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Spine
Diagnosis
Spine Postprocedural Imaging
Post Radiation and Chemotherapy Complications
Postirradiation Vertebral Marrow
Postirradiation Vertebral Marrow
Kevin R. Moore, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Transformation of cellular vertebral marrow into fatty marrow following therapeutic irradiation

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Nuclear Medicine Findings

                        • Other Modality Findings

                          • Imaging Recommendations

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Caranci F et al: Magnetic resonance imaging correlates of benign and malignant alterations of the spinal bone marrow. Acta Biomed. 89(1-S):18-33, 2018
                                              2. Meixel AJ et al: From radiation osteitis to osteoradionecrosis: incidence and MR morphology of radiation-induced sacral pathologies following pelvic radiotherapy. Eur Radiol. 28(8):3550-9, 2018
                                              3. Yoo HJ et al: Measurement of fat content in vertebral marrow using a modified dixon sequence to differentiate benign from malignant processes. J Magn Reson Imaging. 45(5):1534-44, 2017
                                              4. Escalas C et al: [Long-term effects of radiation on the spine - results of a cohort of symptomatic survivors of childhood and review of the literature.] Bull Cancer. 102(7-8):684-90, 2015
                                              5. Carmona R et al: Fat composition changes in bone marrow during chemotherapy and radiation therapy. Int J Radiat Oncol Biol Phys. 90(1):155-63, 2014
                                              6. Bolan PJ et al: Water-fat MRI for assessing changes in bone marrow composition due to radiation and chemotherapy in gynecologic cancer patients. J Magn Reson Imaging. 38(6):1578-84, 2013
                                              7. Hwang S et al: Magnetic resonance imaging of bone marrow in oncology, Part 2. Skeletal Radiol. 36(11):1017-27, 2007
                                              8. Tall MA et al: MR imaging of the spinal bone marrow. Magn Reson Imaging Clin N Am. 15(2):175-98, vi, 2007
                                              9. Foster K et al: MRI of the marrow in the paediatric skeleton. Clin Radiol. 59(8):651-73, 2004
                                              10. Shih WJ et al: Tc-99m depreotide SPECT demonstrates photon-deficiency in the thoracic vertebrae after adjunct radiation therapy of lung cancer: correlation with MRI and bone scintigraphy. Ann Nucl Med. 17(3):245-8, 2003
                                              11. Otake S et al: Radiation-induced changes in MR signal intensity and contrast enhancement of lumbosacral vertebrae: do changes occur only inside the radiation therapy field? Radiology. 222(1):179-83, 2002
                                              12. Onu M et al: Early MR changes in vertebral bone marrow for patients following radiotherapy. Eur Radiol. 11(8):1463-9, 2001
                                              13. Meyer MA et al: Reduced F-18 fluorodeoxyglucose uptake within marrow after external beam radiation. Clin Nucl Med. 25(4):279-80, 2000
                                              14. Blomlie V et al: Female pelvic bone marrow: serial MR imaging before, during, and after radiation therapy. Radiology. 194(2):537-43, 1995
                                              15. Cavenagh EC et al: Hematopoietic marrow regeneration in pediatric patients undergoing spinal irradiation: MR depiction. AJNR Am J Neuroradiol. 16(3):461-7, 1995
                                              16. Steiner RM et al: Magnetic resonance imaging of diffuse bone marrow disease. Radiol Clin North Am. 31(2):383-409, 1993
                                              17. Yankelevitz DF et al: Effect of radiation therapy on thoracic and lumbar bone marrow: evaluation with MR imaging. AJR Am J Roentgenol. 157(1):87-92, 1991
                                              18. Stevens SK et al: Early and late bone-marrow changes after irradiation: MR evaluation. AJR Am J Roentgenol. 154(4):745-50, 1990
                                              19. Casamassima F et al: Hematopoietic bone marrow recovery after radiation therapy: MRI evaluation. Blood. 73(6):1677-81, 1989
                                              20. Naul LG et al: Avascular necrosis of the vertebral body: MR imaging. Radiology. 172(1):219-22, 1989
                                              21. Rosenthal DI et al: Fatty replacement of spinal bone marrow due to radiation: demonstration by dual energy quantitative CT and MR imaging. J Comput Assist Tomogr. 13(3):463-5, 1989
                                              22. Shih WJ et al: Thoracic vertebral photopenia may predict fatty changes of the corresponding bone marrow following irradiation. Radiat Med. 7(1):32-5, 1989
                                              23. Ramsey RG et al: MR imaging of the spine after radiation therapy: easily recognizable effects. AJR Am J Roentgenol. 144(6):1131-5, 1985
                                              24. Maldague BE et al: The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology. 129(1):23-9, 1978
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Definitions

