Download PDF
Semin Musculoskelet Radiol 2009; 13(2): 087-096
DOI: 10.1055/s-0029-1220879
© Thieme Medical Publishers

Normal Variants of the Bone Marrow at MR Imaging of the Spine

Bruno C. Vande Berg1 , Frederic E. Lecouvet1 , Christine Galant2 , Paolo Simoni1 , Jacques Malghem1
  • 1Department of Radiology, Section of Musculoskeletal Radiology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
  • 2Department of Pathology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
Further Information

Publication History

Publication Date:
19 May 2009 (online)

Also available at
    Permissions and Reprints

ABSTRACT

It is the radiologist's cornerstone to decide if imaging findings are normal or abnormal and to differentiate between clinically significant and insignificant findings. This challenge is extremely common in routine clinical practice when performing magnetic resonance (MR) imaging of the spine because it is frequently performed to assess patients with cancer or with spine-related symptoms. MR appearance of the normal vertebral marrow shows important variations not only with age but also among individuals of the same age range. On the contrary, marrow distribution and signal intensity patterns show little variation among each vertebral body of the same subject. Focal alterations in signal intensity can be observed that reflect local variation in the amount of normal expected vertebral components, including fat and hematopoietic cells, bone, and vessels. A more recently recognized condition related to the presence of notochordal cells deserves further study because it could account for some frequent tiny marrow changes. Diffuse alteration in vertebral signal intensity can also be observed and can be difficult—or even impossible—to differentiate from diffuse marrow infiltration by an abnormal process, given the lack of specificity of MR imaging. This article highlights the normal variants and frequent alterations of the vertebral bone marrow as encountered on MR studies of the spine and that can simulate significant lesions.

