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Posttherapeutische Veränderungen am Knochenmark

Posttherapeutic changes in bone marrow

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Zusammenfassung

Das Knochenmark besteht grundsätzlich aus rotem blutbildenden Knochenmark und gelbem Fettmark. Im Skelett besteht eine altersabhängige Verteilung dieser beiden Anteile. Im Rahmen von ärztlichen Eingriffen oder Therapien kann es zu Veränderungen des Knochenmarks kommen, wobei das normale Knochenmark grundsätzlich durch Fett, Ödem oder Fibrose/Sklerose ersetzt werden kann. Dabei zeigen sich in bildgebenden Verfahren spezifische Signalintensitäten und Muster. Nach Bestrahlungstherapien sind ödematöse Veränderungen, Hämorrhagien und Osteoradionekrosen zu beobachten. Ebenso sind Insuffizienzfrakturen, eine Beeinträchtigung der Wachstumsfugen oder das Entstehen von Tumoren möglich. Bei Patienten mit Dialyse sind Ablagerungen von Proteinen im Knochenmark bei der sog. Amyloidoseosteoarthropathie möglich. Nach Arthroskopien können postoperative Knochenmarködeme, Insuffizienzfrakturen oder Osteonekrosen beobachtet werden. Nach Stammzelltransplantationen sind Veränderungen der Verteilung von Fettmark und blutbildendem Knochenmark zu beobachten. Im Rahmen der Therapie mit Kortison sind Insuffizienzfrakturen und Osteonekrosen möglich. Chemotherapien können, abhängig von ihrer Wirkung auf das hämatopoetische System, zunächst zu ödematösen Veränderungen und dann zur Fettmarkkonversion führen, die nach Therapieerfolg wieder reversibel ist. Angiogenesehemmer in Kombination mit anderen Chemotherapeutika führen oft zu Mischbildern von stimuliertem und fettig konvertiertem Knochenmark.

Abstract

The bone marrow basically consists of red blood-forming bone marrow and yellow fat. In the skeleton, there is an age-dependent distribution of these two parts. In the context of medical interventions or therapies, bone marrow changes can occur, whereby the normal bone marrow can basically be replaced by fat, edema, or fibrosis/sclerosis. Here, specific signal intensities and patterns are shown in imaging. After irradiation therapies, edematous changes, hemorrhages, and osteoradionecroses are observed. Likewise, insufficiency fractures, impairment of the growth gaps, or the development of tumors is possible. In patients on dialysis, deposit of protein in the bone marrow is possible in the case of the so-called amyloidosis osteoarthropathy. Postoperative bone marrow edema, insufficiency fractures, or osteonecrosis can be observed after arthroscopy. Changes in the distribution of fat markers and blood-forming bone marrow can be observed after stem cell transplants. In the therapy with cortisone, insufficiency fractures and osteonecroses are possible. Depending on their effect on the hematopoietic system, chemotherapyies can first lead to edematous changes and then to fatty bone marrow, which is reversible after therapy. Angiogenesis inhibitors in combination with other chemotherapeutic agents often lead to mixed images of stimulated and fatty bone marrow.

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Authors and Affiliations

  1. Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistraße 15, 81375, München, Deutschland

    T. Geith, A.-C. Stellwag & A. Baur-Melnyk

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  1. T. Geith
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  2. A.-C. Stellwag
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  3. A. Baur-Melnyk
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Correspondence to T. Geith.

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T. Geith, A.-C. Stellwag und A. Baur-Melnyk geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Geith, T., Stellwag, AC. & Baur-Melnyk, A. Posttherapeutische Veränderungen am Knochenmark. Radiologe 57, 958–963 (2017). https://doi.org/10.1007/s00117-017-0300-5

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  • DOI: https://doi.org/10.1007/s00117-017-0300-5

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