Magnetic Resonance Imaging of the Bone Marrow

375 Pages·2012·20.485 MB·English

by  Reiner Bartl (auth.), Andrea Baur-Melnyk (eds.)

Medical Radiology
Diagnostic Imaging
Series Editors
Maximilian F. Reiser
Hedvig Hricak
Michael Knauth
Editorial Board
Andy Adam, London
Fred Avni, Brussels
Richard L. Baron, Chicago
Carlo Bartolozzi, Pisa
George S. Bisset, Durham
A. Mark Davies, Birmingham
William P. Dillon, San Francisco
D. David Dershaw, New York
Sam Sanjiv Gambhir, Stanford
Nicolas Grenier, Bordeaux
Gertraud Heinz-Peer, Vienna
Robert Hermans, Leuven
Hans-Ulrich Kauczor, Heidelberg
Theresa McLoud, Boston
Konstantin Nikolaou, Munich
Caroline Reinhold, Montreal
Donald Resnick, San Diego
Rüdiger Schulz-Wendtland, Erlangen
Stephen Solomon, New York
Richard D. White, Columbus
For furthervolumes:
http://www.springer.com/series/4354
Andrea Baur-Melnyk
Editor
Magnetic Resonance
Imaging of the Bone
Marrow
Foreword by
Maximilian F. Reiser
123
Editor
Andrea Baur-Melnyk
Institutfür KlinischeRadiologie
Klinikum derUniversität München(Großhadern)
Munich
Germany
ISBN 978-3-642-17859-7 ISBN 978-3-642-17860-3 (eBook)
DOI 10.1007/978-3-642-17860-3
SpringerHeidelbergNewYorkDordrechtLondon
LibraryofCongressControlNumber:2012949706
(cid:2)Springer-VerlagBerlinHeidelberg2013
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To my husband, Robert, and my parents
Andrea Baur-Melnyk
Foreword
Thebonesofbirdscontaingasinsteadofbonemarrowinordertoreducetheir
weight and allow them to fly. Since mammalians developed later in evolution
thanbirdsitcanbeassumedthatthebonemarrowisnotjustanatavism,even
if air crafts were invented at a much later date. In humans and other mam-
malians, the bone marrow is one of the largest organs and the importance of
thisorganisalsoreflectedintheLatinword‘‘medulla’’whichispartoftheterm
‘‘medullary cavity’’ in which the bone marrow is located. Figuratively, this
‘‘medulla’’ has another meaning in the Latin language: ‘‘the dearest, the heart’’
indicating that back in ancient times the most important role of the bone
marrow had been recognized.
For modern diagnostic imaging, especially MRI, the bone marrow plays a
crucial role enabling the radiologist to detect a large variety of different dis-
orders. Not only diseases originating from the bone marrow such as leukemia,
myeloproliferative disorders, diseases of the reticuloendothelial system and
anemias can be detected and characterized with MRI. In oncologic imaging
metastatic spread to the skeleton plays a key role and multiple myeloma is an
oncological disease originating from the bone marrow.
The bone marrow is also an area in which diseases of other organs may
manifest so that their detection contributes to elucidate the health status of a
patient. Bone infarction and bone marrow alterations in non-infective inflam-
matory bone marrow diseases such as Bechterew’s disease and Sapho may
provide direction in the further diagnostic work-up of a particular patient.
MRIopenedtheeyesofradiologistsforapreviouslycompletelyunknownor
atleastneglectedentity,thebonemarrowedemasyndromeandunderstandably
radiologistslovethisentity.Bonemarrowedemacanbeseenasthefootprintof
injuries and disorders and could not be depicted with any other imaging
modality. The visualization of bone marrow edema allows diagnosing a
plethora of diseases and injuries and contributed to the elucidation of the
natural history of various lesions.
All this would not be possible if humans would have bones filled with air.
Alike the antique Romans, radiologists would therefore translate ‘‘medulla’’ as
‘‘the dearest’’.
vii
viii Foreword
On behalf of the editorial board of ‘‘Medical Radiology’’ I would like to
expressmysinceregratitudetoProfessorBaur-Melnykandtheeminentauthors
ofthismonographfortheirtimeandexpertise.Weareconfidentthatthereader
will welcome this state-of-the-art reference book on the fascinating topic of
MRI of the bone marrow. It provides at the same time comprehensive and
compressed information on this topic of utmost clinical importance.
Munich, November 2012 Maximilian F. Reiser
Preface
The bone marrow is one of the largest organs of the human body. In almost
everyMRimagethebonemarroworpartsofitaredisplayed.MRIisthemost
sensitive imaging modality to display the marrow and its components, mainly
