Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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MR Imaging Features of Pediatric Bone Marrow

소아 골수의 MR 영상 소견

  • Arim Yeom (Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • So-Young Yoo (Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Tae Yeon Jeon (Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Jieun Park (Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Ji Hye Kim (Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center)
  • 염아림 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 유소영 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 전태연 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 박지은 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 김지혜 (성균관대학교 의과대학 삼성서울병원 영상의학과)
  • Received : 2024.03.09
  • Accepted : 2024.05.16
  • Published : 2024.05.01
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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 age-related 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.

MRI는 골수의 평가에 있어 가장 예민도가 높은 검사로서 골수 질환의 진단에 있어 매우 중요한 역할을 한다. 그러나, 소아 영상을 자주 접하지 않는 영상의학과 의사들에게는 종종 정상 골수와 병적 골수의 구분이 어려울 수 있고, 소아의 흔한 악성질환인 백혈병이나 신경모세포종의 전이 등 골수를 침범하는 질환들이 임상적으로 다양한 근골격계 증상으로 발현하여 근골격 MRI 검사를 통해 진단되기도 한다. 소아에서 시행되는 MRI를 정확하게 판독하려면 골수의 정상 구성 성분에 대한 이해뿐만 아니라 나이에 따른 골수의 변화(age-related developmental change)와 소아에서 흔하게 골수를 침범하는 질환들에 대한 이해가 중요하다. 본 종설에서는 정상 골수의 구성과 소아 골수의 정상 및 비정상 MRI 소견을 기술하고 백혈병, 신경모세포종의 전이 등의 악성 골수 질환을 중심으로 임상 증례들을 고찰하고자 한다.

