.

Red marrow present in subchondral epiphyses

3

Marrow reconversion
Causes
7

Obese females
Smokers
Haemolytic anaemia
High altitude
Athletes
Marrow stimulating meds eg GCSF ( can mimic reconv or myeloprolif)
Replacement/des of normal marrow

4

Marrow depletion causes
3
T1/T2 - similar to fat

Aplastic anaemia
Radiation
Chemotherapy

5

Marrow oedema due to hyperaemia or ischaemia
Focal

Trauma
Osteonecrosis
Transient oedema
Regional migratory oedema
inflammatory arthritis

6

Miscellaneous marrow disorders
5

Gaucher
Haemosiderin
Serous atrophy
Paget
Osteopetrosis

7

Features of benign vertebral #

usually anterior column
posterior concave margin is preserved
retropulsion can occur
Visible fracture line surrounded by oedema

8

Features of pathologic vertebral #

Expanded vertebral body with convex margins
involved pedicles
soft tissue mass
abnormal signal throughout body
no fracture line ( late to #)
destroyed trabeculae

9

Multiple myeloma
Marrow patterns 4

Normal
Focal ( plasmacytoma)
Diffuse homogeneous - non specific : conf low T1/high T2//STIR
Micronodular/peppered - somewhat specific
Mixed patterns

10

Marrow changes associated with radiation
(after 2 weeks)

Red marrow preferentially destroyed
Focal
Abrupt margin at edges
T1/T2/STIR high
Regeneration at periphery

11

Spine: distinguish pial vessels vs meningeal mets

Pial vessels post Gad will washout early
Pial vessels at 12-6 o'clock positions