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Yeom A, Yoo SY, Jeon TY, Park J, Kim JH. [MR Imaging Features of Pediatric Bone Marrow]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:505-519. [PMID: 38873387 PMCID: PMC11166593 DOI: 10.3348/jksr.2024.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/01/2024] [Accepted: 05/16/2024] [Indexed: 06/15/2024]
Abstract
MRI plays a crucial role in bone marrow (BM) assessment, and has very high sensitivity in diagnosing marrow disorders. However, for radiologists who may not frequently encounter pediatric imaging, distinguishing pathologic BM lesion from normal BM can be challenging. Conditions involving the BM in pediatric patients, such as leukemia and metastatic neuroblastoma, often manifest with diverse musculoskeletal symptoms and may be diagnosed using musculoskeletal MRI examinations. Accurate interpretation of pediatric MRI requires not only an understanding of the normal composition of BM but also an awareness of agerelated developmental changes in the marrow and familiarity with conditions that commonly involve pediatric BM. We aim to describe the composition of normal BM and outline the normal and abnormal MRI findings in pediatric BM. Additionally, we aim to present clinical cases of malignant BM disorders including leukemia, neuroblastoma metastasis, and other malignant BM disorders.
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Booth SM, Kapadia TH, Tang V, Maniyar AF. Pictorial review: challenges in distinguishing bilateral metaphyseal marrow abnormalities on magnetic resonance imaging. Pediatr Radiol 2024:10.1007/s00247-024-05896-7. [PMID: 38491225 DOI: 10.1007/s00247-024-05896-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/18/2024]
Abstract
The paediatric metaphysis is afflicted by a wide range of pathological processes as it is the most metabolically active and well-vascularised part of the developing skeleton. This review focuses on metaphyseal marrow signal change detected with magnetic resonance imaging, which is most often occult on radiographs. When bilateral, these imaging appearances frequently present a diagnostic quandary. This review assists the radiologist to confidently dismiss physiological signal change and confidently work through the differential diagnosis. This is achieved by illustrating a practical method of classifying signal change into four categories: physiological red marrow, red marrow reconversion, marrow infiltration, and oedema-like marrow signal intensity. In doing so, various pathological entities are reviewed along with imaging pearls and next-step investigations.
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Affiliation(s)
- Sean M Booth
- Department of Radiology, Royal Manchester Children's Hospital, Oxford Road, Manchester, Lancashire, M13 9WL, UK.
| | - Tejas H Kapadia
- Department of Radiology, Royal Manchester Children's Hospital, Oxford Road, Manchester, Lancashire, M13 9WL, UK
| | - Vivian Tang
- Department of Radiology, Royal Manchester Children's Hospital, Oxford Road, Manchester, Lancashire, M13 9WL, UK
| | - Amit F Maniyar
- Department of Radiology, Royal Manchester Children's Hospital, Oxford Road, Manchester, Lancashire, M13 9WL, UK
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Park S, Huh JD. Differentiation of bone metastases from benign red marrow depositions: utilizing qualitative and quantitative analysis of conventional T1-weighted imaging and fat-suppressed T2-weighted imaging. Br J Radiol 2024; 97:422-429. [PMID: 38308029 DOI: 10.1093/bjr/tqad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/04/2023] [Accepted: 11/20/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES To distinguish bone metastases (BMs) from benign red marrow depositions (BRMs) by qualitative and quantitative analyses of T1-weighted imaging and fat-suppressed T2-weighted imaging (T2 FS). METHODS For 75 lesions including 38 BMs and 37 BRMs, two radiologists independently evaluated magnetic resonance images by qualitative (signal intensity [SI] of lesions compared to that of normal muscle [NM] or normal bone marrow [NBM]) and quantitative (parameters of the region of interests in the lesions, including T1 ratio [T1 SI ratio of lesion and NM], T2FMu ratio [T2 FS SI ratio of lesion and NM], and T2FMa ratio [T2 FS SI ratio of lesion and NBM]) analyses. RESULTS Hyperintensity relative to NM or NBM on T2 FS was more frequent in BMs than in BRMs (100% vs 59.5%-78.4%, respectively; P ≤ 0.001) but also was present in more than half of BRMs. All quantitative parameters showed a significant difference between BMs and BRMs (T1 ratio, 1.075 vs 1.227 [P = 0.002]; T2FMu ratio, 2.094 vs 1.282 [P < 0.001]; T2FMa ratio, 3.232 vs 1.810 [P < 0.001]). The receiver operating characteristics areas under the curves of T2FMu and T2FMa ratios were clinically useful (0.781 and 0.841, respectively) and did not demonstrate statistically significant differences. CONCLUSIONS The quantitative analysis of T2 FS facilitates distinguishing between BMs and BRMs, regardless of whether the reference was NM or NBM. ADVANCES IN KNOWLEDGE Quantitative parameters derived from T2 FS facilitate differentiation of BMs BRMs without additional scans. The role of NBM as an internal standard for T2 FS to differentiate between BMs and BRMs is similar to that of NM.
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Affiliation(s)
- Sekyoung Park
- Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Korea
| | - Jin Do Huh
- Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Korea
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Liu X, Duan Z, Fang S, Wang S. Imaging Assessment of the Efficacy of Chemotherapy in Primary Malignant Bone Tumors: Recent Advances in Qualitative and Quantitative Magnetic Resonance Imaging and Radiomics. J Magn Reson Imaging 2024; 59:7-31. [PMID: 37154415 DOI: 10.1002/jmri.28760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/10/2023] Open
Abstract
Recent studies have shown that MRI demonstrates promising results for evaluating the chemotherapy efficacy in bone sarcomas. This article reviews current methods for evaluating the efficacy of malignant bone tumors and the application of MRI in this area, and emphasizes the advantages and limitations of each modality. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Xiaoge Liu
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Zhiqing Duan
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Shaobo Fang
- Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Shaowu Wang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
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Patel V, Barakat J, Fanney L, Gendler L, Brown NJ, Ganley TJ, Nguyen JC. Maturation-dependent patterns of knee injuries among symptomatic pediatric soccer players on MRI. Skeletal Radiol 2023:10.1007/s00256-023-04543-w. [PMID: 38153433 DOI: 10.1007/s00256-023-04543-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To systematically investigate the prevalence of knee MRI findings among symptomatic pediatric soccer players with respect to skeletal maturity and to identify predictors of surgery. METHODS This IRB-approved, HIPAA-compliant retrospective study included soccer players (< 18 years of age) who underwent MRI examinations in the past 5 years (2018-2023). Two radiologists retrospectively and independently reviewed all examinations to categorize skeletal maturity and to identify osseous and soft tissue findings. Findings were compared between maturation groups, and logistic regression models were used to identify predictors of surgery. RESULTS Ninety-seven players (45 boys, 52 girls) included 39 skeletally immature, 21 maturing, and 37 mature knees. Kappa coefficient for interobserver reliability ranged between 0.65 and 1.00. Osgood-Schlatter disease (OSD) was more common among immature than maturing and mature knees (25% vs 14% and 5%, p = 0.04); anterior cruciate ligament (ACL) injury was more common among maturing and mature than immature knees (59% and 48%, vs 15%, p < 0.01); and meniscal tears were more common among mature than immature and maturing knees (medial, 41% vs 18% and 14%, p = 0.03; lateral, 43% vs 21% and 19%, p = 0.04). Players in the mature group were more likely to undergo surgery (p = 0.01). The presence of an effusion (OR = 19.5, 95% CI 2.8-240.9, p = 0.01), ACL injury (OR = 170.0, 95% CI 1.3-6996.9, p < 0.01), and lateral meniscal tears (OR = 10.8, 95% CI 1.8-106.1, p = 0.02) were independent predictors of surgery. CONCLUSION Differential patterns of injury were found among symptomatic pediatric soccer players; the presence of an effusion, ACL injury, and lateral meniscal tears were independent predictors of surgery, likely contributing to the higher rates of surgery among skeletally mature players.
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Affiliation(s)
- Vandan Patel
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
| | - Jude Barakat
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania School of Engineering and Applied Sciences, Philadelphia, PA, USA
| | - Lewis Fanney
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Liya Gendler
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Naomi J Brown
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Theodore J Ganley
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jie C Nguyen
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Forestieri M, Napolitano A, Tomà P, Bascetta S, Cirillo M, Tagliente E, Fracassi D, D’Angelo P, Casazza I. Machine Learning Algorithm: Texture Analysis in CNO and Application in Distinguishing CNO and Bone Marrow Growth-Related Changes on Whole-Body MRI. Diagnostics (Basel) 2023; 14:61. [PMID: 38201370 PMCID: PMC10804385 DOI: 10.3390/diagnostics14010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE The purpose of this study is to analyze the texture characteristics of chronic non-bacterial osteomyelitis (CNO) bone lesions, identified as areas of altered signal intensity on short tau inversion recovery (STIR) sequences, and to distinguish them from bone marrow growth-related changes through Machine Learning (ML) and Deep Learning (DL) analysis. MATERIALS AND METHODS We included a group of 66 patients with confirmed diagnosis of CNO and a group of 28 patients with suspected extra-skeletal systemic disease. All examinations were performed on a 1.5 T MRI scanner. Using the opensource 3D Slicer software version 4.10.2, the ROIs on CNO lesions and on the red bone marrow were sampled. Texture analysis (TA) was carried out using Pyradiomics. We applied an optimization search grid algorithm on nine classic ML classifiers and a Deep Learning (DL) Neural Network (NN). The model's performance was evaluated using Accuracy (ACC), AUC-ROC curves, F1-score, Positive Predictive Value (PPV), Mean Absolute Error (MAE) and Root-Mean-Square Error (RMSE). Furthermore, we used Shapley additive explanations to gain insight into the behavior of the prediction model. RESULTS Most predictive characteristics were selected by Boruta algorithm for each combination of ROI sequences for the characterization and classification of the two types of signal hyperintensity. The overall best classification result was obtained by the NN with ACC = 0.91, AUC = 0.93 with 95% CI 0.91-0.94, F1-score = 0.94 and PPV = 93.8%. Between classic ML methods, ensemble learners showed high model performance; specifically, the best-performing classifier was the Stack (ST) with ACC = 0.85, AUC = 0.81 with 95% CI 0.8-0.84, F1-score = 0.9, PPV = 90%. CONCLUSIONS Our results show the potential of ML methods in discerning edema-like lesions, in particular by distinguishing CNO lesions from hematopoietic bone marrow changes in a pediatric population. The Neural Network showed the overall best results, while a Stacking classifier, based on Gradient Boosting and Random Forest as principal estimators and Logistic Regressor as final estimator, achieved the best results between the other ML methods.
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Affiliation(s)
- Marta Forestieri
- Imaging Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (P.T.); (S.B.); (P.D.); (I.C.)
