Friday, February 14, 2014

Age related changes of Spinal Bone Marrow in T1 MRI



·   Human beings are born with red / hematopoietic marrow in their entire skeleton, which gets gradually replaced by fat as age progresses, and reaches the mature state by the age of 25years.
·          
    In adult pattern the red marrow is seen in the axial skeleton and proximal appendicular skeleton.
·          
    The red / hematopoietic marrow SI in neonates may be slightly lower than that of the skeletal muscle; thereafter marrow the signal intensity increases. So if the Marrow SI is found to be lower than of the normal skeletal muscle it almost always indicate a marrow pathology.
·           
    Under 40yrs of age, the axial skeleton contains fat only at the basivertebral vein region.
·          
    The replacement of the red to yellow marrow can occur in 3 patterns :
1.      Bandlike pattern along the endplate.
2.      Small foci of replacement.
3.      Larger globular areas of fatty replacement.
·              
    Near complete fatty replacement may be seen in some elderly patients and in cases of malnutrition or osteoporosis.
·           
    Conditions increasing the need for hematopoiesis like Chronic hypoxia, Anemia etc can cause reversal of fatty replcament, back to red marrow. These are usually seen as patches of T1 hypointensity.
·          

In cases of Sickle cell disease where the yellow marrow,can convert back to red marrow OR may never convert Yellow.
     
    The red marrow contains 40% of fat and yellow marrow contains 80% of fat !!!


      Ref  : AJR article MRI of spinal bone marrow -Part I. 2011.

Sunday, February 9, 2014

The Chiari I Malformation


The main finding in Chiari Type I malformation is the Cerebellar Tonsillar Descent, resulting in the synonym of Congenital Tonsillar Ectopia. The measurements of the Clival length, Supraocciput, the tentorial slope and the Tonsillar Descent have been depicted in these following images.




MEASUREMENT OF CLIVAL LENGTH






MEASUREMENT OF THE SLOPE OF TENTORIUM




MEASUREMENT OF THE SUPRAOCCIPUT




Associated Syringomyelia in the lower cervical and upper thoracic spinal cord.


MEASUREMENT OF THE TONSILLAR DESCENT from the McRae's Line







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