Patel Paras,  Amar Jaspreet,  Poletto Erica

Final Pr. ID: Poster #: EDU-070

Marrow signal changes in the pediatric population are often complex and can appear nonspecific to the inexperienced radiologist. Normal physiological marrow changes from birth to adulthood play a confounding role. A good understanding for diffuse marrow replacing processes that demonstrate T1 hypointense signal on MRI is crucial for the radiologist to correctly identify pathology, provide early and pathology-specific treatment, and ultimately play a profound role in patient care. The purpose of this educational exhibit is to review the various pathological etiologies of diffuse T1 hypointense marrow signal changes in the pediatric patient, including sickle cell anemia, gaucher’s disease, leukemia, diffuse marrow metastasis, osteomyelitis, thalassemia, juvenile inflammatory arthritis, and bone marrow edema syndromes. Additionally, potential pitfalls will be discussed including red marrow hyperplasia, treatment related changes, immobilization/stress reaction, and normal residual red marrow. Case examples will be provided along with pearls that will aid the radiologist in narrowing their differential diagnosis when faced with specific clinical scenarios. Read More

Authors:  Patel Paras , Amar Jaspreet , Poletto Erica

Keywords:  Bone, Marrow, Pathological

Pace Erika,  Clarke Enrico,  Mandeville Henry,  De Souza Nandita

Final Pr. ID: Paper #: 149

To measure and compare early (within 3 months) and late (beyond 3 months) changes in ADC of the clival marrow post-photon and proton therapy. Read More

Authors:  Pace Erika , Clarke Enrico , Mandeville Henry , De Souza Nandita

Keywords:  bone marrow, radiotherapy, proton beam therapy

Pace Erika,  Vaidya Sucheta,  De Souza Nandita

Final Pr. ID: Paper #: 150

To measure early (within 3 months) and late (beyond 3 months) changes in ADC of the lumbosacral vertebral marrow following chemotherapy in children with abdomino-pelvic neoplasms and interpret them in the context of ADC measurement reproducibility. Read More

Authors:  Pace Erika , Vaidya Sucheta , De Souza Nandita

Keywords:  bone marrow, chemotherapy, abdomino-pelvic neoplasm

Miller Stephen,  Scrugham Jeffrey,  Pivnick Eniko

Final Pr. ID: Poster #: CR-080

Congenital generalized lipodystrophy, also known as Berardinelli-Seip syndrome, is a rare autosomal recessive disorder associated with osteosclerosis and cystic intramedullary bone lesions. However, the transition from generalized osteosclerosis in the young patient to the development of cystic intramedullary bone lesions in areas converting from red to yellow marrow in the growing child has not been previously described. We present a young man with congenital generalized lipodystrophy, followed in our clinic from age 5 years through age 14 years, and document the development over time of dramatic cystic lesions within previously sclerotic long bones. The location of these intramedullary bone cysts appears to mirror the transition of red (hematopoietic) to yellow (fatty) marrow in the maturing child. Recognition of this pattern may affect recommended physical activity and subsequent orthopedic management. Read More

Authors:  Miller Stephen , Scrugham Jeffrey , Pivnick Eniko

Keywords:  lipodystrophy, bone cyst, marrow

Alis Jonathan,  Levin Terry,  Kurian Jessica,  Mahadeo Kris,  Taragin Benjamin

Final Pr. ID: Poster #: EDU-092

Sickle Cell Disease (SCD) affects approximately 100,000 individuals in the US. Despite medical advances, morbidity is high and their lifespan remains shortened. Hematopoietic stem cell transplantation (HSCT) is the only curative treatment to date and as outcomes improve its use has increased. Complications of HSCT are frequent and some literature suggests there is a higher incidence in the SCD population. In addition, preexisting vasculopathy in this population may contribute to an increased incidence of post-transplant CNS toxicity. We present the imaging findings of HCST complications in children with SCD. Read More

Authors:  Alis Jonathan , Levin Terry , Kurian Jessica , Mahadeo Kris , Taragin Benjamin

Keywords:  Graft versus host disease, bone marrow transplant, HSCT

Degnan Andrew,  Serai Suraj,  Ho-fung Victor,  Barrera Christian,  Wang Dah-jyuu,  Ahrens-nicklas Rebecca,  Ficicioglu Can

Final Pr. ID: Poster #: EDU-057

Gaucher disease is an inherited metabolic disorder due deficiency of the lysosomal enzyme β-glucocerebrosidase that results in the accumulation of abnormal macrophages (“Gaucher cells”) within multiple organs, most conspicuously affecting the liver, spleen and bone marrow. As the diagnosis is increasingly made during childhood and young adulthood, pediatric radiologists should be familiar with imaging features of Gaucher disease and its complications.

Visceromegaly consisting of hepatosplenomegaly is a hallmark of Gaucher disease and uniformly present in cohorts of pediatric patients. In addition, bone marrow involvement with ‘Erlenmeyer flasks’ have been long recognized as part of this disease, although the classic radiographic finding is not present until adulthood. Marrow involvement confers significant morbidity for these patients with pain, bone infarcts and pathologic fracture.