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.N.); (E.T.); (D.F.)
| | - Paolo Tomà
- Imaging Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (P.T.); (S.B.); (P.D.); (I.C.)
| | - Stefano Bascetta
- Imaging Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (P.T.); (S.B.); (P.D.); (I.C.)
| | - Marco Cirillo
- Imaging Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (P.T.); (S.B.); (P.D.); (I.C.)
| | - Emanuela Tagliente
- Medical Physics Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.N.); (E.T.); (D.F.)
| | - Donatella Fracassi
- Medical Physics Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.N.); (E.T.); (D.F.)
| | - Paola D’Angelo
- Imaging Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (P.T.); (S.B.); (P.D.); (I.C.)
| | - Ines Casazza
- Imaging Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (P.T.); (S.B.); (P.D.); (I.C.)
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Samuels C, Marsh J, Leggett R. An age- and sex-specific biokinetic model for radon . JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:041502. [PMID: 37725955 DOI: 10.1088/1361-6498/acfb19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/19/2023] [Indexed: 09/21/2023]
Abstract
Publication 137 of the International Commission on Radiological Protection (ICRP) describes a biokinetic model for radon used to derive dose coefficients for occupational intake of radon isotopes. The model depicts transfer of inhaled or ingested radon to blood, exchange of radon between blood and tissues, and gradual loss of radon from the body based on physical laws governing transfer of a non-reactive and soluble gas between materials. This paper describes an age- and sex-specific variation of that model developed for use in an upcoming ICRP series of reports on environmental intake of radionuclides by members of the public titled 'Dose Coefficients for Intakes of Radionuclides by Members of the Public'. The proposed model modifies the model structure and transfer coefficients presented in Publication 137 to allow more realistic dosimetric treatment of bone marrow and breast and expands the model to address pre-adult ages, based on the physical principles used in the development of the model of Publication 137 together with anatomical and physiological changes occurring during human development.
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Affiliation(s)
- Caleigh Samuels
- Environmental Sciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, United States of America
| | - James Marsh
- UK Health Security Agency, London, United Kingdom
| | - Rich Leggett
- Environmental Sciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, United States of America
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Zapatero ZD, Zhang H, Zandifar A, Nilan KA, Calabria AC, Swanson JW, Vossough A, Taylor JA, Lang SS, Bartlett SP. A Novel Phenotype of Calvarial Thickening and Increased Rates of Premature Calvarial Suture Closure in Children With Chronic Lung Disease. J Craniofac Surg 2023; 34:1845-1850. [PMID: 37431930 DOI: 10.1097/scs.0000000000009528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/19/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE The purpose of this study was to characterize a novel type of calvarial thickening and provide objective measurements of skull thickness and calvarial suture morphology in patients with bronchopulmonary dysplasia. METHODS Infants with severe bronchopulmonary dysplasia who also had undergone computed tomography (CT) scans were identified from the neonatal chronic lung disease program database. Thickness analysis was performed using Materialise Mimics. RESULTS The chronic lung disease team treated 319 patients during the study interval of which, 58 patients (18.2%) had head CT available. Twenty-eight (48.3%) were found to have calvarial thickening. The rate of premature suture closure in the study population was 36.2% (21 of 58 patients), with 50.0% of affected cohort having evidence of premature suture closure on the first CT scan. Multivariate logistic regression identified 2 risk factors, requiring invasive ventilation at 6 months of age and fraction of inspired oxygen requirement at 6 months of age. Increased head circumference at birth protected against the development of calvarial thickening. CONCLUSIONS We have described a novel subset of patients with chronic lung disease of prematurity who have calvarial thickening with remarkably high rates of premature closure of cranial sutures. The exact etiology of the association is unknown. In this patient population with radiographic evidence of premature suture closure, operative decision should be made after considering unequivocal evidence of elevated intracranial pressure or dysmorphology and balanced against the risk of the procedure.
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Affiliation(s)
- Zachary D Zapatero
- Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia
| | - Huayan Zhang
- Division of Neonatology, The Children's Hospital of Philadelphia
| | - Alireza Zandifar
- Department of Radiology, The Children's Hospital of Philadelphia
| | - Kathleen A Nilan
- Division of Neonatology, The Children's Hospital of Philadelphia
| | | | - Jordan W Swanson
- Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia
| | - Arastoo Vossough
- Department of Radiology, The Children's Hospital of Philadelphia
| | - Jesse A Taylor
- Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia
| | - Shih-Shan Lang
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Scott P Bartlett
- Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia
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9
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Snyder EJ, Sarma A, Krishnasarma R, Pruthi S. Complications of Cancer Therapy in Children: A Comprehensive Review of Body Imaging Findings. J Comput Assist Tomogr 2023; 47:833-843. [PMID: 37707415 DOI: 10.1097/rct.0000000000001489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
ABSTRACT Complications of cancer therapy in children can result in a spectrum of toxicities that can affect any organ system and result in a range of morbidity. Complications may occur at the initiation of therapy or years following treatment. Although childhood cancer remains rare, increasing survival rates means more children are living longer following their treatment. Radiologists often play an important role in the diagnosis and evaluation of these complications, and thus, awareness of their imaging findings is essential to guide management and avoid misdiagnosis. This second part of a 2-part review aims to illustrate the typical body imaging findings of cancer therapy-related toxicities, including both early and late treatment effects. The article also discusses the differential diagnosis of imaging findings, highlighting pearls and pitfalls in making the appropriate diagnosis.
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Affiliation(s)
- Elizabeth J Snyder
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN
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Tanturri de Horatio L, Zadig PK, von Brandis E, Ording Müller LS, Rosendahl K, Avenarius DFM. Whole-body MRI in children and adolescents: Can T2-weighted Dixon fat-only images replace standard T1-weighted images in the assessment of bone marrow? Eur J Radiol 2023; 166:110968. [PMID: 37478654 DOI: 10.1016/j.ejrad.2023.110968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE When performing whole-body MRI for bone marrow assessment in children, optimizing scan time is crucial. The aim was to compare T2 Dixon fat-only and TSE T1-weighted sequences in the assessment of bone marrow high signal areas seen on T2 Dixon water-only in healthy children and adolescents. MATERIALS AND METHODS Whole-body MRIs from 196 healthy children and adolescents aged 6 to 19 years (mean 12.0) were obtained including T2 TSE Dixon and T1 TSE-weighted images. Areas with increased signal on T2 Dixon water-only images were scored using a novel, validated scoring system and classified into "minor" or "major" findings according to size and intensity, where "major" referred to changes easily being misdiagnosed as pathology in a clinical setting. Areas were assessed for low signal on T2 Dixon fat-only images and, after at least three weeks to avoid recall bias, on the T1-weighted sequence by two experienced pediatric radiologists. RESULTS 1250 high signal areas were evaluated on T2 Dixon water-only images. In 1159/1250 (92.7%) low signal was seen on both T2 Dixon fat-only and T1-weighted sequences while in 24 (1.9%) it was not present on either sequence, with an absolute agreement of 94.6%. Discordant findings were found in 67 areas, of which in 18 (1.5%) low signal was visible on T1-weighted images alone and in 49 (3.9%) on T2 Dixon fat-only alone. The overall kappa value between the two sequences was 0.39. The agreement was higher for major as compared to minor findings (kappa values of 0.69 and 0.29, respectively) and higher for the older age groups. CONCLUSION T2 Dixon fat-only can replace T1-weighted sequence on whole-body MRI for bone marrow assessment in children over the age of nine, thus reducing scan time.
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Affiliation(s)
- Laura Tanturri de Horatio
- Department of Clinical Medicine, UiT, The Arctic University of Norway, 9037, Tromsø, Norway; Department of Pediatric Radiology, Ospedale Pediatrico Bambino Gesù, 00165 Rome, Italy.
| | - Pia K Zadig
- Department of Clinical Medicine, UiT, The Arctic University of Norway, 9037, Tromsø, Norway; Department of Radiology, University Hospital of North-Norway, 9038 Tromsø, Norway
| | - Elisabeth von Brandis
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, 0372 Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | | | - Karen Rosendahl
- Department of Clinical Medicine, UiT, The Arctic University of Norway, 9037, Tromsø, Norway; Department of Radiology, University Hospital of North-Norway, 9038 Tromsø, Norway
| | - Derk F M Avenarius
- Department of Clinical Medicine, UiT, The Arctic University of Norway, 9037, Tromsø, Norway; Department of Radiology, University Hospital of North-Norway, 9038 Tromsø, Norway
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11
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Guariento A, Sharma P, Andronikou S. MRI features of spinal chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis in children. Pediatr Radiol 2023; 53:2092-2103. [PMID: 37204463 DOI: 10.1007/s00247-023-05688-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Spinal lesions in pediatric chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis (CRMO/CNO) can cause permanent sequelae; thus, early recognition of these is vital for management. OBJECTIVE To characterize the MR imaging features and patterns of pediatric spinal CRMO/CNO. MATERIALS AND METHODS This cross-section study received IRB approval. The first available MRI with documented spine involvement in children with CRMO/CNO was reviewed by a pediatric radiologist. Descriptive statistics were used to describe the characteristics of vertebral lesions, disc involvement, and soft tissue abnormality. RESULTS Forty-two patients were included (F:M, 30:12); median age was 10 years (range 4-17). At diagnosis, 34/42 (81%) had spine involvement. Kyphosis in 9/42 (21%) and scoliosis in 4/42 (9.5%) patients were present at the time of spinal disease recognition. Vertebral involvement was multifocal in 25/42 (59.5%). Disc involvement was found in 11/42 (26%) patients, commonly in the thoracic spine and often with adjacent vertebrae height loss. Posterior element abnormalities were present in 18/42 patients (43%) and soft tissue involvement in 7/42 (17%). One hundred nineteen vertebrae were affected, commonly the thoracic vertebrae (69/119; 58%). Vertebral body edema was focal in 77/119 (65%) and frequently superior (42/77; 54%). Sclerosis and endplate abnormality were present in 15/119 (13%) and 31/119 (26%) vertebrae, respectively. Height loss was present in 41/119 (34%). CONCLUSION Chronic non-bacterial osteomyelitis of spine is usually thoracic. Vertebral body edema is often focal at the superior vertebral body. Kyphosis and scoliosis occur in a quarter and vertebral height loss in a third of children at spinal disease recognition.
