1. RADIOLOGIC CASE STUDY FOR DIFFUSERED MARROW HYPERPLASIA OF-SPINE- PELVIS- FEMUR

2. PATIENTS PROFILE,RECORD,AND COMPLAINAGE: 45 YEARS OLDGENDER: FEMALECOMPLAIN: HIP PAIN (LEFT SIDE)RADIOGRAPHS RESULTS: HIPS AND PELVIS -UNREMARKABLEMRI DIAGNOSIS: DIFFUSE RED MARROW HYPERPLASIA OF SPINE PELVISAND FEMURDIFFERENTIAL DIAGNOSIS: INLCUDES MARROW INFLITRATING TUMORSUCH AS LYMPHOMA OR LEUKEMIASAGGITAL MRI (LUMBAR SPINE) DIFFUSE DECREASE SIGNAL INTENSITYON T1 AND SLIGHTLY DECREASED MARROW SIGNAL INTENSITY ON T2.CORONAL MRI (PELVIS) T1 DEMONSTRATES DECREASE DIFFUSE MARROWSIGNALS WITHIN THE LUMBAR SPINE ILIAC BONES AND PROXIMALFEMUR.T2 DEMOSTRATES SLIGHTLY DECREASE MARROW SIGNALINTENSITY AND CORONAL S.T.I.R IMAGE SHOWS MILD INCREASE SIGNALINTENSITY WITHIN MARROW OF LUMBAR SPINE VERTEBRAL BODIES ILIACWINGS PROXIMAL FEMURS 3. AFTER 3 MONTHSFOLLOW UP MRI (LUMBAR SPINE &PELVIS= NO CHANGEPERFORMED BONE MARROW BIOPSY =REVEALED HYPERCELLULAR MARROWERYTHROID HYPERPLASIAThe MR signal characteristics of normalmarrow reflect the typical distribution of redand yellow marrow. 4. Tl -weighted spin-echo images, yellow marrow has a highsignal intensity, similar to subcutaneous fat. On conventionalspinecho T2-weighted sequences, yellow marrow demonstrates intermediate signal intensity, and on fast spin echo T2weighted sequences, signal intensity is high. Yellow marrow is dark on fat-suppressed sequences (spectral Fat saturation or STIR)On Tl -weighted sequences, red marrow signal intensity islower than that of yellow marrow but generally higher thanthat of muscles or intervertebral disks. On T2-weighted spin- echo and fast spin-echo sequences, red marrow signalintensity is slightly lower than that of yellow marrow.On fatsuppressed images, red marrow exhibits an intermediate to high signal intensity, significantly brighterthan yellow marrow. Yellow marrow demonstrates nosignificant enhancement following gadolinium administration,while red marrow may exhibit mild to moderateenhancement.1,2 The normal MR appearance of bone marrowand normal distribution of red and yellow marrow depends on age. 5. In the adult,medullary cavity = approximately 50% yellow marrowand 50% by red marrow.Yellow marrow consist of: FAT80%WATER 15% PROTEIN 5% while red marrow contains: 40%FATWATER40% PROTEIN 20% 6. FROM RED TO YELLOW! WHAT,HOW &WHEREWHAT: With increasing age, red marrow is progressively replaced with yellowmarrow in the peripheral skeleton, and the proportion of fat cells in red marrow inthe axial skeleton progressively increases.HOW: Marrow conversion begins within the terminal phalanges shortly beforebirth and proceeds to more proximal portions of the appendicular skeleton. Withineach bone,WHERE: marrow conversion usually begins around the centrally locateddiaphyseal vessels and proceeds outward. The adult pattern of marrowdistribution is generally attained by 25 years, with a red marrow situated in theaxial skeleton, sternum, ribs, and proximal aspects of the femurs andhumeri.1,3,4 With aging, the fatty content of cellular marrow continues toincrease. MRL 7. BONE MARROW PATTERNSThe MR appearance of normal marrow has a fairly wide spectrum:in the spine, Ricci described four common patterns of red andyellow marrow distribution, ranging from fatty marrow confined tolinear areas along the basivertebral vein to band-like and triangularareas of fatty marrow to multiple large areas of fatty marrow.Similar patterns were noted in the Pelvic bones. Preservation ofred marrow in the proximal femurs and humeri is generally moreprominent in women, at least until menopause. Magneticresonance imaging is very sensitive for detection of marrowabnormalities. 8. THE BRILLIANT MIND...Vande Berg - devel oped an el ement ar y cl assi f i cat i onsyst em of bone m r ow l esi ons accor di ng t o t hei rarpat hophysi ol ogi c m echani sms. Bone m r ow edem and arai schem a al so can occur . M r ow abnor m i t i es seen iar ali nci dent al l y on spi ne or ext r em t y MiRI not r esul t i ngf r om t r aum or avascul ar necr osi s gener al l y ei t herar epr esent r econver si on or i nf i l t r at i on, andunf or t unat el y t he M appear ance of t hese ent i t i es canRbe si m l ar on Tl - wei ght ed i m i ages.RECONVERSION Descr i bes r ed m r ow hyper pl asi a or t he ari nf i l t r at i on of yel l ow m r ow by nor mar al r ed m r owarcel l s.IN FILTRATION Or Repl acement i s caused by i nvasi on ofm r ow space by neopl ast i c or i nf l am at or y cel l s.ar mMYELOID D LETION descr i bes depl et i on of EPhem opoi et i c r ed m r ow cel l s at ar 9. HOW COULD YOU DO THAT TO ME? Red marrow hyperplasia is presumably a reaction to a physiologicstress. Its prevalence varies from 0.7%-35% and is seen morefrequently in women.911 It has been associated with heavy smoking,long distance running, obesity, and anorexia.912 Red marrowhyperplasia may result from tissue hypoxia in smokers due toincreased levels of carboxyhemoglobin and from anemia in long distance runners due to chronic mechanical thrombolysis, althoughthe frequency of marrow hyperplasia in runners is higher than the frequency of anemia.7 This case illustrates typicai findings of redmarrow hyperplasia. 10. Magnetic resonance imaging demonstrates diffuse decreasedsignal intensity on Tl weighted images and mild increased signalintensity on STIR images within the marrow of lumbar vertebral bodies, iliac bones, and proximal femurs. The appearance ofmarrow on Tl weighted images is abnormal, but the signal intensityis higher than adjacent vertebral disks and skeletal muscle. Signal intensity of marrow is not significantly increased on T2-weightedimages and is mildly increased On STIR images, consistent with the appearance of red marrow. The MR findings did not changeover a 3month interval in this patient. Clinically, she remains ingood health, with no known malignancy and an MR diagnosis of red marrow hyperplasia. 11. END THEN...By:RENZ ROGER FUERTEBARRY ROSIL