High-signal T2 changes of the bone marrow of the foot and ankle in children: red marrow or traumatic changes?

Shabshin, Nogah; Schweitzer, Mark E.; Morrison, William B.; Carrino, John A.; Keller, Marc S.; Grissom, Leslie E.

doi:10.1007/s00247-006-0129-y

Cited by 105 publications

(70 citation statements)

References 19 publications

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“…Our Type 1 bone marrow changes resembled signal abnormalities shown in runners after exercise, representing possibly transient and physiological reactions to stress [17,18]. Our findings were also similar to signal changes described in asymptomatic children, where such changes are considered to represent hematopoetic marrow [19]. The small and subtle edema-like changes seen in the current study should not be difficult to differentiate from clinically relevant lesions, including malignancy [10].…”

Section: Discussionsupporting

confidence: 85%

“…Reconversion or persistence of hematopoietic bone marrow changes is another possible explanation for this finding in our youngest decade. Although by the age of 5 years bone marrow conversion of hematopoetic marrow to fatty marrow is nearly complete in the foot and ankle [20], isolated islands of red marrow may persist up to the age of young adults [19,21].…”

Section: Discussionmentioning

confidence: 99%

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Bone marrow changes on STIR MR images of asymptomatic feet and ankles

et al. 2007

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The purpose of this study was to evaluate the prevalence, pattern and size of bone marrow changes on short-tau inversion recovery (STIR) magnetic resonance (MR) images of asymptomatic feet and ankles. In 78 asymptomatic volunteers (41 women, 37 men; median age 47 years; range 23-83 years) sagittal STIR MR images of hindfoot and midfoot were reviewed for various patterns of high signal changes in bone marrow. The size of these bone marrow changes was measured, and signal intensity was rated semi-quantitatively using a scale from 0(=normal) to 10(=fluid-like). Fifty percent (39/78) of all volunteers had at least one bone marrow change. Thirty-six percent (28/78) of all volunteers had edemalike changes, 26% (20/78) had necrosis-like changes, and 5% (4/78) had cyst-like changes. The long diameters of all changes varied between 4 mm and 16 mm (median 7.5 mm). The median signal intensity for all changes was 5.0 (range 1-10). Bone marrow changes on STIR MR images are commonly detected in asymptomatic feet and ankles. However, such changes tend to be small (<1 cm) or subtle.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Bone marrow changes on STIR MR images of asymptomatic feet and ankles

et al. 2007

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“…The skeleton develops with enchondral growth, ossification and conversion of haematopoietic (red) marrow into fatty (yellow) marrow. In the foot and ankle, a characteristic pattern of multifocal regions of bone marrow signal deviation in absence of trauma has been described in children [21]. This may be attributed to altered biomechanics related to growth and weight-bearing or to islands of haematopoietic marrow.…”

Section: Discussionmentioning

confidence: 99%

MRI assessment of bone marrow in children with juvenile idiopathic arthritis: intra- and inter-observer variability

et al. 2012

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“…All other lesions were visually compared to signal intensities of adjacent bone marrow and fluid. Small punctiform areas of high signal intensities are common in the bone marrow of children, especially in the feet, and are considered as remnants of red bone marrow [14]. We therefore set the minimum diameter of reported lesions to 5 mm.…”

Section: Mr Imaging and Evaluationmentioning

confidence: 99%

Typical Patterns of Bone Involvement in Whole-Body MRI of Patients with Chronic Recurrent Multifocal Osteomyelitis (CRMO)

Kalle

Heim

Hospach

et al. 2013

Fortschr Röntgenstr

102

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Purpose: The diagnosis of CRMO often involves a long patient history. We evaluated the spectrum of bone involvement in whole-body magnetic resonance imaging (WB-MRI) and assessed its potential contribution to a more rapid diagnosis. Materials and Methods: WB-MRI (1.5?T, coronal STIR sequences) in 53 children and adolescents (mean age 11 years, 4.8???15.1) with histologically (n?=?37) or clinically (n?=?16) confirmed CRMO were retrospectively reviewed by two experienced pediatric radiologists. Results: WB-MRI revealed multifocal lesions in all but one patients. Only 26 of them had presented with multifocal complaints. We detected 1???27 geographic lesions/patient (mean 9.7). 510 of 513 lesions were significantly hyperintense compared to normal bone marrow. The pelvis, lower extremities, shoulders and spine were most frequently involved. 40 patients (75?%) had bilateral symmetrical involvement of bones. Most of the lesions were located in tubular bones, in 87?% adjacent to one or both sides of a growth plate. 32?% of lesions showed periosteal involvement. Of 456 affected bones, 33 (7.2?%) were deformed, 6 (18?%) were vertebra plana. Conclusion: In the absence of more specific diagnostic criteria, WB-MRI can, in synopsis with clinical findings, substantially contribute to a rapid diagnosis of CRMO. It discovers the typical pattern of multifocal and bilateral bone involvement more often than has been reported for targeted MRI. It readily reveals the characteristic proximity of lesions to growth plates, the sacroiliac joint and triradiate cartilage and helps to uncover asymptomatic spinal complications.

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High-signal T2 changes of the bone marrow of the foot and ankle in children: red marrow or traumatic changes?

Abstract: High-signal T2 changes of the bone marrow in pediatric feet and ankle MRIs have a symmetric, fairly consistent pattern and disappear after the age of 15 years. We believe that these high-signal areas are normal and represent residual hematopoietic marrow.

Cited by 105 publications

References 19 publications

Bone marrow changes on STIR MR images of asymptomatic feet and ankles

Bone marrow changes on STIR MR images of asymptomatic feet and ankles

MRI assessment of bone marrow in children with juvenile idiopathic arthritis: intra- and inter-observer variability

Typical Patterns of Bone Involvement in Whole-Body MRI of Patients with Chronic Recurrent Multifocal Osteomyelitis (CRMO)

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