1. To describe the typical features of normal bone marrow.
2. To determine origin of bone marrow changes.
3. To present the imaging characteristics of a bone marrow disease of the different types.
Bone marrow consists of trabecular bone, a stroma of connective tissue, hematopoietic cells (red marrow) and fat (yellow marrow). Distribution of red and yellow marrow is age-dependent, with gradual conversion of red to yellow marrow in the limbs during childhood, and patchy heterogeneity in the spine in the elderly patient. There are many causes of reconversion from yellow to red bone marrow, like smoking, long distance running, obesity, anaemia, erythropoietin, etc. Depletion may occur in aplastic anaemia and after radiation therapy. Gelatinous transformation is seen in anorexia nervosa, cachexia, HIV and after successful therapy in multiple myeloma. Bone infarction and avascular necrosis are well-delineated areas of dead bone marrow. The value of different imaging techniques, including plain radiography, (dual-energy)-CT, bone scintigraphy, PET and the most sensitive technique, MRI (conventional T1, T2, fat suppression techniques, in-phase, out-phase and diffusion imaging), will be explained. The imaging characteristics of many diseases will be reviewed (diffuse bone marrow replacement in hematologic diseases, multiple myeloma, metastases; treatment-related changes of bone marrow, primary bone tumors, and multiple causes of bone marrow edema, like bone contusion, stress fracture, insufficiency fracture, Modic changes, spondylodiscitis, osteomyelitis, abscess, arthritis and specific bone tumors).
1. To determine the origin of a soft tissue tumour (e.g. fat, neural, vascular, etc.).
2. To present current imaging techniques for evaluation of soft tissue tumours.
3. To discuss the imaging findings which are important for the diagnosis of soft tissue tumours.
All imaging modalities can play a role in the diagnosis and management of soft tissue tumours and pseudotumours with a variable contributory performance to both sensitivity and specificity. MRI steals the show with an unparalleled role in soft tissue assessment ranging from detection, localisation, characterisation, identifying multiple lesions, other syndrome stigmata, the probability of benignity/malignancy, local staging and recurrence identification. Sonography does have a supporting role especially in the initial assessment of the likelihood of cystic/benign/abnormal malignant Colour Doppler flow patterns. This presentation aims to provide a distillation of the knowledge regarding soft tissue tumour imaging which can be applied in practice using a stepwise analytical approach. Despite an overwhelming spectrum of potential histological diagnosis, the radiologist needs to remember that eight benign and six malignant lesions account for 80% of all soft tissue tumours.
1. To review the classification of bone tumours.
2. To present current imaging techniques for evaluation of bone tumours.
3. To describe the typical features of common bone tumours.
Bone sarcomas are rare (0.2% of all neoplasms, annual incidence in Europe is 0.8 per 100.000 population), in contrast to benign bone tumours and the so-called tumour-like lesions. The incidence of these benign entities is relatively high, but not known exactly as these are often asymptomatic. The WHO (version 2013) classified benign and malignant bone tumours in 13 main categories; chondrogenic, osteogenic, fibrogenic, fibrohistiocytic, hematopoietic, osteoclastic giant cell rich, notochordal, vascular, myogenic, lipogenic, undefined neoplastic nature and miscellaneous tumours. Each category is further subdivided into 1-14 tumour types. Imaging plays an important role in diagnosis, monitoring therapy, staging, and detecting recurrent disease. Diagnosis is mainly based on conventional radiography using morphologic appearance in combination with location, and age. Advanced imaging techniques are used for local staging (MR), detection of metastases (chest CT), monitoring therapy (MR, ultra-sound, PET-CT), detecting recurrence (MR, ultra-sound, PET-CT). Typical imaging features based on the WHO classification system will be presented with a focus on conventional radiography, common tumours, and relevance.