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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9000
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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I had an MRI done and head looks fine but incidental

Customer Question

I had an MRI done and head looks fine but incidental findings show Heterogeneous marrow signal of calvarium and upper visualized cervical spine. CBC done today looks normal. What could this mean? Should I have additional testing done or ??
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

Hello. Welcome to JA. Marrow signals are fairly common, thought to be due to excess lipid deposition or fat within the marrow. But a recent study found that not all reasons are benign, somewhere between 10% and 24% of patients with marrow signal abnormalities (heterogenous marrow signal) is associated with malignancy. Here is the abstract on the study from Boston (2013).

29,508 MRIs were performed and 77 patients met search criteria. Median age was 58 years with a median follow-up of 41 months at TMC after qualifying MRI. 40/77 (52%) of patients had either an MRI of the lumbar spine or hip with 21/77 (27%) undergoing work-up for the marrow findings. Evaluations included CBC (38%), SPEP (24%), quantitative immunoglobulins (14%), free light chains (10%), peripheral blood flow cytometry (5%), bone marrow biopsy (19%), skeletal survey (14%), bone scan (48%), CT scan (24%), biopsy of other site (24%), and subspecialty referral (48%, 29% to oncology). Definitive diagnosis was assigned in 11/21 (52%) cases, with 5 being malignancies (1 follicular lymphoma, 2 multiple myeloma, 2 lung cancer). Three patients were later diagnosed with malignancy (breast cancer, myelodysplastic syndrome, merkel cell carcinoma) at a median of 19 months. Overall, 10% of patients with abnormal marrow on MRI were diagnosed with a malignancy. Conclusions: Incidentally noted abnormal or heterogeneous bone marrow signal on MRI was not inconsequential. Of those patients who underwent evaluation for the finding, 24% were diagnosed with a malignancy. We conclude that abnormal bone marrow findings on MRI should not be ignored, and given the rates of malignancy in our series, oncologists are ideally suited for this task.

Expert:  Dr. Frank replied 1 year ago.

so yes, the additional studies after the CBC are listed: SPEP (serum protein electrophoresis). quantitative immunoglobulins (IPEP), light chains for myeloma, peripheral blood flow cytometry looking for malignant cells, a bone marrow biopsy if you cannot get an answer with the blood tests. and bone scan (technicium 99 scan) or CT scan of the bones with contrast (upper cervical spine)

Please get back to me with questions and I will reply. If satisfied with this answer, please remember to rate this service by clicking on the rating stars, as that is how I am compensated for this work thanks dr Frank

Expert:  Dr. Frank replied 1 year ago.

Hi. Get back to me if I can help you further and I will reply. Or if satisfied please remember to rate my service by clicking on the rating stars as that is how I am compensated for my work. Thanks *****