Keywords

References

  1. Chiarilli MG, Delli Pizzi A, Mastrodicasa D, Febo MP, Cardinali B, Consorte B, et al. Bone marrow magnetic resonance imaging: physiologic and pathologic findings that radiologist should know. Radiol Med 2021;126:264-276 
  2. Travlos GS. Normal structure, function, and histology of the bone marrow. Toxicol Pathol 2006;34:548-565 
  3. Chan BY, Gill KG, Rebsamen SL, Nguyen JC. MR imaging of pediatric bone marrow. Radiographics 2016;36:1911-1930 
  4. Augusto ACL, Goes PCK, Flores DV, Costa MAF, Takahashi MS, Rodrigues ACO, et al. Imaging review of normal and abnormal skeletal maturation. Radiographics 2022;42:861-879 
  5. Wang H, Leng Y, Gong Y. Bone marrow fat and hematopoiesis. Front Endocrinol (Lausanne) 2018;9:694 
  6. Foster K, Chapman S, Johnson K. MRI of the marrow in the paediatric skeleton. Clin Radiol 2004;59:651-673 
  7. Burdiles A, Babyn PS. Pediatric bone marrow MR imaging. Magn Reson Imaging Clin N Am 2009;17:391-409 
  8. Maˊlkiewicz A, Dziedzic M. Bone marrow reconversion - imaging of physiological changes in bone marrow. Pol J Radiol 2012;77:45-50 
  9. Hwang S, Panicek DM. Magnetic resonance imaging of bone marrow in oncology, part 1. Skeletal Radiol 2007;36:913-920 
  10. Gonzalez FM, Mitchell J, Monfred E, Anguh T, Mulligan M. Knee MRI patterns of bone marrow reconversion and relationship to anemia. Acta Radiol 2016;57:964-970 
  11. Aparisi Gomez 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 
  12. Shah LM, Hanrahan CJ. MRI of spinal bone marrow: part I, techniques and normal age-related appearances. AJR Am J Roentgenol 2011;197:1298-1308 
  13. Hanrahan CJ, Shah LM. MRI of spinal bone marrow: part 2, T1-weighted imaging-based differential diagnosis. AJR Am J Roentgenol 2011;197:1309-1321 
  14. Hynes JP, Hughes N, Cunningham P, Kavanagh EC, Eustace SJ. Whole-body MRI of bone marrow: a review. J Magn Reson Imaging 2019;50:1687-1701 
  15. van Vucht N, Santiago R, Lottmann B, Pressney I, Harder D, Sheikh A, et al. The Dixon technique for MRI of the bone marrow. Skeletal Radiol 2019;48:1861-1874 
  16. Del Grande F, Santini F, Herzka DA, Aro MR, Dean CW, Gold GE, et al. Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system. Radiographics 2014;34:217-233 
  17. Winfeld M, Ahlawat S, Safdar N. Utilization of chemical shift MRI in the diagnosis of disorders affecting pediatric bone marrow. Skeletal Radiol 2016;45:1205-1212 
  18. Maeder Y, Dunet V, Richard R, Becce F, Omoumi P. Bone marrow metastases: T2-weighted Dixon spin-echo fat images can replace T1-weighted spin-echo images. Radiology 2018;286:948-959 
  19. Resnick D, Kang HS, Pretterklieber ML. Internal derangements of joints. 2nd ed. Philadelphia: Saunders/Elsevier 2007:231-257 
  20. Nguyen JC, Davis KW, Arkader A, Guariento A, Sze A, Hong S, et al. 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 
  21. Averill LW, Acikgoz G, Miller RE, Kandula VV, Epelman M. Update on pediatric leukemia and lymphoma imaging. Semin Ultrasound CT MR 2013;34:578-599 
  22. Vesterby A, Myhre Jensen O. Aseptic bone/bone marrow necrosis in leukaemia. Scand J Haematol 1985;35:354-357 
  23. Hwang S, Panicek DM. Magnetic resonance imaging of bone marrow in oncology, part 2. Skeletal Radiol 2007;36:1017-1027 
  24. Nies BA, Kundel DW, Thomas LB, Freireich EJ. Leukopenia, bone pain, and bone necrosis in patients with acute leukemia: a clinicopathologic complex. Ann Intern Med 1965;62:698-705 
  25. Tannenbaum MF, Noda S, Cohen S, Rissmiller JG, Golja AM, Schwartz DM. Imaging musculoskeletal manifestations of pediatric hematologic malignancies. AJR Am J Roentgenol 2020;214:455-464 
  26. Saifuddin A, Tyler P, Rajakulasingam R. Imaging of bone marrow pitfalls with emphasis on MRI. Br J Radiol 2023;96:20220063 
  27. DuBois SG, Kalika Y, Lukens JN, Brodeur GM, Seeger RC, Atkinson JB, et al. Metastatic sites in stage IV and IVS neuroblastoma correlate with age, tumor biology, and survival. J Pediatr Hematol Oncol 1999;21:181-189 
  28. Parmar R, Wadia F, Yassa R, Zenios M. Neuroblastoma: a rare cause of a limping child. How to avoid a delayed diagnosis? J Pediatr Orthop 2013;33:e45-e51 
  29. Chu CM, Rasalkar DD, Hu YJ, Cheng FW, Li CK, Chu WC. Clinical presentations and imaging findings of neuroblastoma beyond abdominal mass and a review of imaging algorithm. Br J Radiol 2011;84:81-91 
  30. Hirano N, Goto H, Suenobu S, Ihara K. Bone marrow metastasis of neuroblastoma mimicking purulent osteomyelitis. Jpn J Clin Oncol 2020;50:1227-1228 
  31. Orr KE, McHugh K. The new international neuroblastoma response criteria. Pediatr Radiol 2019;49:1433-1440 
  32. Nour-Eldin NE, Abdelmonem O, Tawfik AM, Naguib NN, Klingebiel T, Rolle U, et al. Pediatric primary and metastatic neuroblastoma: MRI findings: pictorial review. Magn Reson Imaging 2012;30:893-906 
  33. Kwee TC, Kwee RM, Verdonck LF, Bierings MB, Nievelstein RA. Magnetic resonance imaging for the detection of bone marrow involvement in malignant lymphoma. Br J Haematol 2008;141:60-68 
  34. Kaste SC. Imaging pediatric bone sarcomas. Radiol Clin North Am 2011;49:749-765, vi-vii 
  35. Kim JR, Yoon HM, Koh KN, Jung AY, Cho YA, Lee JS. Rhabdomyosarcoma in children and adolescents: patterns and risk factors of distant metastasis. AJR Am J Roentgenol 2017;209:409-416 
  36. Taoka T, Mayr NA, Lee HJ, Yuh WT, Simonson TM, Rezai K, et al. Factors influencing visualization of vertebral metastases on MR imaging versus bone scintigraphy. AJR Am J Roentgenol 2001;176:1525-1530 
  37. Person A, Janitz E, Thapa M. Pediatric bone marrow: normal and abnormal MRI appearance. Semin Roentgenol 2021;56:325-337 
  38. Walter WR, Goldman LH, Rosenberg ZS. Pitfalls in MRI of the developing pediatric ankle. Radiographics 2021;41:210-223