MyPACS.net: Radiology Teaching Files > Case 5323940

never visited MEDULLARY BONE INFARCT
Contributed by: Radiology Residency Program Faculty & Staff.
Patient: 40 year old male
History: 40 year old male with chronic left knee pain.
Images:[small]larger

Fig. 1: AP: Intramedullary patchy lucent areas and sclerosis in proximal tibial metaphysis

Fig. 2: Lateral: Intramedullary patchy lucent areas and sclerosis in proximal tibial metaphysis

Fig. 3: Coronal T1: Geographic lesion with serpentine low signal intensity margins

Fig. 4: Sagittal PD: Characteristic "double line sign" of decreased signal intensity periphery with adjacent hyperintense inner border

Fig. 5: Coronal Fat Sat T2: chronic medullary infarct with lack of internal edema

Fig. 6: Axial Fat Sat T2: chronic medullary infarct with lack of internal edema
Findings:

Xray: intramedullary patchy lucent areas and sclerosis in proximal tibial metaphysis

MR: Within the proximal tibial metaphysis there is an intramedullary geographic lesion with serpentine low-signal intensity margins on T1, and a "double-line sign" of decreased signal intensity periphery with adjacent hyperintense inner border on T2.

Diagnosis: Medullary Bone Infarct
Discussion:

Medullary Bone Infarct

- Ischemic death of cellular elements of bone and marrow

Radiographic Findings:
Epiphysis: arc-like, subchondral, lucent lesion +/- areas of patchy bone loss mixed with sclerotic areas
Diametaphysis: sheetlike lucency surrounded by shell-like sclerosis and/or calcification and periostitis

CT Findings:
NECT:
- Serpiginous outline
- Increased density

MR Findings:
T1WI:
- Serpiginous lines of decreased signal intensity
- Edema: Moderate decrease in signal intensity

T2WI:
- Double line sign of decreased signal intensity periphery with adjacent increased signal intensity inner border
- Acute infarct as a less well-defined area of edema within cancellous bone

PD/Intermediate:
- Generally same as T2, but less sensitive for edema
- Less sensitive for sclerosis compared to T1WI
- To evaluate overlying chondral surfaces in subarticular infarcts

STIR:
- More hyperintense periphery; less spacial resolution than FS PD FSE

T2* GRE:
- Double line sign
- Edema may be obscured because of susceptibility

T1 C+:
- Peripheral rim of reactive tissue may enhance

Nuclear Medicine Findings:
Bone Scan:
- "Cold spot" (no uptake) in region of disrupted blood supply
- Uptake in acute cases where revascularization has occured (nonspecific and somewhat diffuse)

Differential Diagnosis:
Osteoarthritis
Enchondroma
Healing NOF
OCD
Normal Marrow

References:

Stoller, David W. ... [et al.] Diagnostic Imaging: Orthopaedics. Amirsys, 2004.

Submitted by:
Aakash D. Singh, M.D. - PGY-V Radiology Resident
Joseph A. Mendiola, M.D. - Radiologist

Comments:
No comments posted.
Additional Details:

Case Number: 5323940Last Updated: 07-13-2006
Anatomy: Skeletal System   Pathology: Hematological
Modality: Conventional Radiograph, MRExam Date: 02-27-2006Access Level: Readable by all users
Keywords: medullary bone infarct, double line sign

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