KEYWORDS

Marrow - fat - variant - metastasis - hyperplasia - hemangioma

REFERENCES

  • 1 Vande Berg B C, Malghem J, Lecouvet F E, Maldague B E. Magnetic resonance imaging of the normal bone marrow.  Skeletal Radiol. 1998;  27(9) 471-483
    CrossrefPubMedGoogle Scholar
  • 2 Vogler III J BI, Murphy W A. Bone marrow imaging.  Radiology. 1988;  168(3) 679-693
    PubMedGoogle Scholar
  • 3 Carroll K W, Feller J F, Tirman P F. Useful internal standards for distinguishing infiltrative marrow pathology from hematopoietic marrow at MRI.  J Magn Reson Imaging. 1997;  7(2) 394-398
    CrossrefPubMedGoogle Scholar
  • 4 Montazel J L, Divine M, Lepage E, Kobeiter H, Breil S, Rahmouni A. Normal spinal bone marrow in adults: dynamic gadolinium-enhanced MR imaging.  Radiology. 2003;  229(3) 703-709
    CrossrefPubMedGoogle Scholar
  • 5 Chen W T, Shih T T, Chen R C et al.. Vertebral bone marrow perfusion evaluated with dynamic contrast-enhanced MR imaging: significance of aging and sex.  Radiology. 2001;  220(1) 213-218
    CrossrefPubMedGoogle Scholar
  • 6 Ricci C, Cova M, Kang Y S et al.. Normal age-related patterns of cellular and fatty bone marrow distribution in the axial skeleton: MR imaging study.  , [see comments] Radiology. 1990;  177(1) 83-88
    CrossrefPubMedGoogle Scholar
  • 7 Cristy M. Active bone marrow distribution as a function of age in humans.  Phys Med Biol. 1981;  26(3) 389-400
    CrossrefPubMedGoogle Scholar
  • 8 De Bruyn P PH, Breen P C, Thomas T B. The microcirculation of the bone marrow.  Anat Rec. 1970;  168(1) 55-68
    PubMedGoogle Scholar
  • 9 Weiss L. The structure of bone marrow. Functional interrelationships of vascular and hematopoietic compartments in experimental hemolytic anemia: an electron microscopic study.  J Morphol. 1965;  117(3) 467-537
    CrossrefPubMedGoogle Scholar
  • 10 Hajek P C, Baker L L, Goobar J E et al.. Focal fat deposition in axial bone marrow: MR characteristics.  Radiology. 1987;  162(1 Pt 1) 245-249
    PubMedGoogle Scholar
  • 11 Levine C D, Schweitzer M E, Ehrlich S M. Pelvic marrow in adults.  Skeletal Radiol. 1994;  23(5) 343-347
    CrossrefPubMedGoogle Scholar
  • 12 Schmorl G, Junghans H, Doin G. Clinique et radiologie de la colonne vertébrale normale et pathologique. In: Doin G Lésion du rachis osseux. Paris, France; Flammarion 1956: 71-140
    Google Scholar
  • 13 Murphey M D, Fairbairn K J, Parman L M, Baxter K G, Parsa M B, Smith W S. From the archives of the AFIP. Musculoskeletal angiomatous lesions: radiologic-pathologic correlation.  Radiographics. 1995;  15(4) 893-917
    PubMedGoogle Scholar
  • 14 Wilner D. Radiology of bone tumors and allied disorders. In: Wilner D Benign Vascular Tumors and Allied Disorders of Bone. Philadelphia, PA; WB Saunders 1982: 660-782
    Google Scholar
  • 15 Ross J S, Masaryk T J, Modic M T, Carter J R, Mapstone T, Dengel F H. Vertebral hemangiomas: MR imaging.  Radiology. 1987;  165(1) 165-169
    CrossrefPubMedGoogle Scholar
  • 16 Baudrez V, Gallant C, Lecouvet F E, Malghem J, Maldague B E, Vande Berg B C. Vertebral hemangioma: MR-histological correlation in autopsy specimens.  , [abstract] Radiology. 1999;  213(P) 245
    PubMedGoogle Scholar
  • 17 Laredo J D, Reizine D, Bard M, Merland J J. Vertebral hemangiomas: radiologic evaluation.  Radiology. 1986;  161(1) 183-189
    PubMedGoogle Scholar
  • 18 Bordalo-Rodrigues M, Galant C, Lonneux M, Clause D, Vande Berg B C. Focal nodular hyperplasia of the hematopoietic marrow simulating vertebral metastasis on FDG positron emission tomography.  AJR Am J Roentgenol. 2003;  180(3) 669-671
    PubMedGoogle Scholar
  • 19 Murphey M D, Andrews C L, Flemming D J, Temple H T, Smith W S, Smirniotopoulos J G. From the archives of the AFIP. Primary tumors of the spine: radiologic pathologic correlation.  Radiographics. 1996;  16(5) 1131-1158
    CrossrefPubMedGoogle Scholar
  • 20 Kroon H M, Bloem J L, Holscher H C, van der Woude H J, Reijnierse M, Taminiau A H. MR imaging of edema accompanying benign and malignant bone tumors.  Skeletal Radiol. 1994;  23(4) 261-269
    PubMedGoogle Scholar
  • 21 Resnick D, Nemcek Jr A A, Haghighi P. Spinal enostoses (bone islands).  Radiology. 1983;  147(2) 373-376
    PubMedGoogle Scholar
  • 22 Seymour R, Davies A M, Evans N, Mangham D C. Diagnostic problems with atypical bone islands.  , [abstract] Br J Radiol. 1997;  70 87-88
    PubMedGoogle Scholar
  • 23 Yamaguchi T, Suzuki S, Ishiiwa H, Ueda Y. Intraosseous benign notochordal cell tumours: overlooked precursors of classic chordomas?.  Histopathology. 2004;  44 597-602
    CrossrefPubMedGoogle Scholar
  • 24 Deshpande V, Nielsen G P, Rosenthal D I, Rosenberg A E. Intraosseous benign notochordal cell tumors (BNCT): further evidence supporting a relationship to chordoma.  Am J Surg Pathol. 2007;  31 1573-1577
    CrossrefPubMedGoogle Scholar
  • 25 Yamaguchi T, Iwata J, Sugihara S et al.. Distinguishing benign notochordal cell tumors from vertebral chordoma.  Skeletal Radiol. 2008;  37 291-299
    CrossrefPubMedGoogle Scholar
  • 26 Altehoefer C, Bertz H, Ghanem N A, Langer M. Extent and time course of morphological changes of bone marrow induced by granulocyte-colony stimulating factor as assessed by magnetic resonance imaging of healthy blood stem cell donors.  J Magn Reson Imaging. 2001;  14(2) 141-146
    CrossrefPubMedGoogle Scholar
  • 27 Stäbler A, Doma A B, Baur A, Krüger A, Reiser M F. Reactive bone marrow changes in infectious spondylitis: quantitative assessment with MR imaging.  Radiology. 2000;  217(3) 863-868
    PubMedGoogle Scholar
  • 28 Shellock F G, Morris E, Deutsch A L, Mink J H, Kerr R, Boden S D. Hematopoietic bone marrow hyperplasia: high prevalence on MR images of the knee in asymptomatic marathon runners.  AJR Am J Roentgenol. 1992;  158(2) 335-338
    PubMedGoogle Scholar
  • 29 Poulton T B, Murphy W D, Duerk J L, Chapek C C, Feiglin D H. Bone marrow reconversion in adults who are smokers: MR imaging findings.  AJR Am J Roentgenol. 1993;  161(6) 1217-1221
    PubMedGoogle Scholar
  • 30 Ciray I, Lindman H, Aström G K, Wanders A, Bergh J, Ahlström H K. Effect of granulocyte colony-stimulating factor (G-CSF)-supported chemotherapy on MR imaging of normal red bone marrow in breast cancer patients with focal bone metastases.  Acta Radiol. 2003;  44(5) 472-484
    CrossrefPubMedGoogle Scholar
  • 31 Hollinger E F, Alibazoglu H, Ali A, Green A, Lamonica G. Hematopoietic cytokine-mediated FDG uptake simulates the appearance of diffuse metastatic disease on whole-body PET imaging.  Clin Nucl Med. 1998;  23(2) 93-98
    CrossrefPubMedGoogle Scholar
  • 32 Elstrom R L, Tsai D E, Vergilio J A, Downs L H, Alavi A, Schuster S J. Enhanced marrow [18F]fluorodeoxyglucose uptake related to myeloid hyperplasia in Hodgkin's lymphoma can simulate lymphoma involvement in marrow.  Clin Lymphoma. 2004;  5(1) 62-64
    CrossrefPubMedGoogle Scholar
  • 33 Vande Berg B C, Malghem J, Devuyst O, Maldague B E, Lambert M J. Anorexia nervosa: correlation between MR appearance of bone marrow and severity of disease.  Radiology. 1994;  193 859-864
    PubMedGoogle Scholar

Bruno C Vande BergM.D. Ph.D. 

Department of Radiology, Section of Musculoskeletal Radiology, Université catholique de Louvain, Cliniques universitaires Saint-Luc

Hippocrate Avenue 10/2942, B–1200 Brussels, Belgium

Email: Bruno.vandeberg@uclouvain.be

      >