title: Incidentally detected diffuse signal alterations of bone marrow on MRI: is bone marrow biopsy indicated?
abstract: BACKGROUND
  Advanced imaging techniques as magnetic resonance imaging (MRI) are increasingly performed in the diagnostic workup of patients. Incidentally, diffuse signal alterations of the bone marrow are detected because MRI visualises various components of the bone marrow. The clinical significance of these signal alterations is unknown.
  
  
  OBJECTIVE
  The main goal of this study was to determine the diagnostic value of a bone marrow biopsy in patients with incidentally found diffuse signal alterations of the bone marrow.
  
  
  METHODS
  We retrospectively examined all bone marrow biopsies performed from 1 January 2007 to 31 December 2013 (n = 1947). Patients were included when the biopsy was obtained following an MRI with a diffuse abnormal bone marrow signal. Patients who underwent MRI for suspected malignancy were excluded. Histological and cytological results of the bone marrow examinations were analysed.
  
  
  RESULTS
  15 of the 1947 bone marrow biopsies (0.77%) were performed because of diffuse signal alterations on MRI. In seven of these 15 bone marrow biopsies (47%) a clinically important haematological disorder was found. Eight patients had a normal bone marrow evaluation.
  
  
  CONCLUSIONS
  Based on this retrospective study, a bone marrow examination in patients with incidentally detected diffuse signal alterations should be considered to exclude haematological pathology. Prospective studies have to be performed to further investigate the best diagnostic strategy.
authors.affiliation: Departments of Internal Medicine÷Haematology, Maxima Medical Centre, Eindhoven÷Veldhoven, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Spierings
authors.forename: A N
authors.initials: AN
authors.lastname: van der Linden
authors.forename: P H M
authors.initials: PH
authors.lastname: Kuijper
authors.forename: L W
authors.initials: LW
authors.lastname: Tick
authors.forename: M R
authors.initials: MR
authors.lastname: Nijziel
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology*; D005260:Female; D006402:Hematologic Diseases / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult