Presentation
Back pain for months.
Patient Data
MRI shows L1 and L2 vertebral bodies collapse.
Bone marrow is diffusely and uniformly hypointense on T1W and hyperintense on STIR. At this age, the red marrow should be replaced by the yellow one, indicated by the fatty signal in the bone marrow. This case shows the conversion of the normal yellow marrow into the red marrow. Note that on STIR, bone marrow also has higher signal intensity than skeletal muscle.
Case Discussion
This case was misdiagnosed as benign vertebral body collapse due to osteopenia on the initial report. But after consulting with other doctors, the diffuse abnormality of vertebral body signal on MRI scanning of the spine may suggest bone marrow replacement in hematological pathology.
The patient was later confirmed to have acute myeloid leukemia (AML) by the bone marrow biopsy test.
Musculoskeletal involvement of hematological neoplasm is characterized by bone marrow infiltration. The signal of red marrow replaces the yellow (fatty) signal of bone marrow. These changes are diffuse but can be easily overlooked.
The diffuse low T1W signal with vertebral body collapse is crucial and must be considered carefully. Leukemic bone marrow infiltration is an important differential diagnosis to consider in the situation of vertebra plana.
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