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Affiliation(s)
- Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Parth Sharma
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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12
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Ho ML. Pediatric Spine Tumors and Dysontogenetic Masses. Neuroimaging Clin N Am 2023; 33:375-388. [PMID: 37356857 DOI: 10.1016/j.nic.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
The pediatric spine undergoes complex stages of development and growth, resulting in highly age-dependent physiology and variable susceptibility to certain pathologies. Optimal radiologic evaluation requires image acquisition tailored to the clinical history and an interpretive approach that accounts for demographic variations. In this article, the author discusses the diagnostic approach to pediatric spine masses, beginning with a discussion of normal anatomy and variants, clinical evaluation, and imaging techniques and protocols. The author then covers the major etiologies, imaging appearances, and mimics of pediatric spine masses in the following categories: congenital malformations, genetic syndromes, intramedullary, intradural, epidural, bone, and paraspinal lesions.
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Affiliation(s)
- Mai-Lan Ho
- University of Missouri, University Hospital, 1 Hospital Drive, Columbia, MO 65212, USA.
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Sammer MBK, Akbari YS, Barth RA, Blumer SL, Dillman JR, Farmakis SG, Frush DP, Gokli A, Halabi SS, Iyer R, Joshi A, Kwon JK, Otero HJ, Sher AC, Sotardi ST, Taragin BH, Towbin AJ, Wald C. Use of Artificial Intelligence in Radiology: Impact on Pediatric Patients, a White Paper From the ACR Pediatric AI Workgroup. J Am Coll Radiol 2023; 20:730-737. [PMID: 37498259 DOI: 10.1016/j.jacr.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/07/2023] [Accepted: 06/03/2023] [Indexed: 07/28/2023]
Abstract
In this white paper, the ACR Pediatric AI Workgroup of the Commission on Informatics educates the radiology community about the health equity issue of the lack of pediatric artificial intelligence (AI), improves the understanding of relevant pediatric AI issues, and offers solutions to address the inadequacies in pediatric AI development. In short, the design, training, validation, and safe implementation of AI in children require careful and specific approaches that can be distinct from those used for adults. On the eve of widespread use of AI in imaging practice, the group invites the radiology community to align and join Image IntelliGently (www.imageintelligently.org) to ensure that the use of AI is safe, reliable, and effective for children.
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Affiliation(s)
- Marla B K Sammer
- Singleton Department of Radiology, Texas Children's Hospital, Houston, Texas; Department of Radiology, Baylor College of Medicine, Houston, Texas; and Chair, Pediatric AI Workgroup, Commission on Informatics, American College of Radiology.
| | | | - Richard A Barth
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - Steven L Blumer
- Chair, Pediatrics Panel of the American College of Radiology Data Science Institute; Associate Medical Director of Radiology Informatics, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania; and Department of Radiology, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan R Dillman
- Associate Chief, Research, William S. Ball Chair of Radiology Research, and Medical Director, Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shannon G Farmakis
- Department of Radiology, Mercy Children's Hospital, St. Louis, Missouri; and West County Radiological Group, St. Louis, Missouri
| | | | - Ami Gokli
- Division Chief of Pediatric Radiology, Staten Island University Hospital, Staten Island, New York; and Associate Program Director, Department of Radiology Residency Program, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York
| | - Safwan S Halabi
- University of Chicago, Lurie Children's Hospital, Chicago, Illinois
| | - Ramesh Iyer
- University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Aparna Joshi
- Section of Pediatric Radiology, University of Michigan, Ann Arbor, Michigan
| | - Jeannie K Kwon
- University of Texas Southwestern Medical Center, Dallas, Texas; Chief Radiology Officer, Children's Health System of Texas, Dallas, Texas; and Chair, Informatics Committee, Society for Pediatric Radiology
| | - Hansel J Otero
- University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andrew C Sher
- Singleton Department of Radiology, Texas Children's Hospital, Houston, Texas; and Department of Radiology, Baylor College of Medicine, Houston, Texas
| | - Susan T Sotardi
- University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benjamin H Taragin
- Department of Pediatric Radiology, Samson Assuta Ashdod University Hospital, Ashdod, Israel; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Medical School for International Health, Ben Gurion University, Be'er Sheva, Israel
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio; and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Christoph Wald
- Chair, Department of Radiology, Lahey Hospital & Medical Center, Burlington, Massachusetts; Tufts University Medical School, Boston, Massachusetts; and Chair, Commission on Informatics
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14
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Obuchowicz R, Nurzynska K, Pierzchala M, Piorkowski A, Strzelecki M. Texture Analysis for the Bone Age Assessment from MRI Images of Adolescent Wrists in Boys. J Clin Med 2023; 12:jcm12082762. [PMID: 37109098 PMCID: PMC10141677 DOI: 10.3390/jcm12082762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
Currently, bone age is assessed by X-rays. It enables the evaluation of the child's development and is an important diagnostic factor. However, it is not sufficient to diagnose a specific disease because the diagnoses and prognoses may arise depending on how much the given case differs from the norms of bone age. BACKGROUND The use of magnetic resonance images (MRI) to assess the age of the patient would extend diagnostic possibilities. The bone age test could then become a routine screening test. Changing the method of determining the bone age would also prevent the patient from taking a dose of ionizing radiation, making the test less invasive. METHODS The regions of interest containing the wrist area and the epiphyses of the radius are marked on the magnetic resonance imaging of the non-dominant hand of boys aged 9 to 17 years. Textural features are computed for these regions, as it is assumed that the texture of the wrist image contains information about bone age. RESULTS The regression analysis revealed that there is a high correlation between the bone age of a patient and the MRI-derived textural features derived from MRI. For DICOM T1-weighted data, the best scores reached 0.94 R2, 0.46 RMSE, 0.21 MSE, and 0.33 MAE. CONCLUSIONS The experiments performed have shown that using the MRI images gives reliable results in the assessment of bone age while not exposing the patient to ionizing radiation.
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Affiliation(s)
- Rafal Obuchowicz
- Department of Diagnostic Imaging, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Karolina Nurzynska
- Department of Algorithmics and Software, Silesian University of Technology, 44-100 Gliwice, Poland
| | | | - Adam Piorkowski
- Department of Biocybernetics and Biomedical Engineering, AGH University of Science and Technology, 30-059 Krakow, Poland
| | - Michal Strzelecki
- Institute of Electronics, Lodz University of Technology, 93-590 Lodz, Poland
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15
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Kim GC, Davidson AM, Beyda RM, Eissa MA. Scurvy, abnormal MRI, and gelatinous bone marrow in an adolescent with avoidant restrictive food intake disorder. J Eat Disord 2023; 11:41. [PMID: 36941672 PMCID: PMC10029247 DOI: 10.1186/s40337-023-00770-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Although medical literature describes pediatric scurvy as "rare", a growing number of case reports suggests otherwise. Patients often undergo costly and unnecessary workup due to unfamiliarity with the presentation of scurvy. This case report further supports the small yet growing literature documenting scurvy and its manifestations in patients with eating disorders. CASE PRESENTATION A 15-year-old female presented to the emergency department with bilateral knee and ankle swelling and pain in the setting of chronic lower limb rash and BMI of 16.3. For years, she had restricted her diet to carbohydrates. Exam showed perifollicular petechial hemorrhagic rash with corkscrew hairs, knee edema, ankle edema with restricted range of motion, and antalgic gait. She was admitted for severe malnutrition from avoidant restrictive food intake disorder. Her hospital course was complicated by recurrent normocytic anemia and fever. Hematology workup revealed anemia from iron deficiency, vitamin K deficiency, and anemia of chronic disease. Rheumatology workup was negative. MRI findings showed dark T1 and bright T2 signals and were read as consistent with leukemia/lymphoma, chronic multifocal osteomyelitis, or Langerhans cell histiocytosis. However, bone marrow biopsy showed gelatinous transformation secondary to malnutrition. She was treated with vitamin C and a nutrition plan and her symptoms improved. CONCLUSIONS Although this patient had common manifestations of scurvy, including perifollicular petechial hemorrhagic rash, joint effusions, anemia, and recurrent fevers, she still underwent an extensive workup. Clinicians should be aware that scurvy can present with multiple symptoms that mimic infectious, rheumatic, oncologic and hematological disease. Clinicians should have a high index of suspicion for scurvy in patients with malnutrition and eating disorders.
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Affiliation(s)
- Ginny Claire Kim
- University of Texas Health Science Center, 6431 Fannin, MSB 3.150, Houston, TX, 77030, USA.
| | - Asha M Davidson
- University of Texas Health Science Center, 6431 Fannin, MSB 3.150, Houston, TX, 77030, USA
| | - Rebecca M Beyda
- University of Texas Health Science Center, 6431 Fannin, MSB 3.150, Houston, TX, 77030, USA
| | - Mona A Eissa
- University of Texas Health Science Center, 6431 Fannin, MSB 3.150, Houston, TX, 77030, USA
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16
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Padwal J, Baratto L, Chakraborty A, Hawk K, Spunt S, Avedian R, Daldrup-Link HE. PET/MR of pediatric bone tumors: what the radiologist needs to know. Skeletal Radiol 2023; 52:315-328. [PMID: 35804163 PMCID: PMC9826799 DOI: 10.1007/s00256-022-04113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/11/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023]
Abstract
Integrated 2-deoxy-2-[fluorine-18]fluoro-D-glucose (18F-FDG) positron emission tomography (PET)/magnetic resonance (MR) imaging can provide "one stop" local tumor and whole-body staging in one session, thereby streamlining imaging evaluations and avoiding duplicate anesthesia in young children. 18F-FDG PET/MR scans have the benefit of lower radiation, superior soft tissue contrast, and increased patient convenience compared to 18F-FDG PET/computerized tomography scans. This article reviews the 18F-FDG PET/MR imaging technique, reporting requirements, and imaging characteristics of the most common pediatric bone tumors, including osteosarcoma, Ewing sarcoma, primary bone lymphoma, bone and bone marrow metastases, and Langerhans cell histiocytosis.
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Affiliation(s)
- Jennifer Padwal
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Lucia Baratto
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Amit Chakraborty
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Kristina Hawk
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Sheri Spunt
- Department of Pediatrics, Stanford University, 725 Welch Rd., Rm. 1665, Stanford, CA, 94305-5614, USA
| | - Raffi Avedian
- Department of Surgery, Division of Pediatric Orthopedic Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, 94305, USA
| | - Heike E Daldrup-Link
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA.
- Cancer Imaging Program, Stanford Cancer Institute, Stanford, USA.
- Department of Pediatrics, Stanford University, 725 Welch Rd., Rm. 1665, Stanford, CA, 94305-5614, USA.
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17
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Navas A, Kassarjian A. Bone Marrow Lesions in Athletic Stress Injuries: An Overview. Semin Musculoskelet Radiol 2023; 27:54-72. [PMID: 36868245 DOI: 10.1055/s-0043-1761613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
This article discusses the presumed pathophysiology of osseous sport-related stress changes, the optimal imaging strategy for detecting the lesions, and the progression of the lesions as seen on magnetic resonance imaging. It also describes some of the most common stress-related injuries in athletes by anatomical location and introduces some new concepts in the field.
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Affiliation(s)
- Ana Navas
- Department of Radiology, Division of Musculoskeletal Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Radiology, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
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18
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Igbinoba Z, Jaramillo D. MR Imaging of the Developing Pediatric Marrow: An Overview of Pearls and Pitfalls. Semin Musculoskelet Radiol 2023; 27:22-29. [PMID: 36868242 DOI: 10.1055/s-0043-1762583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
The dynamic and developing pediatric skeleton is a well-elucidated process that occurs in a stepwise faction. Normal development has been reliably tracked and described with Magnetic Resonance (MR) imaging. The recognition of the normal patterns of skeletal development is essential, as normal development may mimic pathology and vice versa. The authors review normal skeleton maturation and the corollary imaging findings while highlighting common marrow imaging pitfalls and pathology.
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Affiliation(s)
- Zenas Igbinoba
- Department of Radiology, New York Presbyterian Hospital, New York, New York
| | - Diego Jaramillo
- Department of Radiology, Columbia University Medical Center, New York, New York
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19
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Saifuddin A, Tyler P, Rajakulasingam R. Imaging of bone marrow pitfalls with emphasis on MRI. Br J Radiol 2023; 96:20220063. [PMID: 35522786 PMCID: PMC9975530 DOI: 10.1259/bjr.20220063] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 01/27/2023] Open
Abstract
Normal marrow contains both hematopoietic/red and fatty/yellow marrow with a predictable pattern of conversion and skeletal distribution on MRI. Many variations in normal bone marrow signal and appearances are apparent and the reporting radiologist must differentiate these from other non-neoplastic, benign or neoplastic processes. The advent of chemical shift imaging has helped in characterising and differentiating more focal heterogeneous areas of red marrow from marrow infiltration. This review aims to cover the MRI appearances of normal marrow, its evolution with age, marrow reconversion, variations of normal marrow signal, causes of oedema-like marrow signal, and some common non-neoplastic entities, which may mimic marrow neoplasms.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Philippa Tyler
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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20
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Tyler PA, Rajakulasingam R, Saifuddin A. Normal Bone Marrow and Non-neoplastic Systemic Hematopoietic Disorders in the Adult. Semin Musculoskelet Radiol 2023; 27:30-44. [PMID: 36868243 DOI: 10.1055/s-0043-1761495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
This article provides an overview of the imaging appearances of normal adult bone marrow with an emphasis on magnetic resonance imaging. We also review the cellular processes and imaging features of normal developmental yellow-to-red marrow conversion and compensatory physiologic or pathologic red marrow reconversion. Key imaging features that differentiate between normal adult marrow, normal variants, non-neoplastic hematopoietic disorders, and malignant marrow disease are discussed, as well as posttreatment changes.
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Affiliation(s)
- Philippa Anne Tyler
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
| | | | - Asif Saifuddin
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
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21
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Herregods N, Lambert RGW, Schiettecatte E, Dehoorne J, Renson T, Laloo F, Van Den Berghe T, Jans LBO, Jaremko JL. Blurring and Irregularity of the Subchondral Cortex in Pediatric Sacroiliac Joints on T1 Images: Incidence of Normal Findings That Can Mimic Erosions. Arthritis Care Res (Hoboken) 2023; 75:190-197. [PMID: 34235890 DOI: 10.1002/acr.24746] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/15/2021] [Accepted: 07/06/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine prevalence of variations of subchondral bone appearance that may mimic erosions on T1-weighted magnetic resonance imaging (MRI) of pediatric sacroiliac (SI) joints according to age and sex. METHODS With ethics committee approval and informed consent, SI joint MRIs of 251 children (132 girls), mean age 12.4 years (range 6.1-18.0 years), were obtained in 2 cohorts: 127 children imaged for nonrheumatic reasons, and 124 children with low back pain but no features of sacroiliitis at initial clinical MRI review. MRIs were reviewed by 3 experienced radiologists, blinded from each other, for 3 features of the cortical black line representing the subchondral bone plate on T1-weighted MRI: visibility, blurring, and irregularity. RESULTS Based on agreement from 2 or more readers, the cortical black line was partially absent in 88.4% of the children, blurred in 34.7%, and irregular in 41.4%. All these features were most common on the iliac side of SI joints and at the first sacral vertebra level. Clearly visualized, sharply delineated SI joints with none of these features were seen in only 8.0% of children, or in 35.1% if we conservatively required agreement of all 3 readers to consider a feature present. There was no significant difference between sexes or cohorts; findings were similar across pediatric age groups. CONCLUSION Understanding the normal MRI appearance of the developing SI joint is necessary to distinguish physiologic findings from disease. At least two-thirds (65%) of normal pediatric SI joints showed at least 1 feature that is a component of the adult definition of SI joint erosions, risking overdiagnosis of sacroiliitis.
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Affiliation(s)
| | - Robert G W Lambert
- University of Alberta and Medical Imaging Consultants, Edmonton, Alberta, Canada
| | | | | | | | | | | | | | - Jacob L Jaremko
- University of Alberta and Medical Imaging Consultants, Edmonton, Alberta, Canada
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22
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Kohada Y, Satani N, Kaiho Y, Iwamura H, Sakamoto T, Kusumoto H, Kukimoto T, Oikawa M, Mikami J, Ito J, Matsuura T, Hinata N, Koyama K, Sato M. Novel quantitative software for automatically excluding red bone marrow on whole‐body magnetic resonance imaging in patients with metastatic prostate cancer: A pilot study. Int J Urol 2022; 30:356-364. [PMID: 36539348 DOI: 10.1111/iju.15124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To establish a novel quantitative method that automatically excludes the red bone marrow and accurately quantifies the tumor volume on whole-body magnetic resonance imaging using updated imaging software. To also evaluate the association between the quantified tumor volume and the prognosis of patients with metastatic prostate cancer. METHODS This prospective analysis included patients diagnosed with metastatic hormone-sensitive or metastatic castration-resistant prostate cancer between 2017 and 2022. We developed an imaging software (Attractive BD_Score) that analyzed whole-body diffusion-weighted and in-phase and opposed-phase T1-weighted images to automatically exclude the red bone marrow. The quantified tumor volume was compared with that quantified by traditional whole-body diffusion-weighted imaging without red bone marrow exclusion. Prostate-specific antigen progression-free survival, time-to-pain progression, and overall survival were evaluated to assess the prognostic value of the quantified tumor volume. RESULTS The quantified tumor volume was significantly smaller than that quantified by the traditional method in metastatic hormone-sensitive (median: 81.0 ml vs. 149.4 ml) and metastatic castration-resistant (median: 29.4 ml vs. 63.5 ml) prostate cancer. A highly quantified tumor volume was associated with prostate-specific antigen progression-free survival (p = 0.030), time-to-pain progression (p = 0.003), and overall survival (p = 0.005) in patients with metastatic hormone-sensitive prostate cancer and with poor prostate-specific antigen progression-free survival (p = 0.001) and time-to-pain progression (p = 0.005) in patients with metastatic castration-resistant prostate cancer. CONCLUSIONS Our imaging method could accurately quantify the tumor volume in patients with metastatic prostate cancer. The quantified tumor volume can be clinically applied as a new prognostic biomarker for metastatic prostate cancer.
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Affiliation(s)
- Yuki Kohada
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
- Department of Urology Hiroshima University Graduate School of Biomedical Sciences Hiroshima Japan
| | - Nozomi Satani
- Division of Radiology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Yasuhiro Kaiho
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Hiromichi Iwamura
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | | | - Hiroki Kusumoto
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Takashi Kukimoto
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Masaaki Oikawa
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Jotaro Mikami
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Jun Ito
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Tomonori Matsuura
- Division of Radiology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Nobuyuki Hinata
- Department of Urology Hiroshima University Graduate School of Biomedical Sciences Hiroshima Japan
| | - Kaneki Koyama
- Division of Radiology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Makoto Sato
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
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23
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Effects of Erythrocytapheresis Procedures on Delayed Bone Marrow Conversion in Sickle Cell Disease. Clin Hematol Int 2022; 4:144-147. [PMID: 36385464 PMCID: PMC9763515 DOI: 10.1007/s44228-022-00022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/16/2022] [Indexed: 11/17/2022] Open
Abstract
The imaging appearances of the skeletal system have been well documented in sickle cell disease (SCD) but there is limited information about the impact of SCD treatments on skeletal abnormalities. We present two patients with SCD maintained on long-term erythrocytapheresis and the changes to their skeletal abnormalities on neuroimaging with this treatment. We observed a reversal of the bone marrow conversion process and the skull appearance was age appropriate without any radiographic findings of iron overload in the patients.
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24
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Gaunt T, Humphries PD. Whole-body MRI in children: state of the art. BJR Open 2022; 4:20210087. [PMID: 38525168 PMCID: PMC10958622 DOI: 10.1259/bjro.20210087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 06/23/2022] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
Abstract
Whole-body magnetic resonance imaging (WBMRI) is an increasingly popular technique in paediatric imaging. It provides high-resolution anatomical information, with the potential for further exciting developments in acquisition of functional data with advanced MR sequences and hybrid imaging with radionuclide tracers. WBMRI demonstrates the extent of disease in a range of multisystem conditions and, in some cases, disease burden prior to the onset of clinical features. The current applications of WBMRI in children are hereby reviewed, along with suggested anatomical stations and sequence protocols for acquisition.
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Affiliation(s)
- Trevor Gaunt
- Radiology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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25
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Aparisi Gómez MP, Ayuso Benavent C, Simoni P, Musa Aguiar P, Bazzocchi A, Aparisi F. Imaging of Bone Marrow: From Science to Practice. Semin Musculoskelet Radiol 2022; 26:396-411. [PMID: 36103883 DOI: 10.1055/s-0042-1745803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The study of the bone marrow may pose important challenges, due to its changing features over the life span, metabolic stress, and in cases of disease or treatment. Bone marrow adipocytes serve as storage tissue, but they also have endocrine and paracrine functions, contributing to local and systemic metabolism.Among different techniques, magnetic resonance (MR) has the benefit of imaging bone marrow directly. The use of advanced MR techniques for bone marrow study has rapidly found clinical applications. Beyond the clinical uses, it has opened up pathways to assess and quantify bone marrow components, establishing the groundwork for further study of its implications in physiologic and pathologic conditions.We summarize the features of the bone marrow as an organ, address the different modalities available for its study, with a special focus on MR advanced techniques and their addition to analysis in recent years, and review some of the challenges in interpreting the appearance of bone marrow.
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Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology, IMSKE, Valencia, Spain
| | | | - Paolo Simoni
- Department of Radiology, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Paula Musa Aguiar
- Serdil, Clinica de Radiologia e Diagnóstico por Imagem, Porto Alegre - RS, Brazil
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francisco Aparisi
- Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
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26
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Differentiation of bone metastases from benign red marrow depositions of the spine: the role of fat-suppressed T2-weighted imaging compared to fat fraction map. Eur Radiol 2022; 32:6730-6738. [PMID: 35798881 DOI: 10.1007/s00330-022-08965-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/09/2022] [Accepted: 06/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To differentiate bone metastases (BMs) from benign red marrow depositions (BRMs) of the spine using quantitative parameters derived from fat-suppressed T2-weighted imaging (T2 FS) and fat fraction (FF) map METHODS: One hundred eleven lesions, divided into 62 BMs and 49 BRMs according to MR images and either bone scan or PET-CT, were assessed with T2 FS and FF map. Two radiologists independently measured quantitative parameters from the ROIs in the lesions, including fat-suppressed (FS) T2 ratio (ratio of lesion FS T2 signal intensity [SI] to normal marrow FS T2 SI), FF, and FF ratio (ratio of lesion FF to normal marrow FF). The mean values of these parameters were compared between the two groups. To evaluate the diagnostic utilities of individual (FS T2 ratio, FF, and FF ratio) and combined parameters, ROC curves were analyzed. For the ROC curves among the individual parameters and their combinations, AUCs were compared. RESULTS The FS T2 ratio of BMs was significantly higher than that of BRMs (2.638 vs. 1.155 [p < 0.001]). The FF and FF ratio of BMs were significantly lower than those of BRMs (FF, 3.554% vs. 20.038% [p < 0.001]; FF ratio, 0.072 vs. 0.364 [p < 0.001]). The ROC AUCs of individual and combined parameters ranged from 0.941 to 0.980. The AUCs of all individual parameters and their combinations did not demonstrate statistically significant differences. CONCLUSION The FS T2 ratio, FF, and FF ratio can be useful in differentiating BMs from BRMs with or without any combination of the parameters. KEY POINTS • Quantitative parameters derived from fat-suppressed T2-weighted imaging and fat fraction map could be used to differentiate bone metastases from benign red marrow depositions with or without any combination of the parameters. • Quantitative parameters of fat-suppressed T2-weighted imaging provide diagnostic performance similar to those of fat fraction map in differentiating bone metastases from benign red marrow depositions.
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Magnetic resonance imaging protocols for pediatric acute hematogenous osteomyelitis. Pediatr Radiol 2022:10.1007/s00247-022-05435-2. [PMID: 35794288 DOI: 10.1007/s00247-022-05435-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/17/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
Pediatric musculoskeletal infection can be a challenging clinical diagnosis. MRI protocols should be tailored appropriately to diagnose and localize sites of infection, to determine alternative pathologies that could explain the child's presentation, and to identify complications that could alter treatment or lead to devastating consequences in growing bones. In this review, we discuss MRI protocols tailored for suspected acute appendicular musculoskeletal infection in children. These protocols are based on patient age in order to generally reflect the developmental stage of the child, the corresponding relevant anatomy and physiology, and the skeletal maturity-dependent physiopathology of musculoskeletal infections.
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Gorelik N, Casagranda BU, Colucci PG, Green JL, Roedl JB, Morrison WB, Zoga AC. Spotty Bone Marrow: A Frequent MRI Finding in the Feet of Ballet Dancers. J Dance Med Sci 2022; 26:125-133. [PMID: 35287786 DOI: 10.12678/1089-313x.061522e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Bone marrow signal abnormalities on magnetic resonance imaging (MRI) are common in athletes. However, few studies evaluate the MRI appearance of bone marrow in the feet of ballet dancers. Our study aims to describe the "spotty bone marrow" (SBM) pattern in the tarsal bones of a cohort of ballet dancers, establishing its prevalence, distribution, potential associations, and evolution.<br/> Methods: Eighty-six MRIs of 68 ankles in 56 ballet dancers were retrospectively reviewed for mar- row signal alterations, which were classified as focal or SBM (defined as patchy fluid-sensitive signal hyperintensity spanning more than one location or tarsal bone). When SBM involved the talus, its anatomic distribution in the bone and morphologic pattern were recorded. Additional osseous and soft tissue findings were documented. For subjects with more than one MRI of the same ankle, the SBM's evolution was monitored.<br/> Results: Spotty bone marrow was identified in 44 ankles (65%). Spotty bone marrow was isolated to the talus (44%), present in all tarsal bones (25%), or distributed between the talus and one to three other tarsal bones (31%). In the talus, The SBM involved the entire bone (65%), the neck and body (31%), or the head and neck (4%). The SBM most commonly showed a random morphologic pattern (87%) but occasionally showed a peripheral predominance (13%). There was no statistically significant difference in the prevalence of other pathologies in ankles with and without SBM. In eight ankles with a follow-up MRI, the SBM worsened in one, remained stable in two, and improved in five ankles. None progressed to a stress fracture.<br/> Conclusion: Spotty bone marrow is an MRI finding frequently encountered in ballet dancers. It is usually self-limiting and should not be misinterpreted as a more aggressive pathology.
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Affiliation(s)
| | | | | | | | - Johannes B Roedl
- Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - William B Morrison
- Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adam C Zoga
- Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Papakonstantinou O, Prountzos S, Karavasilis E, Atsali E, Bizimi V, Alexopoulou E, Fotis L. Whole-body magnetic resonance imaging findings and patterns of chronic nonbacterial osteomyelitis in a series of Greek pediatric patients. Acta Radiol Open 2022; 11:20584601221106701. [PMID: 35757189 PMCID: PMC9228643 DOI: 10.1177/20584601221106701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Chronic nonbacterial osteomyelitis (CNO) is a pediatric autoinflammatory disorder presenting with sterile inflammatory bone lesions. Whole-body MRI (WBMRI) has most recently emerged for disease assessment, but data are limited. Purpose: The purpose is to evaluate the imaging findings and patterns of CNO on WBMRI in a series of Greek pediatric patients. Material and Methods: Whole-body magnetic resonance imaging studies of all children with documented CNO, performed in a single tertiary center, were retrospectively reviewed. WBMRI included coronal T1 and short-tau inversion recovery (STIR), whole spine sagittal STIR, and ankle/foot sagittal STIR images. High signal intensity lesions on STIR images corresponding to bone marrow edema were recorded. The SPSS v.20 statistical package was used for descriptive statistics. Results: Twenty children were included (mean age: 12, range: 6–16 years) with 1–31 lesions (mean: 11.8) on WBMRI. Two children had unifocal disease localized at the clavicle, three paucifocal (1–4 lesions), and 15 multifocal bone involvement. All but two children presented with ankle pain and exhibited lesions at the bones of the ankle joint (90%) followed by the knee (50%) and pelvis (10%). The tibia was the most frequently affected bone (70%) followed by calcaneus (60%), fibula (50%), femur (45%), talus, and metatarsals (45%). No lesions in the cervical, thoracic, lumbar spine, and mandible were documented. Only small sacral lesions were seen in 25% of patients with the extensive peripheral disease. Bilateral metaphyseal and epiphyseal involvement with transphyseal extension were common, but the periosteal reaction and well-defined lesion margins were rare. Conclusion: Frequent involvement of the foot and ankle and paucity of substantial spinal involvement were seen in Greek pediatric patients with CNO.
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Affiliation(s)
- Olympia Papakonstantinou
- Department of Radiology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Spyridon Prountzos
- Department of Radiology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Eustratios Karavasilis
- Department of Radiology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Erato Atsali
- Department of Radiology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Vasiliki Bizimi
- Department of Radiology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Efthymia Alexopoulou
- Department of Radiology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Lampros Fotis
- Department of Radiology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Bao H, He X, Li X, Cao Y, Zhang N. Magnetic resonance imaging study of normal cranial bone marrow conversion at high altitude. Quant Imaging Med Surg 2022; 12:3126-3137. [PMID: 35655838 PMCID: PMC9131338 DOI: 10.21037/qims-21-740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/11/2022] [Indexed: 08/29/2023]
Abstract
BACKGROUND To use conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) to investigate the effects of long-term hypoxia on cranial bone marrow conversion in healthy people at high altitudes. METHODS A total of 1,130 individuals were selected from altitudinal areas of 2,000-3,000, 3,100-4,000, and >4,100 m. Each altitude range was divided into 5 age groups: 0-5, 6-14, 15-29, 30-49, and ≥50 years. Firstly, cranial bone marrow typing of the participants in each altitude range was performed on sagittal T1-weighted images (T1WI) according to the average diploe thickness and signal intensity of the normal skull, and the relationship between bone marrow conversion and age was analyzed. Secondly, the apparent diffusion coefficient (ADC) values of the frontal bone, parietal bone, occipital bone, and temporal bone were measured in the DWI post-processing workstation and statistical methods were used to analyze whether different altitudinal gradients and long-term hypoxic environment had any effect on cranial bone marrow conversion. RESULTS There was a positive correlation between bone marrow type and age in the healthy populations at all 3 levels of altitude (P<0.05). The average thickness of the cranial diploe also positively correlated with age (P<0.05); in the age ranges of 30-49 and ≥50 years, the ADC values of the occipital and temporal bone marrow positively correlated with increasing altitude (P<0.05). CONCLUSIONS The cranial bone marrow of normal people at high altitudes changes from Type I to Type IV with increasing age and under the influence of long-term chronic hypoxia. The bone marrow of the occipital and temporal bones of healthy people aged 30-49 and ≥50 years showed erythromedularization during the process of Type III and IV bone marrow conversion.
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Affiliation(s)
| | | | - Xiaoguang Li
- Department of Medical Imaging Center, Qinghai University Affiliated Hospital, Xining, China
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Augusto ACDL, Goes PCK, Flores DV, Costa MAF, Takahashi MS, Rodrigues ACO, Padula LC, Gasparetto TD, Nogueira-Barbosa MH, Aihara AY. Imaging Review of Normal and Abnormal Skeletal Maturation. Radiographics 2022; 42:861-879. [PMID: 35213260 DOI: 10.1148/rg.210088] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The growing skeleton undergoes well-described and predictable normal developmental changes, which may be misinterpreted a as pathologic condition at imaging. Primary and secondary ossification centers (SOCs), which form the diaphysis and the epiphysis of long bones, respectively, are formed by endochondral and intramembranous ossification processes. During skeletal maturation, the SOCs may appear irregular and fragmented, which should not be confused with fractures, osteochondritis dissecans, and osteochondrosis. These normal irregularities are generally symmetric with a smooth, round, and sclerotic appearance, which are aspects that help in the differentiation. The metaphysis, epiphysis, and growth plates or physes are common sites of injuries and normal variants in the pediatric skeleton. The metaphysis contains the newly formed bone from endochondral ossification and is highly vascularized. It is predisposed to easy spread of infections and bone tumors. The physis is the weakest structure of the immature skeleton. Injuries to this location may disrupt endochondral ossification and lead to growth disturbances. Pathologic conditions of the epiphyses may extend into the articular surface and lead to articular damage. At MRI, small and localized foci of bone marrow changes within the epiphysis and metaphysis are also a common finding. These can be related to residual red marrow (especially in the metaphysis of long bones and hindfoot), focal periphyseal edema (associated with the process of physeal closure), and ultimately to a normal ossification process. The authors review the imaging appearance of normal skeletal maturation and discuss common maturation disorders on the basis of developmental stage and location. ©RSNA, 2022.
