Abstract
The bone marrow consists of active red marrow and inactive fatty marrow which is mainly situated in the extremities. Red marrow can be replaced by various conditions. Focal disease is easy to perceive; however, diffuse disease is often hard to detect. Gadolinium application can help for quantification of contrast enhancement. Based on the results of a control cohort, the enhancement of normal bone marrow showed great variations between 3% and 40%, mean 17% (in adults age >40 years). In patients with multiple myeloma, mean enhancement is significantly higher >40 Vol.%. Other diseases with stimulation of red marrow can simulate diffuse disease and also lead to an increase of contrast enhancement. Therefore the clinical background is of great importance when interpreting such exams. Quantitative whole-body MRI with ADC analysis might be a feasible diagnostic tool to assess the short-term treatment response in myeloma patients.
Measurements have also been performed for therapy control in patients with Gaucher’s disease. Gaucher’s disease is a disease of the reticuloendothelial system. The reduction of the fat cell content, which reflects the severity of the disease, can be measured quantitatively by the chemical shift method. A semiquantitative method is the BMB score, which is a combination of scoring systems of the peripheral skeleton and the axial bone marrow component in patients with Gaucher’s disease. It incorporates both the visual interpretation of the signal intensities and the geographic location of the disease on conventional MR images of the spine and femur.
Dynamic contrast-enhanced MRI (DCE-MRI) has the potential to noninvasively assess the microvascular structure of bone marrow. In patients with acute myeloid leukemia in complete remission, Kep (efflux rate constant) measured with tracer kinetic modeling represents the contrast exchange between blood plasma and extravascular extracellular space. It is thought that bone marrow vessels and their endothelium should be normalized with reduced vessel wall permeability in complete remission, and therefore show low values of Kep. Increased values for Kep may indicate a high risk of relapse and were associated with shorter overall survival and relapse-free survival, as could be shown in an initial study.
A sometimes challenging question is the differentiation of acute osteoporotic and malignant vertebral fractures. In uncertain cases, quantitative diffusion-weighted imaging and chemical shift imaging can provide additional features to overcome the diagnostic limitations of morphologic signs in MRI.
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Baur-Melnyk, A., Geith, T. (2020). Bone Marrow Disease. In: Cassar-Pullicino, V., Davies, A. (eds) Measurements in Musculoskeletal Radiology. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-68897-6_20
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