The Many Faces of Marrow Necrosis

Depending on the age and location within the skeleton, bone marrow can be mostly fatty or hematopoietic, and both types can be affected by marrow necrosis. This review article highlights the magnetic resonance imaging findings of disorders in which marrow necrosis is the dominant feature.Fatty marrow necrosis is detected on T1-weighted images that show an early and specific finding: the reactive interface. Collapse is a frequent complication of epiphyseal necrosis and detected on fat-suppressed fluid-sensitive sequences or using conventional radiographs. Nonfatty marrow necrosis is less frequently diagnosed. It is poorly visible on T1-weighted images, and it is detected on fat-suppressed fluid-sensitive images or by the lack of enhancement after contrast injection.Pathologies historically misnamed as osteonecrosis but do not share the same histologic or imaging features of marrow necrosis are also highlighted.

Automated summary

Depending on the age and location within the skeleton, bone marrow can be mostly fatty or hematopoietic, and both types can be affected by marrow necrosis.Fatty marrow necrosis is detected by a specific finding on T1-weighted images, while collapse is a common complication of epiphyseal necrosis and can be detected through various imaging techniques. Nonfatty marrow necrosis is less frequently diagnosed and is poorly visible on T1-weighted images, but can be detected on fluid-sensitive images or by lack of enhancement after contrast injection. Pathologies historically misnamed as osteonecrosis but do not share the same features as marrow necrosis are also highlighted.