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Effects of treatment on bone and bone marrow

This chapter describes the imaging appearance of the effect of treatment for malignant disorders on bone and bone marrow. The pathophysiology of changes related to radiation therapy and chemotherapy are described initially. Osseous complications of radiation treatment, including insufficiency fractures and osteonecrosis, are then discussed with detailed reference on incidence, time from initiation of therapy and characteristic appearance on conventional radiographs, computed tomography, and radionuclide studies. The effect of both radiation and chemotherapy on the growing skeleton is discussed in detail. The chapter ends with a presentation of changes that occur in the bone marrow of patients in the early and late phases of treatment with either chemotherapy or radiation, along with characteristic findings on magnetic resonance imaging (MRI) that allow the differential diagnosis of such changes from persistent or relapsed tumour.