Traditionally, imaging of disease severity has been based on hepatic and splenic visceral organ enlargement and/or qualitative assessment of bone marrow involvement. However, advances in the understanding of Gaucher disease and observations of elevated ferritin levels and increased risk of hepatic fibrosis emphasize the importance of more comprehensive assessment of liver involvement beyond simple enlargement. Moreover, quantitative MRI assessment of bone fat-fractions also may have a role in assessing marrow involvement. These methods of disease assessment are important in addressing management decisions regarding enzyme replacement and substrate reduction therapy. Read More

Authors:  Degnan Andrew , Serai Suraj , Ho-fung Victor , Barrera Christian , Wang Dah-jyuu , Ahrens-nicklas Rebecca , Ficicioglu Can

Keywords:  Gaucher disease, bone marrow, hepatic involvement

Medina Perez Mariangeles,  Gupta Saurabh,  Salastekar Ninad,  Badar Zain,  Majmudar Anand

Final Pr. ID: Poster #: EDU-059

Bone marrow is composed of fat and cellular elements supported by the trabecular bone. Pathological lesions of the bone marrow usually replace its normal constituent to a variable degree. Differentiation among traumatic, neoplastic, and inflammatory processes of the bone marrow is often not possible with MRI, which commonly requires the patient to undergo additional invasive diagnostic procedures to obtain an accurate diagnosis.

In-phase and opposed-phase imaging has been used extensively in imaging of the liver and adrenal glands. However, recently it has been introduced into the evaluation of the bone marrow. The technique takes advantage of different excitation frequencies of water and fat protons due to differences in their molecular environments. The main concept is that the presence of normal bone marrow would result in suppression of signal intensity on the opposed-phase images. In the presence of infiltration lesions of the bone marrow, normal fat-containing marrow will be replaced with neoplastic cells and result in lack of suppression on the opposed-phase images.

The main teaching purpose of this exhibit will be to demonstrate, by a pictorial case-based review, the appearance of multiple cases of biopsy-proven infiltrating lesions of the bone marrow, and emphasize how they can be differentiated from other traumatic or inflammatory processes.
Read More

Authors:  Medina Perez Mariangeles , Gupta Saurabh , Salastekar Ninad , Badar Zain , Majmudar Anand

Keywords:  In-phase, opposed-phase, marrow

Raissaki Maria,  Demetriou Stelios,  Skiadas Christos,  Spanakis Kostas,  Stratigaki Maria,  Katzilakis Nikos,  Stiakaki Eftichia,  Karantanas Apostolos

Final Pr. ID: Poster #: EDU-012

There are various conditions or diseases that may cause multiple bone marrow lesions in children or adolescents. Radiographically, lytic lesions may become apparent after loss of >50% of bone mineral content. Scintigraphy requires osteoblastic activity and is not specific. MRI has been increasingly employed for the investigation of diseases that involve the skeleton and for further delineation of radiographic findings in symptomatic children.
Purpose: To describe the MRI findings of entities resulting in multiple bone marrow lesions in children and provide a wide differential diagnosis. Read More

Authors:  Raissaki Maria , Demetriou Stelios , Skiadas Christos , Spanakis Kostas , Stratigaki Maria , Katzilakis Nikos , Stiakaki Eftichia , Karantanas Apostolos

Keywords:  bone marrow, polyostotic, multifocal bone lesions, mri

Kelleher Michael

Final Pr. ID: Poster #: EDU-035

The purpose of this educational exhibit is to describe the most common pediatric bone marrow patterns, including normal variants and common pathology. Read More

Authors:  Kelleher Michael

Keywords:  MR, Bone marrow

Samet Jonathan,  Schafernak Kristian,  Arva Nicoleta,  Deng Jie

Final Pr. ID: Poster #: SCI-049

MRI interpretation of pediatric bone marrow is a challenging task due to the highly variable appearance. The bone marrow composition, especially the cellularity, changes with age, benign and malignant hematologic conditions, medications, among other etiologies. Detection of a marrow replacement process on MRI can be missed even by experienced radiologists. Normal hematopoietic bone marrow from birth to 9 years ranges from 20-40% fat (inversely related to cellularity). In malignant marrow replacement processes such as leukemia, bone marrow is highly cellular and fat percentage is low. Currently, no technique is routinely used in clinical practice to quantify bone marrow fat percentage on MRI. Read More

Authors:  Samet Jonathan , Schafernak Kristian , Arva Nicoleta , Deng Jie

Keywords:  Bone Marrow, Fat fraction, leukemia

Pace Erika,  De Souza Nandita

Final Pr. ID: Paper #: 151

To establish the reproducibility of the apparent diffusion coefficient (ADC) measurement in the bone marrow of the clivus and lumbosacral spine. Read More

Authors:  Pace Erika , De Souza Nandita

Keywords:  bone marrow, reproducibility, apparent diffusion coefficient