Vertebral Body, T1 Hyperintense Signal, Diffuse
Kevin R. Moore, MD
DIFFERENTIAL DIAGNOSIS
Common
Post-Irradiation Vertebral Marrow
Normal Variant
Heterogeneous Fatty Marrow
Osteoporosis
Less Common
Hemangiomas (Multiple)
Paget Disease
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Establish whether pattern is diffusely hyperintense marrow signal or multiple foci of hyperintensity within more cellular marrow
Helpful Clues for Common Diagnoses
Post-Irradiation Vertebral Marrow
Diffuse hyperintense fatty marrow signal intensity within correct clinical context
Look for abrupt sharp demarcation between hyperintense fatty marrow and lower signal intensity normal marrow at peripheral margin of radiation field
Normal Variant
Normal marrow complement of fat and cellular elements
More frequently seen in older patients
Heterogeneous Fatty Marrow
Multiple patchy areas of fat signal intensity within multiple vertebral bodies
More frequently seen in older patients
Osteoporosis
Decreased cellular marrow elements with proportionally greater marrow fat content
Osteopenia on CT or plain radiography may help assist diagnosis
Helpful Clues for Less Common Diagnoses
Hemangiomas (Multiple)
Fatty stroma within well-delineated benign indolent vertebral body tumors
Rarely a diagnostic dilemma
Distinct fat signal intensity masses within more conventional appearing marrow distinguishes from diffuse hyperintensity of fatty marrow involving entirety of vertebral body marrow
Paget Disease
Fibrovascular marrow in active phase
Heterogeneous but predominantly hypointense on T1WI MR, hyperintense on T2WI MR
Interspersed foci of fatty marrow
Post-gadolinium enhancement helps distinguish from diffuse fatty marrow
Fatty marrow in mixed phase
Hyperintense on T1WI and T2WI MRRelated posts:
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