I am trying to understand the marrow signal alteration that is more apparent on PDFS than PD images, and really not visible on T1W…predominantly within the posterior femoral condyles in a 62F who fell 2.5 months ago.She has a previously undiagnosed healing patellar fracture and a known ipsilateral acetabular fracture (not shown)
Is this a normal marrow pattern with disuse osteoporosis?
The shape of the signal changes kind of looks infarction-ish in the Cor, but that doesn’t make sense…
I am confused that the T1 marrow signal is not decreased at all
I think it’s a spectacular case of disuse osteoporosis. And a great history to explain it. This is described as a confluent regions of increased signal on fluid sensitive sequences and nodular (or regional) trabecular resorption, replaced with fat on T1. It lingers for months and maybe years after weight bearing was resumed.
The three landmark papers on the topic that put the pieces together for me were:
Nardo L, Sandman DN, Virayavanich W, Zhang L, Souza RB, Steinbach L, Guindani M, Link TM. Bone marrow changes related to disuse. Eur Radiol. 2013 Dec;23(12):3422-31. doi: 10.1007/s00330-013-2943-6. Epub 2013 Jul 7. PMID: 23832388; PMCID: PMC4026184.
de Abreu MR, Wesselly M, Chung CB, Resnick D. Bone marrow MR imaging findings in disuse osteoporosis. Skeletal Radiol. 2011 May;40(5):571-5. doi: 10.1007/s00256-010-1042-x. Epub 2010 Oct 16. PMID: 20953606.
Vande Berg BC, Mourad C, Omoumi P, Malghem J. Magnetic Resonance Imaging of Accelerated Bone Remodeling. Semin Musculoskelet Radiol. 2023 Feb;27(1):114-123. doi: 10.1055/s-0043-1761611. Epub 2023 Mar 3. PMID: 36868249.
Just came across an example of the same phenomenon in the ankle of a 59M 6 weeks after bad ankle sprain (images below). We see this all the time in the subacute time frame after injury. As Phil Tirman says, “you may not have seen it, but it has seen you.”
Sorry to reply all…but I respectfully disagree….Andy, you are not in my head or my eyeballs…
I see the changes in this ankle MRI all of the time and recognize them for what they are…..would not have wasted anyone’s time with findings that are demonstrated in this ankle MRI.
I thought the knee case was less uniform subchondral / periarticular…and seemed to be pretending to be shaped a bit like an infarct in the posterior femoral condyle—-what confused me was the normal T1 signal.
I think Bruno’s article does a bit of a deeper dive on the changes which are “occult on T1”.
It’s a good read.
This article was shared with me….by someone who didn’t realize she had a patellar fracture to explain her pain.
I wonder if this is an early infarct when T1 is still not affected much. Especially if pt has no other reason for pain in the knee. Take a look at this article: https://pmc.ncbi.nlm.nih.gov/articles/PMC6440034/
It’s most notable for one of the best names ever
The “birth of death”: MRI step-by-step reveals the early appearance of a bone marrow infarct