Abstract
Bone marrow necrosis (BMN) is usually associated with malignancies and is characterized by multiple geographic signal abnormalities on magnetic resonance imaging (MRI). We report a 28-year-old female with BMN and underlying diffuse large B-cell lymphoma. Diffuse abnormal signal intensities through the vertebral column were demonstrated on her pretreatment MRI, and the diagnosis of BMN was challenging. Positron emission tomography/computed tomography (PET/CT) for lymphoma staging showed multiple decreased or absent 18F-fluorodeoxyglucose (18F-FDG) uptake within the vertebrae and pelvis. Marrow biopsy pathological examination showed lymphoma infiltration and massive necrosis. On the follow-up MRI obtained approximately 21 months after the PET/CT scan, multiple geographic abnormal signal intensities were detected within the vertebral column and were consistent with the areas of decreased 18F-FDG uptake on PET/CT. This case indicates that 18F-FDG PET/CT is helpful in the diagnosis of BMN with atypical MRI appearances.
Keywords:
Bone marrow necrosis, lymphoma, 18F-FDG PET/CT, MRI
Ethics
Informed Consent: The written informed consent has been obtained from the patient.
Authorship Contributions
Surgical and Medical Practices: L.S., Concept: W.Z., Design: W.Z., Data Collection or Processing: L.S., H.L., Analysis or Interpretation: L.S., W.Z., Literature Search: L.S., H.L., Writing: L.S.
Conflict of Interest: No conflicts of interest were declared by the authors.
Financial Disclosure: The authors declare that this study has received no financial support.
References
1Janssens AM, Offner FC, Van Hove WZ. Bone marrow necrosis. Cancer. 2000;88:1769-1780.
2Murphy PT, Sivakumaran M, Casey MC, Liddicoat A, Wood JK. Lymphoma associated bone marrow necrosis with raised anticardiolipin antibody. J Clin Pathol. 1998;51:407-409.
3Carloss H, Winslow D, Kastan L, Yam LT. Bone marrow necrosis. Diagnosis and assessment of extent of involvement by radioisotope studies. Arch Intern Med. 1977;137:863-866.
4Navari RM, Carter J, Hillman RS. Bone marrow necrosis in acute leukemia. Acta Haematol. 1983;69:158-163.
5Cowan JD, Rubin RN, Kies MS, Cerezo L. Bone marrow necrosis. Cancer. 1980;46:2168-2171.
6Weissman DE, Negendank WG, al-Katib AM, Smith MR. Bone marrow necrosis in lymphoma studied by magnetic resonance imaging. Am J Hematol. 1992;40:42-46.
7Tang YM, Jeavons S, Stuckey S, Middleton H, Gill D. MRI features of bone marrow necrosis. AJR Am J. Roentgenol. 2007;188:509-514.
8Dong P, Tian R, Li L, Su M. Bone marrow necrosis secondary to metastatic adenocarcinoma revealed by 18F-FDG PET/CT: A clinical case report. Medicine (Baltimore). 2017;96:e9067.
