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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Dec 28, 2015; 7(12): 448-458
Published online Dec 28, 2015. doi: 10.4329/wjr.v7.i12.448
Magnetic resonance imaging of the spinal marrow: Basic understanding of the normal marrow pattern and its variant
Mohamed Ragab Nouh, Ahmed Fathi Eid
Mohamed Ragab Nouh, Faculty of Medicine, Alexandria University, Alexandria 21563, Egypt
Ahmed Fathi Eid, National Guard hospital, Al Ehsa 31982, Eastern Provience, Saudi Arabia
Author contributions: Nouh MR had the idea of the manuscript, reviewed the literature, drafted the manuscript and supplied some of the figures; Eid AF supplied some of the figures, critically reviewed the manuscript; Both authors approved the manuscript in its current final form.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mohamed Ragab Nouh, MD, Assistant Professor of radiology and clinical imaging, Faculty of Medicine, Alexandria University, 1 Kolyat El-Teb Street, Mahata El-Ramel, Alexandria 21563, Egypt. mragab73@yahoo.com
Telephone: +20-111-6590365
Received: June 2, 2015
Peer-review started: June 5, 2015
First decision: August 8, 2015
Revised: September 29, 2015
Accepted: October 23, 2015
Article in press: October 27, 2015
Published online: December 28, 2015
Processing time: 208 Days and 17 Hours
Abstract

For now, magnetic resonance (MR) is the best noninvasive imaging modality to evaluate vertebral bone marrow thanks to its inherent soft-tissue contrast and non-ionizing nature. A daily challenging scenario for every radiologist interpreting MR of the vertebral column is discerning the diseased from normal marrow. This requires the radiologist to be acquainted with the used MR techniques to judge the spinal marrow as well as its normal MR variants. Conventional sequences used basically to image marrow include T1W, fat-suppressed T2W and short tau inversion recovery (STIR) imaging provides gross morphological data. Interestingly, using non-routine MR sequences; such as opposed phase, diffusion weighted, MR spectroscopy and contrasted-enhanced imaging; may elucidate the nature of bone marrow heterogeneities; by inferring cellular and chemical composition; and adding new functional prospects. Recalling the normal composition of bone marrow elements and the physiologic processes of spinal marrow conversion and reconversion eases basic understanding of spinal marrow imaging. Additionally, orientation with some common variants seen during spinal marrow MR imaging as hemangiomas and bone islands is a must. Moreover, awareness of the age-associated bone marrow changes as well as changes accompanying different variations of the subject’s health state is essential for radiologists to avoid overrating normal MR marrow patterns as pathologic states and metigate unnecessary further work-up.

Keywords: Magnetic resonance imaging; Normal; Spinal; Marrow; Variants

Core tip: Magnetic resonance (MR) remains the ideal noninvasive imaging modality to evaluate vertebral bone marrow. Radiologists have to be aware by age-associated bone marrow changes as well as changes accompanying different variations of the subject’s health state. Moreover, acquaintation with the used MR techniques, their privileges and limitations, in evaluation of spinal marrow is a prime requirement for radiologist to discern the normal spinal marrow as well as its variants from diseased one.