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Diffuse Marrow Infiltration and Replacement
Brady K. Huang, MD; 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 "marrow 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
            • 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
            • Bone metastases
            • Erdheim-Chester disease
            • 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 does 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. Colombo A et al: Effects of sex and age on fat fraction, diffusion-weighted image signal intensity and apparent diffusion coefficient in the bone marrow of asymptomatic individuals: a cross-sectional whole-body MRI study. Diagnostics (Basel). 11(5), 2021
                                  2. van Vucht N et al: Anomalous signal intensity increase on out-of-phase chemical shift imaging: a manifestation of marrow mineralisation? Skeletal Radiol. 49(8):1269-75, 2020
                                  3. Degnan AJ et al: Imaging of non-neuronopathic Gaucher disease: recent advances in quantitative imaging and comprehensive assessment of disease involvement. Insights Imaging. 10(1):70, 2019
                                  4. Messiou C et al: Guidelines for acquisition, interpretation, and reporting of whole-body MRI in myeloma: myeloma response assessment and diagnosis system (MY-RADS). Radiology. 291(1):5-3, 2019
                                  5. van Vucht N et al: The Dixon technique for MRI of the bone marrow. Skeletal Radiol. 48(12):1861-74, 2019
                                  6. Kumar NM et al: Chemical shift imaging with in-phase and opposed-phase sequences at 3 T: what is the optimal threshold, measurement method, and diagnostic accuracy for characterizing marrow signal abnormalities? Skeletal Radiol. 47(12):1661-71, 2018
                                  7. Young JR et al: 18F-FDG PET/CT in Erdheim-Chester disease: imaging findings and potential BRAF mutation biomarker. J Nucl Med. 59(5):774-79, 2018
                                  8. Douis H et al: Chemical shift MRI can aid in the diagnosis of indeterminate skeletal lesions of the spine. Eur Radiol. 26(4):932-40, 2016
                                  9. Lecouvet FE: Whole-body MR imaging: musculoskeletal applications. Radiology. 279(2):345-65, 2016
                                  10. 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):1093-8, 2015
                                  11. 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
                                  12. Padhani AR et al: Assessing the relation between bone marrow signal intensity and apparent diffusion coefficient in diffusion-weighted MRI. AJR Am J Roentgenol. 200(1):163-70, 2013
                                  13. Moore SL et al: Can sarcoidosis and metastatic bone lesions be reliably differentiated on routine MRI? AJR Am J Roentgenol. 198(6):1387-93, 2012
                                  14. Kung JW et al: Bone marrow signal alteration in the extremities. AJR Am J Roentgenol. 196(5):W492-510, 2011
                                  15. Kan JH et al: MRI diagnosis of bone marrow relapse in children with ALL. Pediatr Radiol. 38(1):76-81, 2008
                                  16. 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. Elsevier. 1417-30, 2008
                                  17. Steinbach LS: "MRI in the detection of malignant infiltration of bone marrow"--a commentary. AJR Am J Roentgenol. 188(6):1443-5, 2007
                                  18. Tang YM et al: MRI features of bone marrow necrosis. AJR Am J Roentgenol. 188(2):509-14, 2007
                                  19. Dion E et al: Bone involvement in Erdheim-Chester disease: imaging findings including periostitis and partial epiphyseal involvement. Radiology. 238(2):632-9, 2006
                                  20. Moore SL et al: MRI of sarcoidosis patients with musculoskeletal symptoms. AJR Am J Roentgenol. 185(1):154-9, 2005
                                  21. 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
                                  22. Maas M et al: Quantification of bone involvement in Gaucher disease: MR imaging bone marrow burden score as an alternative to Dixon quantitative chemical shift MR imaging--initial experience. Radiology. 229(2):554-61, 2003
                                  23. Moore SL et al: Musculoskeletal sarcoidosis: spectrum of appearances at MR imaging. Radiographics. 23(6):1389-99, 2003
                                  24. Lecouvet FE et al: Magnetic resonance and computed tomography imaging in multiple myeloma. Semin Musculoskelet Radiol. 5(1):43-55, 2001
                                  25. Walker RE et al: Whole-body magnetic resonance imaging: techniques, clinical indications, and future applications. Semin Musculoskelet Radiol. 5(1):5-20, 2001
                                  26. Panicek DM et al: MR imaging of bone Marrow in patients with musculoskeletal tumors. Sarcoma. 3(1):37-41, 1999
                                  27. Vande Berg BC et al: Classification and detection of bone marrow lesions with magnetic resonance imaging. Skeletal Radiol. 27(10):529-45, 1998
                                  28. Vanel D et al: MRI of bone metastases. Eur Radiol. 8(8):1345-51, 1998
                                  29. Wismer GL et al: Chemical shift imaging of bone marrow: preliminary experience. AJR Am J Roentgenol. 145(5):1031-7, 1985
                                  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 "marrow 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
                                            • 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
                                            • Bone metastases
                                            • Erdheim-Chester disease
