Nouh Mohamed Ragab, Eid Ahmed Fathi
Mohamed Ragab Nouh, Faculty of Medicine, Alexandria University, Alexandria 21563, Egypt.
World J Radiol. 2015 Dec 28;7(12):448-58. doi: 10.4329/wjr.v7.i12.448.
For now, magnetic resonance (MR) is the best noninvasive imaging modality to evaluate vertebral bone marrow thanks to its inherent soft-tissue contrast and non-ionizing nature. A daily challenging scenario for every radiologist interpreting MR of the vertebral column is discerning the diseased from normal marrow. This requires the radiologist to be acquainted with the used MR techniques to judge the spinal marrow as well as its normal MR variants. Conventional sequences used basically to image marrow include T1W, fat-suppressed T2W and short tau inversion recovery (STIR) imaging provides gross morphological data. Interestingly, using non-routine MR sequences; such as opposed phase, diffusion weighted, MR spectroscopy and contrasted-enhanced imaging; may elucidate the nature of bone marrow heterogeneities; by inferring cellular and chemical composition; and adding new functional prospects. Recalling the normal composition of bone marrow elements and the physiologic processes of spinal marrow conversion and reconversion eases basic understanding of spinal marrow imaging. Additionally, orientation with some common variants seen during spinal marrow MR imaging as hemangiomas and bone islands is a must. Moreover, awareness of the age-associated bone marrow changes as well as changes accompanying different variations of the subject's health state is essential for radiologists to avoid overrating normal MR marrow patterns as pathologic states and metigate unnecessary further work-up.
目前,由于其固有的软组织对比度和非电离特性,磁共振成像(MR)是评估椎体骨髓的最佳非侵入性成像方式。对于每位解读脊柱MR的放射科医生来说,每天都面临的一个具有挑战性的情况是区分病变骨髓和正常骨髓。这要求放射科医生熟悉所使用的MR技术,以便判断脊髓以及其正常的MR变异情况。基本用于骨髓成像的传统序列包括T1加权成像(T1W)、脂肪抑制T2加权成像(fat-suppressed T2W)和短tau反转恢复(STIR)成像,可提供大体形态学数据。有趣的是,使用非常规MR序列,如反相位成像、扩散加权成像、磁共振波谱成像和对比增强成像,通过推断细胞和化学成分,并增加新的功能前景,可能有助于阐明骨髓异质性的本质。回顾骨髓成分的正常构成以及脊髓转化和再转化的生理过程,有助于对脊髓成像有基本的理解。此外,了解脊髓MR成像中一些常见的变异情况,如血管瘤和骨岛,也是必不可少的。此外,放射科医生必须了解与年龄相关的骨髓变化以及伴随受试者健康状态不同变化的情况,以避免将正常的MR骨髓模式过度评估为病理状态,并避免不必要的进一步检查。