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Affiliation(s)
- Ana Carolina de Lima Augusto
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - Paola Cecy Kuenzer Goes
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - Dyan V Flores
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - Maria Alice F Costa
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - Marcelo Straus Takahashi
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - André C O Rodrigues
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - Luiz C Padula
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - Taisa Davaus Gasparetto
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - Marcello H Nogueira-Barbosa
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - André Yui Aihara
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
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Yauger YJ, Johnson MD, Mark J, Le T, Woodruff T, Silvey S, Revis J, Blouin D, O'Sullivan J, Brady K, Hensler JG, Johnson D. Tibial Intraosseous Administration of Epinephrine Is Effective in Restoring Return of Spontaneous Circulation in a Pediatric Normovolemic But Not Hypovolemic Cardiac Arrest Model. Pediatr Emerg Care 2022; 38:e1166-e1172. [PMID: 32453255 DOI: 10.1097/pec.0000000000002127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We compared the efficacy of tibial intraosseous (TIO) administration of epinephrine in a pediatric normovolemic versus hypovolemic cardiac arrest model to determine the incidence of return of spontaneous circulation (ROSC) and plasma epinephrine concentrations over time. METHODS This experimental study evaluated the pharmacokinetics of epinephrine and/or incidence of ROSC after TIO administration in either a normovolemic or hypovolemic pediatric swine model. RESULTS All subjects in the TIO normovolemia cardiac arrest group experienced ROSC after TIO administration of epinephrine. In contrast, subjects experiencing hypovolemia and cardiac arrest were significantly less likely to experience ROSC when epinephrine was administered TIO versus intravenous (TIO hypovolemia: 14% [1/7] vs IV hypovolemia: 71% [5/7]; P = 0.031). The TIO hypovolemia group exhibited significantly lower plasma epinephrine concentrations versus IV hypovolemia at 60, 90, 120, and 150 seconds (P < 0.05). Although the maximum concentration of plasma epinephrine was similar, the TIO hypovolemia group exhibited significantly slower time to maximum concentration times versus TIO normovolemia subjects (P = 0.004). CONCLUSIONS Tibial intraosseous administration of epinephrine reliably facilitated ROSC among normovolemic cardiac arrest pediatric patients, which is consistent with published reports. However, TIO administration of epinephrine was ineffective in restoring ROSC among subjects experiencing hypovolemia and cardiac arrest. Tibial intraosseous-administered epinephrine during hypovolemia and cardiac arrest may have resulted in a potential sequestration of epinephrine in the tibia. Central or peripheral intravascular access attempts should not be abandoned after successful TIO placement in the resuscitation of patients experiencing concurrent hypovolemia and cardiac arrest.
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Affiliation(s)
- Young J Yauger
- From the United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX
| | - Michelle D Johnson
- From the United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX
| | - Jordan Mark
- From the United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX
| | - Tho Le
- From the United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX
| | - Thomas Woodruff
- From the United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX
| | - Stephanie Silvey
- From the United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX
| | - James Revis
- From the United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX
| | - Dawn Blouin
- From the United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX
| | - Joseph O'Sullivan
- From the United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX
| | - Kerianne Brady
- Department of Emergency Medicine, New York-Presbyterian/Queens, Flushing, NY
| | - Julie G Hensler
- From the United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX
| | - Don Johnson
- From the United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX
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Bone Marrow Fat Distribution in Patients With β-Thalassemia: A Study Using Chemical Shift-Based Water-Fat MRI. Acad Radiol 2022; 29:e39-e48. [PMID: 33992535 DOI: 10.1016/j.acra.2021.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Molecular studies have shown the changes in bone marrow fat in relation to altered hematopoiesis. This study aims to investigate the changes in the bone marrow fat in patients affected by β-thalassemia by using chemical shift-encoded (CSE)-MRI. MATERIALS AND METHODS Twenty-three subjects, comprising of six healthy (17-31 years old) and 17 β-thalassemia subjects (19-39 years old), were scanned using a multiecho fast low angle shot sequence (0.94 × 0.94 × 3.00 mm3) and a stimulated echo acquisition mode sequence using 3T MRI. Bone marrow proton density fat fraction (PDFF) was quantified in the left femur of each subject. Regression and Bland-Altman analysis were used to analyze agreement between CSE-MRI and 1H-MRS. PDFF distribution was analyzed using Hartigan's dip test and the computed Wasserstein distances. Jonckheere-Terpstra trend analysis was performed to evaluate the effect of disease severity on PDFF distribution. RESULTS An excellent agreement was found between PDFF measured using CSE-MRI with 1H-MRS (R2 = 0.91; bias =-1.41%). Healthy subjects showed left-skewed or bimodal PDFF distribution while β-thalassemia subjects showed bimodal, normal or right-skewed distribution. Jonckheere-Terpstra test shows that PDFF distribution was increasingly different from the norm as disease severity increased (TJT = 166.0, z = 3.806, p < 0.05). Increase in variability of PDFF distribution within each subject group was also seen with increasing disease severity (TJT = 169.0, z = 3.971, p < 0.05). CONCLUSION CSE-MRI is a promising tool to demonstrate spatial changes and variability in marrow fat distribution, resulting from ineffective erythropoiesis.
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O'Donnell L, Hill EC, Anderson AS, Edgar HJH. A biological approach to adult sex differences in skeletal indicators of childhood stress. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 177:381-401. [PMID: 36787691 DOI: 10.1002/ajpa.24424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/01/2021] [Accepted: 09/24/2021] [Indexed: 05/05/2023]
Abstract
OBJECTIVES In previous work examining the etiology of cribra orbitalia (CO) and porotic hyperostosis (PH) in a contemporary juvenile mortality sample, we noted that males had higher odds of having CO lesions than females. Here, we examine potential reasons for this pattern in greater detail. Four non-mutually exclusive mechanisms could explain the observed sex differences: (1) sex-biased mortality; (2) sexual dimorphism in immune responses; (3) sexual dimorphism in bone turnover; or (4) sexual dimorphism in marrow conversion. SUBJECTS AND METHODS The sample consists of postmortem computed tomography scans and autopsy reports, field reports, and limited medical records of 488 individuals from New Mexico (203 females; 285 males) aged between 0.5 and 15 years. We used Kaplan-Meier survival analysis, predicted probabilities, and odds ratios to test each mechanism. RESULTS Males do not have lower survival probabilities than females, and we find no indications of sex differences in immune response. Overall, males have a higher probability of having CO or PH lesions than females. CONCLUSIONS All results indicate that lesion formation in juveniles is influenced by some combination of sex differences in the pace of red-yellow conversion of the bone marrow and bone turnover. The preponderance of males with CO and PH likely speaks to the potential for heightened osteoblastic activity in males. We find no support for the hypotheses that sex biases in mortality or immune responses impacted lesion frequency in this sample. Sex differences in biological processes experienced by children may affect lesion formation and lesion expression in later life.
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Affiliation(s)
- Lexi O'Donnell
- Department of Sociology and Anthropology, University of Mississippi, Oxford, Mississippi, USA
| | - Ethan C Hill
- Division of Physical Therapy, Department of Orthopaedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Amy S Anderson
- Department of Anthropology, University of California, Santa Barbara, California, USA
| | - Heather Joy Hecht Edgar
- Department of Anthropology, University of New Mexico, Albuquerque, New Mexico, USA
- Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico, USA
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MRI in the Diagnosis and Treatment Response Assessment of Chronic Nonbacterial Osteomyelitis in Children and Adolescents. Curr Rheumatol Rep 2022; 24:27-39. [PMID: 35133566 DOI: 10.1007/s11926-022-01053-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To explain the central role of magnetic resonance imaging (MRI) in the diagnosis and follow-up of chronic nonbacterial osteomyelitis (CNO) in children and adolescents, centering on practical technical aspects and salient diagnostic features. RECENT FINDINGS In the absence of conclusive clinical features and widely accepted laboratory tests, including validated disease biomarkers, MRI (whether targeted or covering the entire body) currently plays an indispensable role in the diagnosis and therapy response assessment of CNO. Whole-body MRI, which is the reference imaging standard for CNO, can be limited to a short tau inversion recovery (STIR) coronal image set covering the entire body and a STIR sagittal set covering the spine, an approximately 30-min examination with no need for intravenous contrast or diffusion-weighted imaging. The hallmark of CNO is periphyseal (metaphyseal and/or epi-/apophyseal) osteitis, identified as bright foci on STIR, with or without inflammation of the adjacent periosteum and surrounding soft tissue. Response to bisphosphonate treatment for CNO has some unique MRI findings that should not be mistaken for residual or relapsing disease. Diagnostic features and treatment response characteristics of MRI in pediatric CNO are discussed, also describing the techniques used, pitfalls encountered, and differential diagnostic possibilities considered during daily practice.
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Indolent enhancing spinal lesions mimicking spinal metastasis in pediatric patients with malignant primary brain tumors. Sci Rep 2022; 12:1728. [PMID: 35110660 PMCID: PMC8811062 DOI: 10.1038/s41598-022-05831-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/13/2022] [Indexed: 12/01/2022] Open
Abstract
Spinal metastasis from malignant primary brain tumors (MPBTs) in pediatric patients is rare and often appears as enhancing lesions on MRI. However, some indolent enhancing spinal lesions (IESLs) resulting from previous treatment mimic metastasis on MRI, leading to unnecessary investigation and treatment. In 2005–2020, we retrospectively enrolled 12 pediatric/young patients with clinical impression of spinal metastasis and pathological diagnosis of their spinal lesions. Three patients had MPBT with IESL, and 9 patients had malignant tumors with metastases. The histopathologic diagnosis of IESL was unremarkable marrow change. We evaluated their MRI, CT, and bone scan findings. The following imaging findings of IESL vs. spinal metastasis were noted: (1) IESLs appeared round/ovoid (3/3, 100%), whereas spinal metastasis appeared irregular (9/9, 100%) (P = 0.005); (2) target-shaped enhancement was noted in (3/3, 100%) vs. (0/9, 0%) of cases, respectively (P = 0.005); (3) pathologic fracture of the vertebral body was noted in (1/3, 33.3%) vs. (9/9, 100%) of cases, respectively (P = 0.045); (4) expansile vertebral shape was noted in (0/3, 0%) vs. (9/9, 100%) of cases, respectively (P = 0.005); (5) obliteration of the basivertebral vein was noted in (0/3, 0%) vs. (9/9, 100%) of cases, respectively (P = 0.005); and (6) osteoblastic change on CT was noted in (3/3, 100%) vs. (2/9, 22.2%) of cases, respectively (P = 0.034). IESL in pediatric patients with MPBT can be differentiated from metastasis based on their imaging characteristics. We suggest close follow-up rather than aggressive investigation and treatment for IESL.
