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Diffuse Marrow Infiltration and Replacement
Sandra Moore, MD; B.J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Synonyms

        • Myelodysplasia: Formerly known as preleukemia
      • Definitions

        • "Marrow infiltration" and "replacement" refer to amount of cellular vs. adipocytes admixed in lesion
          • Diffuse marrow infiltration: Moderately cellular tissue admixed with fat, with diffuse bone involvement
            • Regenerated/repopulated/stimulated red marrow
            • Chronic infection
            • HIV/AIDS
            • Marrow storage disorders
            • Early (or treated) phase of myelodysplasia and myeloproliferative disorders
          • Diffuse marrow replacement: Densely cellular lesions, with no significant adipocytes, distributed diffusely in skeleton
            • Osseous carcinomatosis
            • Multiple myeloma
            • Myelodysplasias: Diverse group of hematologic conditions due to ineffective production of myeloid elements
              • Characterized by variety of refractory anemic conditions
            • Myeloproliferative disorders: Overproduction of myeloid elements
              • Platelets (essential thrombocytosis)
              • Reticulocytes (polycythemia vera)
              • Fibroblasts/collagen (myelofibrosis)
              • White cells (leukemia)
        • Diffuse marrow infiltration or replacement do not connote benignity or malignancy per se

      IMAGING

      • General Features

        • Radiographic Findings

          • CT Findings

            • MR Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • Staging, Grading, & Classification

                    • Gross Pathologic & Surgical Features

                      CLINICAL ISSUES

                      • Presentation

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              • Image Interpretation Pearls

                                • Reporting Tips

                                  Selected References

                                  1. Laudemann K et al: Evaluation of bone marrow infiltration in non-neuropathic gaucher disease patients with use of whole-body MRI - a retrospective data analysis. Rofo. 187(12):1093-1098, 2015
                                  2. Kohl CA et al: Accuracy of chemical shift MR imaging in diagnosing indeterminate bone marrow lesions in the pelvis: review of a single institution's experience. Skeletal Radiol. 43(8):1079-84, 2014
                                  3. Kung JW et al: Bone marrow signal alteration in the extremities. AJR Am J Roentgenol. 196(5):W492-510, 2011
                                  4. Kan JH et al: MRI diagnosis of bone marrow relapse in children with ALL. Pediatr Radiol. 38(1):76-81, 2008
                                  5. Vande Berg, BC: General principles of magnetic resonance imaging of the bone marrow. In Pope T et al: Imaging of the Musculoskeletal System. 1st ed. Philadelphia: Elsevier. 1417-30, 2008
                                  6. Steinbach LS: "MRI in the detection of malignant infiltration of bone marrow"--a commentary. AJR Am J Roentgenol. 188(6):1443-5, 2007
                                  7. Tang YM et al: MRI features of bone marrow necrosis. AJR Am J Roentgenol. 188(2):509-14, 2007
                                  8. Zajick DC Jr et al: Benign and malignant processes: normal values and differentiation with chemical shift MR imaging in vertebral marrow. Radiology. 237(2):590-6, 2005
                                  9. Lecouvet FE et al: Magnetic resonance and computed tomography imaging in multiple myeloma. Semin Musculoskelet Radiol. 5(1):43-55, 2001
                                  10. Walker RE et al: Whole-body magnetic resonance imaging: techniques, clinical indications, and future applications. Semin Musculoskelet Radiol. 5(1):5-20, 2001
                                  11. Panicek DM et al: MR imaging of bone Marrow in patients with musculoskeletal tumors. Sarcoma. 3(1):37-41, 1999
                                  12. Vande Berg BC et al: Classification and detection of bone marrow lesions with magnetic resonance imaging. Skeletal Radiol. 27(10):529-45, 1998
                                  13. Vanel D et al: MRI of bone metastases. Eur Radiol. 8(8):1345-51, 1998
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      TERMINOLOGY

