Semin Musculoskelet Radiol 2011; 15(3): 269-280
DOI: 10.1055/s-0031-1278426
© Thieme Medical Publishers

Musculoskeletal Manifestations of Chronic Anemias

Carlo Martinoli1 , Lorenzo Bacigalupo2 , Gian Luca Forni3 , Manuela Balocco3 , Giacomo Garlaschi1 , Alberto Tagliafico4
  • 1Radiologia–DISC, Università di Genova, Genoa, Italy
  • 2Reparto di Radiologia, Genoa, Italy
  • 3Reparto di Ematologia–Ospedali Galliera, Genoa, Italy
  • 4Radiologia–National Institute for Cancer Research, Genoa, Italy
Further Information

Publication History

Publication Date:
03 June 2011 (online)

ABSTRACT

This article provides an overview of the current use of diagnostic imaging modalities in the evaluation of a heterogeneous group of disorders causing chronic anemias by impaired blood cell production (inherited bone marrow failure syndromes of childhood, aplastic anemia and myelodysplastic syndromes, β-thalassemia) or increased blood cell destruction (sickle cell disease). During the course of these disorders, various musculoskeletal abnormalities can be encountered, including marrow hyperplasia, reversion of yellow marrow to red marrow, growth disturbances, and, occasionally, extramedullary hematopoiesis. Diagnostic imaging may help the clinician to identify specific complications related to either the disease (e.g., bone infarction and acute osteomyelitis in sickle cell disease) or transfusion (e.g., iron overload due to increased hemolysis) and iron chelation (e.g., desferrioxamine-related dysplastic bone changes and deferiprone-related degenerative arthritis) treatments. In this field, magnetic resonance imaging plays a pivotal role because of its high tissue contrast that enables early assessment of bone marrow changes before they become apparent on plain films or computed tomography or metabolic changes occur on bone scintigraphy or positron emission tomography scan. Overall, familiarity with the range of radiological appearances in chronic anemias is important to diagnose complications and establish appropriate therapy.

