Bone Marrow MRI: A Pattern-Based Approach

183 Pages·2015·31.337 MB·English

by  Lia Angela Moulopoulos, Vassilis Koutoulidis

Lia Angela Moulopoulos
Vassilis Koutoulidis
Bone Marrow MRI
A Pattern-Based Approach
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Bone Marrow MRI

Lia Angela Moulopoulos (cid:129) Vassilis Koutoulidis
Bone Marrow MRI
A Pattern-Based Approach
Lia Angela Moulopoulos Vassilis Koutoulidis
Professor of Radiology and Chair Assistant Professor of Radiology
1st Department of Radiology 1st Department of Radiology
University of Athens School of Medicine University of Athens School of Medicine
Athens Athens
Greece Greece
ISBN 978-88-470-5315-1 ISBN 978-88-470-5316-8 (eBook)
DOI 10.1007/978-88-470-5316-8
Springer Milan Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014956375
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To my father, a scientist. With love and admiration.
LAM
To my father, Constantinos Koutoulidis, M.D., who passed away during the
writing of this book.
To Olga and our children, Constantinos and Ariadne. With unstinting love
and gratitude.
VK

Pref ace
Why a Pattern-Based Approach?
Bone marrow, responsible for blood cell production, is a dynamic, ever-shifting, continuously
adapting organ. Dynamic changes commence from the moment hematopoietic tissue appears
in the cavities of the fetal long bones at approximately the 10th to 11th week of gestation in
humans. They continue after birth until the adult pattern of red/yellow marrow distribution is
reached at about 25 years of age. After this point, bone marrow fat continues to increase slowly
in an orderly, predictable way. Reconversion of yellow marrow into red marrow may occur at
any time point when the needs for hematopoiesis increase. All these processes, which alter the
composition of bone marrow, complex as they are, can be simplifi ed and better understood by
using a pattern-based approach. Patterns are repeatedly recognized when studying both bone
marrow physiology and pathology. Orderly patterns predict the way red marrow converts into
yellow marrow at the skeletal level as well as at the level of each individual bone. When yellow
marrow reconverts into red marrow, patterns reverse from the above are observed. Familiarity
with the patterns of normal bone marrow changes is essential to identify the presence of dis-
ease. Conditions that affect bone marrow by infi ltrating it with infl ammatory or neoplastic cells
do so in ways that may be schematically presented with patterns. MRI provides an excellent
means of visualizing these patterns of normal and abnormal marrow.
We fi nd this pattern recognition approach very useful because it provides an organized way
of MR image interpretation. Pattern assignment facilitates the learning of bone marrow MRI
as it links imaging appearances to underlying pathophysiological changes. It is interesting that
discrete patterns of disease are also refl ected in more advanced MRI techniques such as
Dynamic Contrast-Enhanced MRI and Diffusion-Weighted MRI. In certain clinical entities,
MRI patterns may also have important prognostic value.
We did not set out, therefore, in this book to provide an exhaustive list of MRI features of
every single disease that may affect bone marrow. We chose instead this pattern-based
approach, which we have found very useful over the years, both for teaching purposes and in
day-to-day clinical practice. The fi rst chapters of the book address the anatomy and physiology
of bone marrow as well as normal marrow MRI. A chapter is then devoted to the analysis of
the different MRI patterns of abnormal marrow, and extensive differential diagnosis lists are
provided. The most important disease entities affecting the marrow are presented in the next
chapters in a uniform fashion. The relevant clinical information is provided fi rst, followed by
fi ndings on other imaging modalities; fi nally, the MRI fi ndings of each disease are presented
in detail. Apart from the discussion of imaging features, we have tried to emphasize the clinical
implications of MRI fi ndings and the way in which they may affect patient management and
treatment. Common diagnostic dilemmas, such as benign versus malignant vertebral fracture
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and treated inactive marrow versus residual active disease, are addressed in separate chapters.
With the help of key points highlighting the most important information and a large number of
richly annotated fi gures, we hope to make the challenging task of bone marrow MRI interpre-
tation a little bit easier for the reader and as exciting as it is for us.
Lia Angela Moulopoulos
Vassilis Koutoulidis
Acknowledgments
We would like to thank the following:
Our families for their love and understanding and for putting up with us during our intermi-
nable preoccupation with “The Book.”
T he MRI technologists at our institution (Miltiadis Ioannidis, Maria Roussaki, Virginia
Mantikou) for their commitment and excellent work.
T he clinical staff in the Department of Clinical Therapeutics—Division of Hematology/
Oncology of the University of Athens School of Medicine led by Professor Meletios A.
Dimopoulos for their hard work and support.
From Springer, Antonella Cerri for embracing our project with enthusiasm and conviction,
Andrea Ridolfi for his expert assistance and encouragement during the writing of the book,
and Magesh Rajagopalan and Sushil Kumar Sharma for a fi rst-rate production job.
And, lastly:
L AM wishes to thank VK, a challenging and inspiring partner for all those shared moments of
creative thinking and fun.
VK would like to thank LAM: a mentor, a friend, and the best writing partner he could ever
hope for.
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