Radiotherapy effects on vertebral bone marrow: Easily recognizable changes in T₂ relaxation times

The effect of localized radiotherapy on vertebral bone marrow was demonstrated in two patients using quantitative MRI studies with pixel-by- pixel measurement of T₂ relaxation times with generation of T₂ images. Conventional T₁-weighted spin-echo images were obtained as well. Irradiated vertebral bone marrow was found to have longer T₂ relaxation times than the neighboring nonirradiated bone marrow. These changes corresponded to the increased signal intensity on T₁-weighted images and to the field of radiotherapy and were noted 2.5 to 32 mo after radiotherapy. Radiologists should be aware of the increased T: relaxation times in irradiated bone marrow to correctly assess spinal disorders in irradiated patients. The reported T₂ changes may reflect the abundance of adipose cells that proliferate in bone marrow after radiotherapy, or may indicate an additional histological change, such as bone marrow necrosis or edema. Conclusive histological proof remains to be obtained.