consistingoffatandwaterbound protons.Theexact knowledgeofthenormal
marrowdistributionaswellasmarrowvariantsinMRIisimportantforspecific
diagnoses. Benign variants often constitute mimickers of malignant diseases.
Pathologies that may arise from bone marrow and marrow components are
numerous. In this book haematological bone marrow malignancies, bone
metastases,multiplemyelomaasmalignantcausesforbonemarrowalterations
are presented. MRI can also be used as a tool for the assessment of treatment
response in oncologic marrow involvement. The differentiation of benign and
malignant vertebral compression fractures is an common clinical challenge
which is discussed in detail in one separate chapter. Benign processes can also
affect the bone marrow, such as diseases of the reticuloendothelial system,
anemias and marrow insufficiency. Osteonecrosis and bone marrow infarction
is another common clinical problem in musculoskeletal imaging which will be
presented in detail. It has to be differentiated from bone marrow edema syn-
dromes which may havemultiple underlying causes. Bone marrow changes are
frequently found in acute and chronic trauma and their patterns are often
specificforaparticulartypeofinjury.Infectiveandnoninfectivebonemarrow
diseases have to be differentiated from bone marrowedema syndromes. At the
end technical aspects and new techniques for bone marrow imaging in MRI,
such as diffusion and perfusion as well as contrast media application are
discussed.
We hope that this book will aid in clinical practise and can aid in patient
care.Wewanttothankallcontributingauthors,whoareinternationallyknown
experts in their field, for their great efforts and for their outstanding contri-
butions. We would also like to acknowledge the continuous support and
encouragement by Springer.
Andrea Baur-Melnyk
ix
Contents
Part I Histology and Normal Bone Marrow
Histology of Normal Bone and Bone Marrow,
and Their Main Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Reiner Bartl
MR Imaging of the Normal Bone Marrow and Normal Variants . . . . . 21
Bruno C. Vande Berg, P. Omoumi, C. Galant,
N. Michoux, and F. E. Lecouvet
Part II Bone Marrow Neoplasia
Haematological Bone Marrow Malignancies. . . . . . . . . . . . . . . . . . . . . 49
Sung Kim, Kathleen Carrigan, and Michael Mulligan
MRI of Bone Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Gerwin Paul Schmidt and Andrea Baur-Melnyk
Multiple Myeloma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Andrea Baur-Melnyk and Melvin D’Anastasi
MRI for Response Assessment in Oncologic Bone Marrow Lesions. . . . 121
F. Lecouvet, P. Omoumi, A. Larbi, B. Tombal, N. Michoux,
B. Vande Berg, and J. Malghem
Differentiation of Benign and Malignant Vertebral
Compression Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Andrea Baur-Melnyk and Tobias Geith
Part III Benign Processes Affecting the Bone Marrow
Diseases of the Reticuloendothelial System. . . . . . . . . . . . . . . . . . . . . . 177
Robert Hemke and Mario Maas
xi
xii Contents
Anemias and Bone Marrow Insufficiency . . . . . . . . . . . . . . . . . . . . . . . 193
Iris-Melanie Noebauer-Huhmann and Martin Uffmann
Osteonecrosis and Bone Infarction. . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Anastasia Fotiadou and Apostolos Karantanas
Bone Marrow Edema Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Alain Blum, Sophie Lecocq, Matthias Louis, and Pedro Teixeira
Bone Marrow Changes in Acute and Chronic Trauma. . . . . . . . . . . . . 265
Filip M. Vanhoenacker, Michiel Eyselbergs, and Annick Demeyere
Infective Inflammatory Bone Disease . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Klaus Bohndorf and Hassan Douis
Non-Infective Inflammatory Bone Marrow Disease. . . . . . . . . . . . . . . . 311
Bernhard J. Tins and Victor N. Cassar-Pullicino
Part IV Technical Aspects in Bone Marrow Imaging
Techniques for Diffusion and Perfusion Assessment
in Bone-Marrow MRI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Olaf Dietrich
Magnetic Resonance Imaging of the Bone Marrow
Contrast Media for Bone Marrow Imaging . . . . . . . . . . . . . . . . . . . . . 355
Daniel Golovko, Elizabeth Sutton, and Heike E. Daldrup-Link
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367