Systemic mastocytosis

  • 50s to 80s
  • M=F
  • Bone marrow involvement in 90%
  • Often asymptomatic
  • Sometimes thoracic and lumbar pain, arthralgia
  • Associated with myelodysplastic syndrome, myeloproliferative neoplasia, leukemia, lymphoma
  • Findings due to direct effect of mast cells and indirect effect of histamine, heparin, prostaglandins
  • Osteolytic and osteosclerotic lesions
  • Diffuse or focal
  • 4-5 mm lytic lesions with sclerotic rim seen in spine, ribs, skull, pelvis, tubular bones
  • Diffuse osteopenia
  • Osteosclerosis: trabecular thickening, cortical thickening, reduced marrow space
  • MRI signals depend on extent of marrow fibrosis. Usually T1 low and T2 high
  • PET/CT shows FDG uptake in bone marrow, lymph nodes and spleen
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Avila, Nilo A., et al. “Systemic mastocytosis: CT and US features of abdominal manifestations.” Radiology 202.2 (1997): 367-372.

Fritz, J., et al. “Advanced imaging of skeletal manifestations of systemic mastocytosis.” Skeletal radiology 41.8 (2012): 887-897.