REFERENCES

  • 1 Burdiles A, Babyn P S. Pediatric bone marrow MR imaging.  Magn Reson Imaging Clin N Am. 2009;  17 (3) 391-409 v
  • 2 Deely D M, Schweitzer M E. MR imaging of bone marrow disorders.  Radiol Clin North Am. 1997;  35 (1) 193-212
  • 3 Steiner R M, Mitchell D G, Rao V M, Schweitzer M E. Magnetic resonance imaging of diffuse bone marrow disease.  Radiol Clin North Am. 1993;  31 (2) 383-409
  • 4 Gilkeson R C, Basile V, Sands M J, Hsu J T. Chest case of the day. Extramedullary hematopoiesis (EMH).  AJR Am J Roentgenol. 1997;  169 (1) 267 270-273
  • 5 Ejindu V C, Hine A L, Mashayekhi M, Shorvon P J, Misra R R. Musculoskeletal manifestations of sickle cell disease.  Radiographics. 2007;  27 (4) 1005-1021
  • 6 Dooms G C, Fisher M R, Hricak H, Richardson M, Crooks L E, Genant H K. Bone marrow imaging: magnetic resonance studies related to age and sex.  Radiology. 1985;  155 (2) 429-432
  • 7 Cristy M. Active bone marrow distribution as a function of age in humans.  Phys Med Biol. 1981;  26 (3) 389-400
  • 8 Kricun M E. Red-yellow marrow conversion: its effect on the location of some solitary bone lesions.  Skeletal Radiol. 1985;  14 (1) 10-19
  • 9 Price E A, Mehra R, Holmes T H et al.. Anemia in older persons: etiology and evaluation.  Blood Cells Mol Dis. 2011;  46 (2) 159-165
  • 10 Dokal I, Vulliamy T. Inherited bone marrow failure syndromes.  Haematologica. 2010;  95 (8) 1236-1240
  • 11 Juhl J H, Wesenberg R L, Gwinn J L. Roentgenographic findings in Fanconi's anemia.  Radiology. 1967;  89 (4) 646-653
  • 12 Minagi H, Steinbach H L. Roentgen appearance of anomalies associated with hypoplastic anemias of childhood: Fanconi's anemia and congenital hypoplastic anemia (erythrogenesis imperfecta).  Am J Roentgenol Radium Ther Nucl Med. 1966;  97 (1) 100-109
  • 13 Barrett J, Saunthararajah Y, Molldrem J. Myelodysplastic syndrome and aplastic anemia: distinct entities or diseases linked by a common pathophysiology?.  Semin Hematol. 2000;  37 (1) 15-29
  • 14 Kaplan P A, Asleson R J, Klassen L W, Duggan M J. Bone marrow patterns in aplastic anemia: observations with 1.5-T MR imaging.  Radiology. 1987;  164 (2) 441-444
  • 15 McKinstry C S, Steiner R E, Young A T, Jones L, Swirsky D, Aber V. Bone marrow in leukemia and aplastic anemia: MR imaging before, during, and after treatment.  Radiology. 1987;  162 (3) 701-707
  • 16 Tefferi A, Vardiman J W. Myelodysplastic syndromes.  N Engl J Med. 2009;  361 (19) 1872-1885
  • 17 Lewis S, Wainscoat J S, Moore N R, Golding S J. Magnetic resonance imaging in myelodysplastic syndromes.  Br J Radiol. 1995;  68 (806) 121-127
  • 18 Kusumoto S, Jinnai I, Matsuda A et al.. Bone marrow patterns in patients with aplastic anaemia and myelodysplastic syndrome: observations with magnetic resonance imaging.  Eur J Haematol. 1997;  59 (3) 155-161
  • 19 Cazzola M, Della Porta M G, Malcovati L. Clinical relevance of anemia and transfusion iron overload in myelodysplastic syndromes.  Hematology (Am Soc Hematol Educ Program). 2008;  166-175
  • 20 Kuzmich P V, Ecker G A, Karsh J. Rheumatic manifestations in patients with myelodysplastic and myeloproliferative diseases.  J Rheumatol. 1994;  21 (9) 1649-1654
  • 21 George S W, Newman E D. Seronegative inflammatory arthritis in the myelodysplastic syndromes.  Semin Arthritis Rheum. 1992;  21 (6) 345-354
  • 22 Nam E J, Kang Y M, Kang H R et al.. Rheumatoid arthritis associated with myelodysplastic syndrome: a case report.  J Korean Med Sci. 1999;  14 (3) 319-322
  • 23 Chandran G, Ahern M J, Seshadri P, Coghlan D. Rheumatic manifestations of the myelodysplastic syndromes: a comparative study.  Aust N Z J Med. 1996;  26 (5) 683-688
  • 24 Cooley T B, Witwer E R, Lee P. Anemia in children with splenomegaly and peculiar changes in the bones.  Am J Dis Child. 1927;  34 347-363
  • 25 Tunaci M, Tunaci A, Engin G et al.. Imaging features of thalassemia.  Eur Radiol. 1999;  9 (9) 1804-1809
  • 26 Rund D, Rachmilewitz E. Beta-thalassemia.  N Engl J Med. 2005;  353 (11) 1135-1146
  • 27 Henderson S, Timbs A, McCarthy J et al.. Incidence of haemoglobinopathies in various populations—the impact of immigration.  Clin Biochem. 2009;  42 (18) 1745-1756
  • 28 Tyler P A, Madani G, Chaudhuri R, Wilson L F, Dick E A. The radiological appearances of thalassaemia.  Clin Radiol. 2006;  61 (1) 40-52
  • 29 Williams H J, Davies A M, Chapman S. Bone within a bone.  Clin Radiol. 2004;  59 (2) 132-144
  • 30 Loh C K, Alcorta C, McElhinney A J. Extramedullary hematopoiesis simulating posterior mediastinal tumors.  Ann Thorac Surg. 1996;  61 (3) 1003-1005