                                                            • Transformation of cellular vertebral marrow into fatty marrow following therapeutic irradiation

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Nuclear Medicine Findings

                                                                    • Other Modality Findings

                                                                      • Imaging Recommendations

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Caranci F et al: Magnetic resonance imaging correlates of benign and malignant alterations of the spinal bone marrow. Acta Biomed. 89(1-S):18-33, 2018
                                                                                          2. Meixel AJ et al: From radiation osteitis to osteoradionecrosis: incidence and MR morphology of radiation-induced sacral pathologies following pelvic radiotherapy. Eur Radiol. 28(8):3550-9, 2018
                                                                                          3. Yoo HJ et al: Measurement of fat content in vertebral marrow using a modified dixon sequence to differentiate benign from malignant processes. J Magn Reson Imaging. 45(5):1534-44, 2017
                                                                                          4. Escalas C et al: [Long-term effects of radiation on the spine - results of a cohort of symptomatic survivors of childhood and review of the literature.] Bull Cancer. 102(7-8):684-90, 2015
                                                                                          5. Carmona R et al: Fat composition changes in bone marrow during chemotherapy and radiation therapy. Int J Radiat Oncol Biol Phys. 90(1):155-63, 2014
                                                                                          6. Bolan PJ et al: Water-fat MRI for assessing changes in bone marrow composition due to radiation and chemotherapy in gynecologic cancer patients. J Magn Reson Imaging. 38(6):1578-84, 2013
                                                                                          7. Hwang S et al: Magnetic resonance imaging of bone marrow in oncology, Part 2. Skeletal Radiol. 36(11):1017-27, 2007
                                                                                          8. Tall MA et al: MR imaging of the spinal bone marrow. Magn Reson Imaging Clin N Am. 15(2):175-98, vi, 2007
                                                                                          9. Foster K et al: MRI of the marrow in the paediatric skeleton. Clin Radiol. 59(8):651-73, 2004
                                                                                          10. Shih WJ et al: Tc-99m depreotide SPECT demonstrates photon-deficiency in the thoracic vertebrae after adjunct radiation therapy of lung cancer: correlation with MRI and bone scintigraphy. Ann Nucl Med. 17(3):245-8, 2003
                                                                                          11. Otake S et al: Radiation-induced changes in MR signal intensity and contrast enhancement of lumbosacral vertebrae: do changes occur only inside the radiation therapy field? Radiology. 222(1):179-83, 2002
                                                                                          12. Onu M et al: Early MR changes in vertebral bone marrow for patients following radiotherapy. Eur Radiol. 11(8):1463-9, 2001
                                                                                          13. Meyer MA et al: Reduced F-18 fluorodeoxyglucose uptake within marrow after external beam radiation. Clin Nucl Med. 25(4):279-80, 2000
                                                                                          14. Blomlie V et al: Female pelvic bone marrow: serial MR imaging before, during, and after radiation therapy. Radiology. 194(2):537-43, 1995
                                                                                          15. Cavenagh EC et al: Hematopoietic marrow regeneration in pediatric patients undergoing spinal irradiation: MR depiction. AJNR Am J Neuroradiol. 16(3):461-7, 1995
                                                                                          16. Steiner RM et al: Magnetic resonance imaging of diffuse bone marrow disease. Radiol Clin North Am. 31(2):383-409, 1993
                                                                                          17. Yankelevitz DF et al: Effect of radiation therapy on thoracic and lumbar bone marrow: evaluation with MR imaging. AJR Am J Roentgenol. 157(1):87-92, 1991
                                                                                          18. Stevens SK et al: Early and late bone-marrow changes after irradiation: MR evaluation. AJR Am J Roentgenol. 154(4):745-50, 1990
                                                                                          19. Casamassima F et al: Hematopoietic bone marrow recovery after radiation therapy: MRI evaluation. Blood. 73(6):1677-81, 1989
                                                                                          20. Naul LG et al: Avascular necrosis of the vertebral body: MR imaging. Radiology. 172(1):219-22, 1989
                                                                                          21. Rosenthal DI et al: Fatty replacement of spinal bone marrow due to radiation: demonstration by dual energy quantitative CT and MR imaging. J Comput Assist Tomogr. 13(3):463-5, 1989
                                                                                          22. Shih WJ et al: Thoracic vertebral photopenia may predict fatty changes of the corresponding bone marrow following irradiation. Radiat Med. 7(1):32-5, 1989
                                                                                          23. Ramsey RG et al: MR imaging of the spine after radiation therapy: easily recognizable effects. AJR Am J Roentgenol. 144(6):1131-5, 1985
                                                                                          24. Maldague BE et al: The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology. 129(1):23-9, 1978