%0 Journal Article
%T The ˇ°birth of deathˇ±: MRI step-by-step reveals the early appearance of a bone marrow infarct
%A Elie Barakat
%A Frederic E. Lecouvet
%A Fr¨¦d¨¦ric Houssiau
%A Nathalie Guischer
%J Archive of "Acta Radiologica Open".
%D 2019
%R 10.1177/2058460119834691
%X The magnetic resonance imaging (MRI) appearance of an ˇ°establishedˇ± bone marrow infarct is well-known, consisting of an area of preserved bone marrow signal surrounded by a serpiginous line. We report the uncommon observation of the very early phases of appearance of a bone marrow infarct, showing its progressive de novo appearance on MR images paralleling clinical symptoms and high-dose systemic steroid administration in a young female patient, presenting with acute knee pain. The initial knee MR examination performed one week after pain onset showed no abnormality. One week later, a second examination showed subtle ill-defined dotted signal abnormalities of the bone marrow of uncertain significance, of high signal on PDFS sequences. A third MR study obtained again one week later showed more evident findings with confluence of the high signal ˇ°dotsˇ± into a serpiginous line with a geographical appearance of the lesion, corresponding to the typical MRI presentation of bone marrow infarcts. Follow-up MRI at seven weeks showed definitive stability of this bone marrow infarct. A whole-body MRI performed for whole skeleton screening revealed multiple bone marrow infarcts typical for systemic avascular necrosis. This case represents a novel observation of the ˇ°birthˇ± of a bone marrow infarct, from early intriguing changes to its typical ring-shaped appearance on MR images. It also reminds of the key role of MRI for early diagnosis of bone marrow infarcts and illustrates the emerging role of whole-body MRI for the detection of multifocal, asymptomatic skeletal involvement by ischemic lesions in systemic osteonecrosis
%K Bone marrow
%K infarcts
%K magnetic resonance imaging
%K MRI
%K knee
%K corticosteroids
%U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440034/