The Open Orthopaedics Journal




ISSN: 1874-3250 ― Volume 12, 2018
RESEARCH ARTICLE

Diffuse Appearance of Red Bone Marrow on MRI Mimics Cancer Metastasis and Might be Associated with Heavy Smoking



Akio Sakamoto1, *, Bungo Otsuki1, Takeshi Okamoto1, Takayuki Goto2, Tetsuro Yoshimura3, Shuichi Matsuda1
1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, 606-8507, Kyoto, Japan
2 Department of Urology Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, 606-8507, Kyoto, Japan
3 Shinyukuhashi Hospital, Fukuoka, Japan

Abstract

Background:

Red bone marrow develops early in life and converts into yellow bone marrow with aging. Reconversion occurs when yellow bone marrow reconverts into red bone marrow due to increased oxygen demands.

Objective:

Diffuse appearance of red bone marrow on Magnetic Resonance Imaging (MRI) is rarely encountered.

Materials and Methods:

Seven patients, five male and two female, with the diffuse appearance of red bone marrow were evaluated. The average age was 71.4 (47-86) years old. All patients had been referred based on a working diagnosis of cancer metastasis. All patients were eventually rediagnosed with bone marrow reconversion.

Results:

Spinal MRI was evaluated in all patients, including the whole spine in four patients and lumbar spine in three patients. Six patients had slight anemia or close to the lower limit of normal hemoglobin (within 1mg/dl). Six patients were heavy smokers, having more than 20 cigarettes per day. Four patients had a history of stomach or bladder cancer (2 cases each). MRI revealed red bone marrow with a diffuse appearance and low signal intensity on T1- and T2-weighted images. Compared with the spinal cord/conus, the red bone marrow appeared isointense in about half of the cases, and in the other cases, the intensities were either slightly high or low. The signal of yellow bone marrow was isointense with the retroperitoneal fat.

Conclusion:

Diffuse red marrow can be difficult to differentiate from cancer metastasis. Compared to the MRI, signal intensity of the cord/conus is useful in the diagnosis of red marrow. Slight anemia may also be present. Heavy smoking might be related to the appearance of diffuse red marrow.

Keywords: Bone marrow, Red marrow, Yellow marrow, Hematopoietic, Smoking, Magnetic resonance imaging.


Article Information


Identifiers and Pagination:

Year: 2018
Volume: 12
First Page: 451
Last Page: 461
Publisher Id: TOORTHJ-12-451
DOI: 10.2174/1874325001812010451

Article History:

Received Date: 27/4/2018
Revision Received Date: 26/10/2018
Acceptance Date: 28/10/2018
Electronic publication date: 27/11/2018
Collection year: 2018

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© 2018 Sakamoto et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan; Tel: +81-75-751-3366; E-mail: akiosaka@kuhp.kyoto-u.ac.jp


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