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[Incidental bone marrow findings]
Simone Schüle, Carsten Hackenbroch1
1Klinik für Radiologie und Neuroradiologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland. carstenhackenbroch@bundeswehr.org.
Background:
Bone marrow incidentalomas are being detected with increasing frequency due to the growing use of magnetic resonance imaging (MRI). It is essential to distinguish benign from malignant lesions that require further investigation.
Objectives:
The aim is to describe the imaging characteristics to facilitate the practical differentiation between malignant and benign incidental findings in bone marrow.
Methods:
A narrative literature review focusing on a pattern-based approach to the spinal and extraspinal skeleton.
Results:
The signal characteristics, morphology, and location of the bone marrow incidentaloma are crucial for classifying the lesion. In the spine, classifying the lesion as diffuse, focal, microfocal, or regional helps limit the differential diagnoses. Osteolytic lesions are hypointense on T1w- and hyperintense on T2w-imaging; sclerotic lesions are signal-free on all sequences; and fatty lesions are hyperintense on both T1w- and T2w-imaging. The presence of micro- or macroscopic fat within a lesion is a criterion for benignity.
Conclusion:
By using a few MRI sequences and correlating them with X‑ray and computed tomography (CT) images, it is possible to reliably classify incidental bone marrow lesions.
