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Review
. 2007 Dec;36(12):1109-19.
doi: 10.1007/s00256-007-0323-5. Epub 2007 Jun 7.

Whole-body imaging of the musculoskeletal system: the value of MR imaging

Gerwin P Schmidt  1 , Maximilian F Reiser, Andrea Baur-Melnyk
Affiliations
Review

Whole-body imaging of the musculoskeletal system: the value of MR imaging

Gerwin P Schmidt et al. Skeletal Radiol. 2007 Dec.

Abstract

In clinical practice various modalities are used for whole-body imaging of the musculoskeletal system, including radiography, bone scintigraphy, computed tomography, magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET-CT). Multislice CT is far more sensitive than radiographs in the assessment of trabecular and cortical bone destruction and allows for evaluation of fracture risk. The introduction of combined PET-CT scanners has markedly increased diagnostic accuracy for the detection of skeletal metastases compared with PET alone. The unique soft-tissue contrast of MRI enables for precise assessment of bone marrow infiltration and adjacent soft tissue structures so that alterations within the bone marrow may be detected before osseous destruction becomes apparent in CT or metabolic changes occur on bone scintigraphy or PET scan. Improvements in hard- and software, including parallel image acquisition acceleration, have made high resolution whole-body MRI clinically feasible. Whole-body MRI has successfully been applied for bone marrow screening of metastasis and systemic primary bone malignancies, like multiple myeloma. Furthermore, it has recently been proposed for the assessment of systemic bone diseases predisposing for malignancy (e.g., multiple cartilaginous exostoses) and muscle disease (e.g., muscle dystrophy). The following article gives an overview on state-of-the-art whole-body imaging of the musculoskeletal system and highlights present and potential future applications, especially in the field of whole-body MRI.

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Figures

Fig. 1
Fig. 1
A 60-year-old patient with a malignant melanoma. a Coronal T1-weighted turbo spin echo (TSE) whole-body (WB) magnetic resonance imaging (MRI) indicates multifocal metastatic disease of the liver (arrow). b Whole-body positron emission tomography-computed tomography (PET-CT) shows multiple areas of pathologic [18F]-fluorodeoxyglucose (FDG)-uptake in the right atrium (arrow), the liver (arrowheads), and in the right iliac bone (arrowhead). c Contrast-enhanced CT reveals a metastasis within the right atrium. d T1-weighted TSE WB-MRI confirms a hypointense lesion in the right iliac bone indicating bone metastasis. e Axial fat-saturated contrast-enhanced MRI of the pelvis shows another bone metastasis in the right sacral bone (arrow). f, g The corresponding CT images in the bone window setting show extensive osteolysis within the right iliac bone; however, no morphologic changes are found in the right sacral bone
Fig. 2
Fig. 2
A 28-year-old man with non-Hodgkin’s lymphoma. a Coronal whole-body STIR imaging shows suspect areas with hyperintense signal in the right clavicular region and both iliac bones. b Magnification shows a mass extending from the right clavicular fossa and infiltrating the right apical thoracic cage. c The lesion shows a pathological FDG uptake in PET-CT, indicating malignancy. d The T1-weighted sagittal image of the spine shows extensive multifocal lymphoma manifestations. e PET-CT underestimates the degree of tumor involvement by showing tracer uptake only in the thoraco-lumbar region
Fig. 3
Fig. 3
A 70-year-old man with multiple myeloma. a The radiograph of the pelvis is inconspicuous. b Coronal MS-CT reconstruction of the pelvis in a bone window setting reveals a large area of destruction within the left iliac bone (arrow). c) STIR-WB-MRI confirms focal tumor manifestation within the iliac bone (arrow) and reveals multiple small nodular infiltrations within the sacral bone and pelvis. d MS-CT of the spine shows a compression fracture of Th9. e, f T1-weighted SE- and STIR imaging of the spine reveals diffuse myeloma infiltration of the spine. g Coronal STIR sequences of the pelvis show additional focal infiltration of the left femoral head missed on radiography and MS-CT
Fig. 4
Fig. 4
a Whole-body MRI of a 60-year-old man suffering from severe progressive muscle dystrophy, symmetrically affecting the muscles of the rib cage, abdomen, pelvis, and lower extremities. b WB-STIR shows signs of diffuse reactive edematous processes in the left upper thighs and muscles of the distal lower limbs. c, d T1-weighted imaging displays fatty tissue replacement affecting most of the muscles of the pelvis. Residual adductor muscle tissue is shown with high contrast due to its hypointense signal. e Progressive muscle dystrophy has also occurred in the lower extremities, affecting all compartments
Fig. 5
Fig. 5
A 35-year-old man with multiple cartilaginous exostoses. a, b Whole-body MRI shows typical manifestations in the metaphyseal parts of the long bones of the upper and lower extremities. c Enlargement of the left knee joint shows an exostosis at the medial side of the femur and at the proximal tibia. d Deformation of the radius. e Exostoses and deformation of both femoral necks. In summary, no indications of malignant transformation (e.g., widening of the cartilaginous cap) were found in this patient
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