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Elangovan SM, Meyers AB. Pearls and Pitfalls of Imaging of the Developing Pediatric Skeleton: Differentiating Normal and Pathology With MRI. Semin Ultrasound CT MR 2022; 43:73-87. [PMID: 35164912 DOI: 10.1053/j.sult.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Developmental changes occurring in the pediatric skeleton throughout childhood cause imaging appearances that may be confused with pathology. Knowledge of the typical pattern of red to yellow bone marrow conversion and areas of normal developmental irregular ossification is essential for radiologists interpreting musculoskeletal imaging in children to avoid mistaking normal findings for disease. Here we review the normal conversion of hematopoietic to yellow marrow on pediatric MRI and illustrate how MRI can distinguish the normal areas of irregular ossification from various pathology that can occur at and around growth centers in the developing skeleton.
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Affiliation(s)
- Stacey M Elangovan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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Vande Berg BC, Kirchgesner T, Acid S, Malghem J, Vekemans MC, Lecouvet FE. Diffuse vertebral marrow changes at MRI: Multiple myeloma or normal? Skeletal Radiol 2022; 51:89-99. [PMID: 34550397 DOI: 10.1007/s00256-021-03886-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 02/02/2023]
Abstract
Five MRI patterns of marrow involvement (diffuse, focal, combined diffuse and focal, variegated, and normal) are observed in patients with a marrow proliferative disorder including MM. The wide range of marrow involvement patterns in monoclonal plasma cell proliferative disorders mirrors that of their natural histories that can vary from indolent to rapidly lethal. MRI of the axial bone marrow contributes to stage these disorders, but it should not be obtained for disease detection and characterization because of its limited specificity and sensitivity. At MRI, diffuse benign hematopoietic marrow hyperplasia and marrow heterogeneities in elderly patients mimic the diffuse and variegated patterns observed in MM patients. Careful analysis of fat- and fluid-sensitive MR images and quantitative marrow assessment by using MRI and FDG-PET can contribute in differentiating these changes from those associated with neoplastic marrow infiltration, with some residual overlapping findings.
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Affiliation(s)
- B C Vande Berg
- Department of Radiology, IREC, Saint Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue 10/2942, 1200, Brussels, Belgium.
| | - T Kirchgesner
- Department of Radiology, IREC, Saint Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue 10/2942, 1200, Brussels, Belgium
| | - S Acid
- Department of Radiology, IREC, Saint Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue 10/2942, 1200, Brussels, Belgium
| | - J Malghem
- Department of Radiology, IREC, Saint Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue 10/2942, 1200, Brussels, Belgium
| | - M C Vekemans
- Department of Hematology, IREC, Saint Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue 10/2942, 1200, Brussels, Belgium
| | - F E Lecouvet
- Department of Radiology, IREC, Saint Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue 10/2942, 1200, Brussels, Belgium
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Giani T, Matteoni V, Perrone A, Simonini G, Cimaz R. Whole-body MRI in pediatric undefined inflammatory conditions. Pediatr Int 2021; 63:1282-1288. [PMID: 33567119 DOI: 10.1111/ped.14650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/26/2021] [Accepted: 02/08/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Whole-body magnetic resonance imaging (WBMRI) is a multiregional imaging technique suitable for investigating the extent of multisystemic diseases without exposure to radiation, with a high sensitivity to bone alterations. The aim of our study was to evaluate the role of WBMRI in the workup of children with non-specific musculoskeletal features and non-indicative laboratory and instrumental data, who were suspected to have a rheumatologic disease. METHODS We retrospectively analyzed medical records, including laboratory tests and radiological data of 34 children who had been evaluated due to non-specific musculoskeletal manifestations, for which a WBMRI was prescribed. RESULTS We included 34 children, 19 females and 15 males, mean age 10 years (range 2-16 years), with the following clinical features: diffuse arthralgia (12 children), persistent fever (2 children), persistent fever and diffuse arthralgia (20 children). Serologic inflammatory markers were increased in 29/34 patients. Twenty-five children had already received X-ray and / or ultrasound before WBMRI, with a negative / uninformative result. WBMRI was performed 3-6 weeks (median, 3.5 weeks) after the initial presentation of symptoms. In 22/34 (65%) children, WBMRI revealed some abnormalities that supported the final diagnosis. Twelve out of 34 children (35%) were be affected by chronic recurrent multifocal osteomyelitis. CONCLUSIONS WBMRI is helpful in pediatric rheumatology for the differential diagnosis of undefined inflammatory conditions. It appears to be a promising tool, especially in the detection of multifocal bone lesions. The diagnosis that mainly benefits from WBMRI in our series is chronic recurrent multifocal osteomyelitis. WBMRI can also help in excluding neoplastic diseases.
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Affiliation(s)
- Teresa Giani
- Pediatric Rheumatology Unit, Meyer Children University Hospital, Florence, Italy.,Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Veronica Matteoni
- Pediatric Rheumatology Unit, Meyer Children University Hospital, Florence, Italy
| | - Anna Perrone
- Radiology Unit, Meyer Children University Hospital, Florence, Italy
| | - Gabriele Simonini
- Pediatric Rheumatology Unit, Meyer Children University Hospital, Florence, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Evaluation of Computed Tomography Attenuation Value of Proximal Femoral Marrow to Diagnose and Differentiate Hematologic Malignancies, Myelofibrosis, and Aplastic Anemia. J Comput Assist Tomogr 2021; 45:912-918. [PMID: 34347713 DOI: 10.1097/rct.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to diagnose hematologic diseases using computed tomography (CT) number of proximal femoral marrow. METHODS The average CT number of marrow in hematologic diseases was measured on the caudal side of the greater trochanter. RESULTS The CT numbers were -60.3 ± 16.8 in 12 patients with aplastic anemia, -53.2 ± 19.4 in 11 patients with monoclonal gammopathy of undetermined significance, -44.2 ± 21.1 in 10 normal controls, -30.9 ± 42.3 in 9 patients with chronic lymphatic leukemia, -29.8 ± 29.9 in 17 patients with benign anemia, -13.7 ± 40.9 in 33 patients with multiple myeloma, 0.32 ± 44.6 in 17 patients with myelodysplastic syndrome (MDS), 18.7 ± 40.0 in 44 patients with acute myeloid leukemia, 50.3 ± 27.4 in 13 patients with acute lymphatic leukemia, 51.5 ± 16.8 in 8 patients with myelofibrosis, and 56.4 ± 15.6 in 9 patients with chronic myeloid leukemia. Significant differences were observed between acute myeloid leukemia and MDS, between MDS and aplastic anemia, and between multiple myeloma and monoclonal gammopathy of undetermined significance (P < 0.01). CONCLUSION The marrow CT numbers may be indicators of hematologic diseases and can be used as a diagnostic tool.
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Chaturvedi A. Pediatric skeletal diffusion-weighted magnetic resonance imaging, part 2: current and emerging applications. Pediatr Radiol 2021; 51:1575-1588. [PMID: 34018037 DOI: 10.1007/s00247-021-05028-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/07/2021] [Accepted: 02/17/2021] [Indexed: 01/07/2023]
Abstract
Diffusion-weighted imaging (DWI) complements the more established T1, fluid-sensitive and gadolinium-enhanced magnetic resonance pulse sequences used to assess several pediatric skeletal pathologies. There is optimism that the technique might not just be complementary but could serve as an alternative to gadolinium and radiopharmaceuticals for several indications. As a non-contrast, free-breathing and noninvasive technique, DWI is especially valuable in children and is readily incorporated into existing MRI protocols. The indications for skeletal DWI in children include distinguishing between benign and malignant skeletal processes, initial assessment and treatment response assessment for osseous sarcomas, and assessment of inflammatory arthropathies and femoral head ischemia, among others. A notable challenge of diffusion MRI is the dynamic nature of the growing pediatric skeleton. It is important to consider the child's age when placing DWI findings in context with potential marrow pathology. This review article summarizes the current and evolving applications of DWI for assessing the pediatric skeleton, rounding off the discussion with evolving directions for further research in this realm.
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Affiliation(s)
- Apeksha Chaturvedi
- Division of Pediatric Radiology, Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY, 14642, USA.
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42
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Chaturvedi A. Pediatric skeletal diffusion-weighted magnetic resonance imaging: part 1 - technical considerations and optimization strategies. Pediatr Radiol 2021; 51:1562-1574. [PMID: 33792751 DOI: 10.1007/s00247-021-04975-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/12/2020] [Accepted: 01/15/2021] [Indexed: 12/28/2022]
Abstract
Diffusion-weighted MRI, or DWI, is a fast, quantitative technique that is easily integrated into a morphological MR acquisition. The ability of DWI to aid in detecting multifocal skeletal pathology and in characterizing tissue cellularity to a level beyond that possible with other techniques makes it a niche component of multiparametric MR imaging of the skeleton. Besides its role in disease detection and establishing cellularity and character of osseous lesions, DWI continues to be examined as a surrogate biomarker for therapeutic response of several childhood bone tumors. There is increasing interest in harnessing DWI as a potential substitute to alternative modes of imaging evaluation that involve radiation or administration of intravenous contrast agent or radiopharmaceuticals, for example in early detection and diagnosis of capital femoral epiphyseal ischemia in cases of Legg-Calvé-Perthes disease, or diagnosis and staging of lymphoma. The expected evolution of skeletal diffusivity characteristics with maturation and the unique disease processes that affect the pediatric skeleton necessitate a pediatric-specific discussion. In this article, the author examines the developmentally appropriate normal appearances, technique, artifacts and pitfalls of pediatric skeletal DWI.
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Affiliation(s)
- Apeksha Chaturvedi
- Division of Pediatric Radiology, Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY, 14642, USA.