  • 31 Kalina P, Hillstrom M M. MR of extramedullary hematopoiesis causing cord compression in beta-thalassemia.  AJNR Am J Neuroradiol. 1992;  13 (5) 1407-1409
  • 32 Lawson J P, Ablow R C, Pearson H A. The ribs in thalassemia. II. The pathogenesis of the changes.  Radiology. 1981;  140 (3) 673-679
  • 33 Levin T L, Sheth S S, Ruzal-Shapiro C, Abramson S, Piomelli S, Berdon W E. MRI marrow observations in thalassemia: the effects of the primary disease, transfusional therapy, and chelation.  Pediatr Radiol. 1995;  25 (8) 607-613
  • 34 Brasch R C, Wesbey G E, Gooding C A, Koerper M A. Magnetic resonance imaging of transfusional hemosiderosis complicating thalassemia major.  Radiology. 1984;  150 (3) 767-771
  • 35 Jelbert A, Vaidya S, Fotiadis N. Imaging and staging of haemophilic arthropathy.  Clin Radiol. 2009;  64 (11) 1119-1128
  • 36 Drakonaki E E, Maris T G, Maragaki S, Klironomos V, Papadakis A, Karantanas A H. Deferoxamine versus combined therapy for chelating liver, spleen and bone marrow iron in beta-thalassemic patients: a quantitative magnetic resonance imaging study.  Hemoglobin. 2010;  34 (1) 95-106
  • 37 Kellenberger C J, Schmugge M, Saurenmann T et al.. Radiographic and MRI features of deferiprone-related arthropathy of the knees in patients with beta-thalassemia.  AJR Am J Roentgenol. 2004;  183 (4) 989-994
  • 38 Chan Y L, Pang L M, Chik K W, Cheng J C, Li C K. Patterns of bone diseases in transfusion-dependent homozygous thalassaemia major: predominance of osteoporosis and desferrioxamine-induced bone dysplasia.  Pediatr Radiol. 2002;  32 (7) 492-497
  • 39 Miller T T, Caldwell G, Kaye J J, Arkin S, Burke S, Brill P W. MR imaging of deferoxamine-induced bone dysplasia in an 8-year-old female with thalassemia major.  Pediatr Radiol. 1993;  23 (7) 523-524
  • 40 De Sanctis V, Pinamonti A, Di Palma A et al.. Growth and development in thalassaemia major patients with severe bone lesions due to desferrioxamine.  Eur J Pediatr. 1996;  155 (5) 368-372
  • 41 Hartkamp M J, Babyn P S, Olivieri F. Spinal deformities in deferoxamine-treated homozygous beta-thalassemia major patients.  Pediatr Radiol. 1993;  23 (7) 525-528
  • 42 Diav-Citrin O, Koren G. Oral iron chelation with deferiprone.  Pediatr Clin North Am. 1997;  44 (1) 235-247
  • 43 Lonergan G J, Cline D B, Abbondanzo S L. Sickle cell anemia.  Radiographics. 2001;  21 (4) 971-994
  • 44 Rodgers G P. Overview of pathophysiology and rationale for treatment of sickle cell anemia.  Semin Hematol. 1997;  34 (3, Suppl 3) 2-7
  • 45 Aluoch J R. Higher resistance to Plasmodium falciparum infection in patients with homozygous sickle cell disease in western Kenya.  Trop Med Int Health. 1997;  2 568-571
  • 46 Sebes J I, Diggs L W. Radiographic changes of the skull in sickle cell anemia.  AJR Am J Roentgenol. 1979;  132 (3) 373-377
  • 47 Madani G, Papadopoulou A M, Holloway B, Robins A, Davis J, Murray D. The radiological manifestations of sickle cell disease.  Clin Radiol. 2007;  62 (6) 528-538
  • 48 Marlow T J, Brunson C Y, Jackson S, Schabel S I. “Tower vertebra”: a new observation in sickle cell disease.  Skeletal Radiol. 1998;  27 (4) 195-198
  • 49 Almeida A, Roberts I. Bone involvement in sickle cell disease.  Br J Haematol. 2005;  129 (4) 482-490
  • 50 Sidhu P S, Rich P M. Sonographic detection and characterization of musculoskeletal and subcutaneous tissue abnormalities in sickle cell disease.  Br J Radiol. 1999;  72 (853) 9-17
  • 51 Booz M M, Hariharan V, Aradi A J, Malki A A. The value of ultrasound and aspiration in differentiating vaso-occlusive crisis and osteomyelitis in sickle cell disease patients.  Clin Radiol. 1999;  54 (10) 636-639
  • 52 Umans H, Haramati N, Flusser G. The diagnostic role of gadolinium enhanced MRI in distinguishing between acute medullary bone infarct and osteomyelitis.  Magn Reson Imaging. 2000;  18 (3) 255-262
  • 53 Skaggs D L, Kim S K, Greene N W, Harris D, Miller J H. Differentiation between bone infarction and acute osteomyelitis in children with sickle-cell disease with use of sequential radionuclide bone-marrow and bone scans.  J Bone Joint Surg Am. 2001;  83-A (12) 1810-1813
  • 54 Lanzkron S, Strouse J J, Wilson R et al.. Systematic review: hydroxyurea for the treatment of adults with sickle cell disease.  Ann Intern Med. 2008;  148 (12) 939-955

Carlo MartinoliM.D. 

Radiologia–DISC, Università di Genova, Largo Rosanna Benzi 8

I-16132 Genoa, Italy

Email: carlo.martinoli@libero.it

    >