Painful sickle cell crisis: bone marrow patterns observed with MR imaging.

Abstract

Eleven patients with homozygous sickle cell anemia (SCA) undergoing painful crisis were studied with magnetic resonance (MR) imaging. The signal intensity of bone marrow was diffusely decreased in the axial and peripheral skeleton on short repetition time (TR)/echo time (TE) images and long TR/TE images, which suggested hematopoietic marrow hyperplasia and was confirmed by isotope marrow scans in five patients. Focal areas of further decrease in signal intensity were seen on short TR/TE images in 12 of the 14 (86%) painful joints and three of the five (60%) painless joints. In the painful joints, these focal areas converted to high signal intensity on long TR/TE images, presumably due to edema, which suggested acute marrow infarction. In the painless joints, these low-intensity focal areas remained as low signal on long TR/TE images, which suggested absence of edema and thus areas of old infarction or fibrosis. These results indicate that MR imaging may enable differentiation between acute and chronic marrow infarcts in patients with SCA and serve as a useful guide in monitoring and directing therapy.

Bone marrow embolism in sickle cell disease: A review

“…The fat emboli are thought to arise from bone marrow necrosis. Infarction of bone marrow is common in sickle cell patients, as evident from autopsy reports [1,19,20,34], bone marrow biopsies [21], and bone marrow magnetic resonance imaging [35,36]. It is thought that the infarcted bone marrow material gains entry into venous vessels within bone and passes into the venous circulation.…”

Modeling sickle cell vasoocclusion in the rat leg: quantification of trapped sickle cells and correlation with 31P metabolic and 1H magnetic resonance imaging changes.

“…Due to its noninvasive character, MRI is a promising modality for the evaluation of vasoocclusion involving muscle or bone marrow. Although there have been reports of MRI-detectable changes in painful crisis (20,21), the sensitivity of MRI to sickle-cell-induced vasoocclusion of skeletal muscle has not been conclusively demonstrated.…”

Femoral infarction following intraarterial chemotherapy for osteosarcoma of the leg: a possible pitfall in magnetic resonance imaging

“…Rao et al [8] described focal abnormalities in bone marrow in patients with painful sickle cell crises: areas of low signal intensity on Tl-weighted sequences, converting to high signal intensity on Y zweighted sequences, suggesting acute marrow infarction. On the contrary, in patients with sickle cell anemia but not in pain, these focal abnormalities in bone marrow remained of low signal intensity on Tz-weighted sequences, suggesting an old infarction or fibrosis.…”

“…It induces effects on the tumor and also on surrounding normal tissues. These local undesirable effects on the normal tissues may be misdiagnosed as a tumoral progression under chemotherapy [7][8][9]. We report abnormal images with MRI examination appearing on the distal femur after intraarterial chemotherapy (IAC) for osteosarcoma of the tibia in one case, the fibula in the other.…”