                                      • Synonyms

                                        • Myelodysplasia: Formerly known as preleukemia
                                      • Definitions

                                        • "Marrow infiltration" and "replacement" refer to amount of cellular vs. adipocytes admixed in lesion
                                          • Diffuse marrow infiltration: Moderately cellular tissue admixed with fat, with diffuse bone involvement
                                            • Regenerated/repopulated/stimulated red marrow
                                            • Chronic infection
                                            • HIV/AIDS
                                            • Marrow storage disorders
                                            • Early (or treated) phase of myelodysplasia and myeloproliferative disorders
                                          • Diffuse marrow replacement: Densely cellular lesions, with no significant adipocytes, distributed diffusely in skeleton
                                            • Osseous carcinomatosis
                                            • Multiple myeloma
                                            • Myelodysplasias: Diverse group of hematologic conditions due to ineffective production of myeloid elements
                                              • Characterized by variety of refractory anemic conditions
                                            • Myeloproliferative disorders: Overproduction of myeloid elements
                                              • Platelets (essential thrombocytosis)
                                              • Reticulocytes (polycythemia vera)
                                              • Fibroblasts/collagen (myelofibrosis)
                                              • White cells (leukemia)
                                        • Diffuse marrow infiltration or replacement do not connote benignity or malignancy per se

                                      IMAGING

                                      • General Features

                                        • Radiographic Findings

                                          • CT Findings

                                            • MR Findings

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • Staging, Grading, & Classification

                                                    • Gross Pathologic & Surgical Features

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        • Natural History & Prognosis

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Consider

                                                              • Image Interpretation Pearls

                                                                • Reporting Tips

                                                                  Selected References

                                                                  1. Laudemann K et al: Evaluation of bone marrow infiltration in non-neuropathic gaucher disease patients with use of whole-body MRI - a retrospective data analysis. Rofo. 187(12):1093-1098, 2015
                                                                  2. Kohl CA et al: Accuracy of chemical shift MR imaging in diagnosing indeterminate bone marrow lesions in the pelvis: review of a single institution's experience. Skeletal Radiol. 43(8):1079-84, 2014
                                                                  3. Kung JW et al: Bone marrow signal alteration in the extremities. AJR Am J Roentgenol. 196(5):W492-510, 2011
                                                                  4. Kan JH et al: MRI diagnosis of bone marrow relapse in children with ALL. Pediatr Radiol. 38(1):76-81, 2008
                                                                  5. Vande Berg, BC: General principles of magnetic resonance imaging of the bone marrow. In Pope T et al: Imaging of the Musculoskeletal System. 1st ed. Philadelphia: Elsevier. 1417-30, 2008
                                                                  6. Steinbach LS: "MRI in the detection of malignant infiltration of bone marrow"--a commentary. AJR Am J Roentgenol. 188(6):1443-5, 2007
                                                                  7. Tang YM et al: MRI features of bone marrow necrosis. AJR Am J Roentgenol. 188(2):509-14, 2007
                                                                  8. Zajick DC Jr et al: Benign and malignant processes: normal values and differentiation with chemical shift MR imaging in vertebral marrow. Radiology. 237(2):590-6, 2005
                                                                  9. Lecouvet FE et al: Magnetic resonance and computed tomography imaging in multiple myeloma. Semin Musculoskelet Radiol. 5(1):43-55, 2001
                                                                  10. Walker RE et al: Whole-body magnetic resonance imaging: techniques, clinical indications, and future applications. Semin Musculoskelet Radiol. 5(1):5-20, 2001
                                                                  11. Panicek DM et al: MR imaging of bone Marrow in patients with musculoskeletal tumors. Sarcoma. 3(1):37-41, 1999
                                                                  12. Vande Berg BC et al: Classification and detection of bone marrow lesions with magnetic resonance imaging. Skeletal Radiol. 27(10):529-45, 1998
                                                                  13. Vanel D et al: MRI of bone metastases. Eur Radiol. 8(8):1345-51, 1998