                                            • 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 does 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. Colombo A et al: Effects of sex and age on fat fraction, diffusion-weighted image signal intensity and apparent diffusion coefficient in the bone marrow of asymptomatic individuals: a cross-sectional whole-body MRI study. Diagnostics (Basel). 11(5), 2021
                                                                  2. van Vucht N et al: Anomalous signal intensity increase on out-of-phase chemical shift imaging: a manifestation of marrow mineralisation? Skeletal Radiol. 49(8):1269-75, 2020
                                                                  3. Degnan AJ et al: Imaging of non-neuronopathic Gaucher disease: recent advances in quantitative imaging and comprehensive assessment of disease involvement. Insights Imaging. 10(1):70, 2019
                                                                  4. Messiou C et al: Guidelines for acquisition, interpretation, and reporting of whole-body MRI in myeloma: myeloma response assessment and diagnosis system (MY-RADS). Radiology. 291(1):5-3, 2019
                                                                  5. van Vucht N et al: The Dixon technique for MRI of the bone marrow. Skeletal Radiol. 48(12):1861-74, 2019
                                                                  6. Kumar NM et al: Chemical shift imaging with in-phase and opposed-phase sequences at 3 T: what is the optimal threshold, measurement method, and diagnostic accuracy for characterizing marrow signal abnormalities? Skeletal Radiol. 47(12):1661-71, 2018
                                                                  7. Young JR et al: 18F-FDG PET/CT in Erdheim-Chester disease: imaging findings and potential BRAF mutation biomarker. J Nucl Med. 59(5):774-79, 2018
                                                                  8. Douis H et al: Chemical shift MRI can aid in the diagnosis of indeterminate skeletal lesions of the spine. Eur Radiol. 26(4):932-40, 2016
                                                                  9. Lecouvet FE: Whole-body MR imaging: musculoskeletal applications. Radiology. 279(2):345-65, 2016
                                                                  10. 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):1093-8, 2015
                                                                  11. 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
                                                                  12. Padhani AR et al: Assessing the relation between bone marrow signal intensity and apparent diffusion coefficient in diffusion-weighted MRI. AJR Am J Roentgenol. 200(1):163-70, 2013
                                                                  13. Moore SL et al: Can sarcoidosis and metastatic bone lesions be reliably differentiated on routine MRI? AJR Am J Roentgenol. 198(6):1387-93, 2012
                                                                  14. Kung JW et al: Bone marrow signal alteration in the extremities. AJR Am J Roentgenol. 196(5):W492-510, 2011
                                                                  15. Kan JH et al: MRI diagnosis of bone marrow relapse in children with ALL. Pediatr Radiol. 38(1):76-81, 2008
                                                                  16. 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. Elsevier. 1417-30, 2008
                                                                  17. Steinbach LS: "MRI in the detection of malignant infiltration of bone marrow"--a commentary. AJR Am J Roentgenol. 188(6):1443-5, 2007
                                                                  18. Tang YM et al: MRI features of bone marrow necrosis. AJR Am J Roentgenol. 188(2):509-14, 2007
                                                                  19. Dion E et al: Bone involvement in Erdheim-Chester disease: imaging findings including periostitis and partial epiphyseal involvement. Radiology. 238(2):632-9, 2006
                                                                  20. Moore SL et al: MRI of sarcoidosis patients with musculoskeletal symptoms. AJR Am J Roentgenol. 185(1):154-9, 2005
                                                                  21. 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
                                                                  22. Maas M et al: Quantification of bone involvement in Gaucher disease: MR imaging bone marrow burden score as an alternative to Dixon quantitative chemical shift MR imaging--initial experience. Radiology. 229(2):554-61, 2003
                                                                  23. Moore SL et al: Musculoskeletal sarcoidosis: spectrum of appearances at MR imaging. Radiographics. 23(6):1389-99, 2003
                                                                  24. Lecouvet FE et al: Magnetic resonance and computed tomography imaging in multiple myeloma. Semin Musculoskelet Radiol. 5(1):43-55, 2001
                                                                  25. Walker RE et al: Whole-body magnetic resonance imaging: techniques, clinical indications, and future applications. Semin Musculoskelet Radiol. 5(1):5-20, 2001
                                                                  26. Panicek DM et al: MR imaging of bone Marrow in patients with musculoskeletal tumors. Sarcoma. 3(1):37-41, 1999
                                                                  27. Vande Berg BC et al: Classification and detection of bone marrow lesions with magnetic resonance imaging. Skeletal Radiol. 27(10):529-45, 1998
                                                                  28. Vanel D et al: MRI of bone metastases. Eur Radiol. 8(8):1345-51, 1998
                                                                  29. Wismer GL et al: Chemical shift imaging of bone marrow: preliminary experience. AJR Am J Roentgenol. 145(5):1031-7, 1985