Incidentally Detected Bone Marrow Reconversion in a large Prospective Adult Cohort on Routine MRI lumbar Spine: Unmasking the Underlying Etiology

Dr. Gopinathan Kathirvelu; Dr. Prasanna Parthasarathy; Dr. Alamelu Mahalingam

Volume : VIII, Issue : II, February - 2019

Incidentally Detected Bone Marrow Reconversion in a large Prospective Adult Cohort on Routine MRI lumbar Spine: Unmasking the Underlying Etiology

Dr. Gopinathan Kathirvelu, Dr. Prasanna Parthasarathy, Dr. Alamelu Mahalingam

Abstract :

PURPOSE: The purpose of this study was to evaluate the incidence and various etiologies of the incidentally detected abnormal bone marrow signal changes of reconversion on routine lumbar MRI spine examinations and to determine the prevalence of subsequent oncologic and non-oncologic diagnosis. MATERIAL AND METHODS: MR images of the lumbar spine of 998 patients with lower back pain obtained between July 2015 and December 2016 were analyzed prospectively. MRI studies were reviewed for bone marrow signal changes of the verteae for marrow reconversion. The patients with marrow reconversion changes in lumbar spine were checked for Vitamin D levels, reviewed with whole spine imaging to look for changes in cervical and dorsal spine, and sacroiliac joints. RESULTS: Of the 220 patients with marrow reconversion changes who fulfilled the inclusion criteria,66 (29.5%)patients had subclinical vitamin D deficiency,26(12%) patients had imaging features suggestive of tuberculosis in spine, 23(10%) patients had findings of sacroiliitis, 89(40.04%) were found to be normal & 17(8%) cases had metastasis /multiple myeloma. CONCLUSION: The knowledge of the normal and abnormal signal intensities of bone marrow on MRI lumbar spine imaging is mandatory to decide what is potentially pathologic and what is not. We conclude that any signal alteration on MRI spine in bone marrow should not be ignored. Altered marrow signal particularly homogenous hypointensity on T1-W imaging of lumbar spine is one of the indicator of subclinical vitamin D deficiency. Routine measurement of blood vitamin D levels and screening of whole spine is suggested to evaluate for the underlying cause for the incidental finding of marrow reconversion.