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43
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Atlas of MRI findings of sacroiliitis in pediatric sacroiliac joints to accompany the updated preliminary OMERACT pediatric JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system: Part II: Structural damage lesions. Semin Arthritis Rheum 2021; 51:1099-1107. [PMID: 34311987 DOI: 10.1016/j.semarthrit.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/15/2021] [Accepted: 07/05/2021] [Indexed: 01/20/2023]
Abstract
Magnetic resonance imaging (MRI) is the imaging modality of choice for identifying sacroiliitis in juvenile idiopathic arthritis (JIA). Besides active lesions of sacroiliitis, of which bone marrow edema (BME) is the key feature, structural damage lesions can also be detected. Structural changes include erosion, sclerosis, fat lesion, backfill and ankylosis, and are more common at later stages. Systematic MRI assessment of inflammation and structural damage may aid in monitoring the course of the disease and evaluating treatment options. In this pictorial essay, we illustrate normal MRI findings and growth-related changes of the SIJ in the pediatric population, as well as the different MRI features of structural damage of sacroiliitis. This atlas can serve as a reference for assessing structural lesions of SIJ arthritis according to the updated preliminary JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system proposed by the MRI in JIA working group of Outcome Measures in Rheumatology and Clinical Trials (OMERACT). The atlas is intended to be read in conjunction with its companion Part 1, Active Lesions.
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44
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Abstract
Research examining bone marrow adipose tissue (BMAT) has rapidly expanded during the last two decades, leading to advances in knowledge on the role of BMAT in the pathogenesis of bone loss and endocrine disorders. Clinical imaging has played a crucial role for the in vivo assessment of BMAT, allowing non-invasive quantification and evaluation of BMAT composition. In the present work, we review different imaging methods for assessing properties of BMAT. Our aim is to review conventional magnetic resonance imaging (MRI), water-fat imaging, and single-voxel proton magnetic resonance spectroscopy (1H-MRS), as well as computed tomography (CT)-based techniques, including single energy and dual energy CT. We will also discuss the clinical applications of these methods in type 2 diabetes mellitus, obesity and anorexia nervosa.
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Affiliation(s)
- Mohamed Jarraya
- Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA, USA.
| | - Miriam A Bredella
- Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA, USA
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45
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Imaging findings of granulocyte colony-stimulating factor-producing tumors: a case series and review of the literature. Jpn J Radiol 2021; 39:857-867. [PMID: 34021462 PMCID: PMC8413199 DOI: 10.1007/s11604-021-01130-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022]
Abstract
Granulocyte colony-stimulating factor (G-CSF)-producing tumors have an aggressive clinical course. Here, we report five cases of G-CSF-producing tumors and review the literature, focusing on imaging findings related to tumor-produced G-CSF. In addition to our cases, we identified 30 previous reports of G-CSF-producing tumors on which 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT, bone scintigraphy, or evaluation of bone marrow MR findings was performed. White blood cell count, serum C-reactive protein, and serum interleukin-6 were elevated in all cases for which these parameters were measured. G-CSF-producing tumors presented large necrotic masses (mean diameter 83.2 mm, range 17–195 mm) with marked FDG uptake (mean maximum standardized uptake value: 20.09). Diffuse FDG uptake into the bone marrow was shown in 28 of the 31 cases in which FDG-PET/CT was performed. The signal intensity of bone marrow suggested marrow reconversion in all seven MRI-assessable cases. Bone scintigraphy demonstrated no significant uptake, except in two cases with bone metastases. Splenic FDG uptake was increased in 8 of 10 cases in which it was evaluated. These imaging findings may reflect the effects of tumor-produced G-CSF. The presence of G-CSF-producing tumors should be considered in patients with cancer who show these imaging findings and marked inflammatory features of unknown origin.
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Person A, Janitz E, Thapa M. Pediatric Bone Marrow: Normal and Abnormal MRI Appearance. Semin Roentgenol 2021; 56:325-337. [PMID: 34281683 DOI: 10.1053/j.ro.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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47
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Singhal V, Karzar NH, Bose A, Buckless C, Ackerman KE, Bredella MA, Klibanski A, Misra M. Changes in marrow adipose tissue in relation to changes in bone parameters following estradiol replacement in adolescent and young adult females with functional hypothalamic amenorrhea. Bone 2021; 145:115841. [PMID: 33418100 PMCID: PMC8022869 DOI: 10.1016/j.bone.2021.115841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/14/2020] [Accepted: 01/01/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Low energy availability causes disruption of hypothalamic gonadotropin-releasing hormone secretion leading to functional hypothalamic amenorrhea (FHA) and hypoestrogenism, which in turn contributes to decreased bone mineral density (BMD) and increased bone marrow adipose tissue (MAT). Transdermal estradiol administration in physiologic doses increases BMD in adolescents and adults with FHA. However, the impact of estrogen replacement on MAT in relation to changes in BMD has not been studied in adolescents and young adults. We hypothesized that physiologic estrogen replacement would lead to decreases in MAT, associated with increases in BMD. METHODS AND MATERIALS We studied 15 adolescent and young adult females with FHA (14-25 years). All participants received a17β- estradiol transdermal patch at a dose of 0.1 mg/day (applied twice weekly) for 12 months. Participants also received cyclic progestin for 10-12 days each month. We quantified MAT (lipid/water ratio) of the fourth lumbar (L4) vertebral body and femoral diaphysis by single proton (1H)-magnetic resonance spectroscopy, and compartmental volumetric BMD of the distal radius and tibia using high-resolution peripheral quantitative computed tomography. RESULTS Transdermal estradiol therapy over 12 months resulted in a decrease in MAT at the lumbar (L4) vertebra from 0.92 ± 0.55 at baseline to 0.63 ± 0.29 at 12-months (p = 0.008), and an increase in radial and tibial cortical vBMD (p = 0.006, p = 0.0003). Changes in L4 MAT trended to be inversely associated with changes in radial cortical vBMD (rho = -0.47, p = 0.08). CONCLUSION We show that in adolescent and young adult girls with FHA, MAT decreases following transdermal estrogen therapy and these changes are associated with increased cortical vBMD.
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Affiliation(s)
- Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Pediatric Endocrinology, Mass General Hospital for Children and Harvard Medical School, Boston, MA, United States; MGH Weight Center, Massachusetts General Hospital, Boston, MA, United States.
| | - Nazanin Hazhir Karzar
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
| | - Amita Bose
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
| | - Colleen Buckless
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
| | - Kathryn E Ackerman
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Pediatric Endocrinology, Mass General Hospital for Children and Harvard Medical School, Boston, MA, United States.
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Nguyen JC, Davis KW, Arkader A, Guariento A, Sze A, Hong S, Jaramillo D. Pre-treatment MRI of leukaemia and lymphoma in children: are there differences in marrow replacement patterns on T1-weighted images? Eur Radiol 2021; 31:7992-8000. [PMID: 33768286 DOI: 10.1007/s00330-021-07814-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/18/2020] [Accepted: 02/18/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate the prevalence and distribution of specific marrow patterns on pre-treatment magnetic resonance imaging (MRI) examinations in children with leukaemia and lymphoma and with respect to the anatomic location. MATERIALS AND METHODS This retrospective IRB-approved and HIPAA-compliant study included children with leukaemia or lymphoma who underwent pre-treatment MRI examinations over 18 years (between 1 January 1995 and 31 August 2013). Two radiologists blinded to the clinical diagnosis reviewed each study to determine the presence or absence of abnormal marrow signal and, when present, sub-categorised the pattern into diffuse, patchy, or focal abnormal marrow. Chi-square and Fisher's exact tests were used to compare marrow patterns between leukaemia and lymphoma. RESULTS The study included 50 children (32 males and 18 females; mean age 9.5 ± 5.3 years) with 54 MRI examinations (27 leukaemia and 27 lymphoma) that included 26 spine and 28 non-spine studies. Marrow replacement was present on 43 (80%) studies, significantly more common with leukaemia than with lymphoma (p = 0.039). The diffuse replacement pattern was significantly more common with leukaemia when compared to lymphoma (p < 0.001) and the focal pattern was only observed with lymphoma. In the spine, the diffuse pattern was observed with lymphoma (3/14, 21%). All patients with leukaemia and MRI outside of the spine showed marrow involvement. CONCLUSION Marrow replacement is common on MRI from children with leukaemia and lymphoma. A diffuse pattern was significantly associated with leukaemia on studies outside of the spine and a focal pattern was only observed with lymphoma, independently of the anatomic location. KEY POINTS • Bone marrow replacement on pre-treatment MRI examinations in children with leukaemia and lymphoma was observed in 93% (25/27) and 67% (18/27), respectively. • Diffuse pattern of marrow replacement was significantly more common in leukaemia even though this pattern was also observed with lymphoma on the spine MRI studies. • Focal pattern of marrow replacement was present only with lymphoma and not with leukaemia regardless of the anatomic location.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA. .,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Kirkland W Davis
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alexandre Arkader
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Divison of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Alyssa Sze
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Shijie Hong
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Diego Jaramillo
- Department of Radiology, Columbia University Medical Center, New York City, NY, USA
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49
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Osseous Pathology on Wrist Magnetic Resonance Imaging. Top Magn Reson Imaging 2021; 29:245-261. [PMID: 33021576 DOI: 10.1097/rmr.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Advanced imaging of the osseous structures of the wrist by magnetic resonance imaging (MRI) yields powerful information regarding marrow composition and overall bone structure. Various forms of pathology, both benign and malignant, have unique marrow signal abnormalities that can be easily detected by MRI given its high sensitivity to radiographically occult processes. In particular, osseous pathology can be seen in the setting of traumatic, degenerative, congenital, infectious, and neoplastic conditions. The acuity or chronicity of these conditions can often be determined by imaging to aid in appropriate therapy. A thorough understanding of the breadth of pathology and corresponding MRI appearances can allow the interpreting radiologist to formulate a concise and accurate assessment of an examination.
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50
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Ganske A, Kolbe AB, Thomas K, Hull N. Pediatric scurvy MRI appearance. Radiol Case Rep 2021; 16:1148-1152. [PMID: 33747331 PMCID: PMC7960501 DOI: 10.1016/j.radcr.2021.02.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 11/28/2022] Open
Abstract
We present a rare case of pediatric scurvy in a 9-year-old male who presented with nontraumatic knee pain. MRI was obtained due to the puzzling presentation. MRI demonstrated a systemic bone marrow abnormality which led to a conversation with the clinician and further elucidation of an extremely narrow diet lacking sufficient vitamin C (ascorbic acid). Diagnosis was confirmed biochemically with undetectable ascorbic acid level and clinically with compatible exam and history. This case highlights a thought process for unexpected bone marrow abnormality on MRI.
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Affiliation(s)
- Alec Ganske
- Division of Radiology, Mayo Clinic, 200 1st St SW; Rochester, MN 55905, USA
| | - Amy B Kolbe
- Division of Radiology, Mayo Clinic, 200 1st St SW; Rochester, MN 55905, USA
| | - Kristen Thomas
- Division of Radiology, Mayo Clinic, 200 1st St SW; Rochester, MN 55905, USA
| | - Nathan Hull
- Division of Radiology, Mayo Clinic, 200 1st St SW; Rochester, MN 55905, USA
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