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Focal Marrow Infiltration and Replacement
Brady K. Huang, MD; Sandra Moore, MD
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • Focal lesions can infiltrate or replace normal marrow
          • Terms refer to amount of cellularity vs. admixed fat in lesion
          • Infiltration or replacement do not imply benignity or malignancy per se
        • Focal infiltration can occur
          • At margins of fractures, tumors, infarction
            • Represents marrow edema, reactive change
        • Marrow replacement occurs with
          • Highly cellular lesions, such as tumor or osteomyelitis

      IMAGING

      • General Features

        • Radiographic Findings

          • CT Findings

            • MR Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • Microscopic Features

                    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. van Vucht N et al: The Dixon technique for MRI of the bone marrow. Skeletal Radiol. 48(12):1861-74, 2019
                          4. 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
                          5. 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
                          6. Lee EY et al: Bone marrow uptake of indolent non-Hodgkin lymphoma on PET/CT with histopathological correlation. Nucl Med Commun. 36(10):1035-41, 2015
                          7. Mai EK et al: A magnetic resonance imaging-based prognostic scoring system to predict outcome in transplant-eligible patients with multiple myeloma. Haematologica. 100(6):818-25, 2015
                          8. 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
                          9. 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
                          10. Kung JW et al: Bone marrow signal alteration in the extremities. AJR Am J Roentgenol. 196(5):W492-510, 2011
                          11. 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
                          12. Collins MS et al: T1-weighted MRI characteristics of pedal osteomyelitis. AJR Am J Roentgenol. 185(2):386-93, 2005
                          13. 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
                          14. Castillo M: Diffusion-weighted imaging of the spine: is it reliable? AJNR Am J Neuroradiol. 24(6):1251-3, 2003
                          15. Zanetti M et al: Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. Radiology. 215(3):835-40, 2000
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Imaging

                              TERMINOLOGY

                              • Definitions

                                • Focal lesions can infiltrate or replace normal marrow
                                  • Terms refer to amount of cellularity vs. admixed fat in lesion
                                  • Infiltration or replacement do not imply benignity or malignancy per se
                                • Focal infiltration can occur
                                  • At margins of fractures, tumors, infarction
                                    • Represents marrow edema, reactive change
                                • Marrow replacement occurs with
                                  • Highly cellular lesions, such as tumor or osteomyelitis

                              IMAGING

                              • General Features

                                • Radiographic Findings

                                  • CT Findings

                                    • MR Findings

                                      • Imaging Recommendations

                                        DIFFERENTIAL DIAGNOSIS

                                          PATHOLOGY

                                          • Microscopic Features

                                            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. van Vucht N et al: The Dixon technique for MRI of the bone marrow. Skeletal Radiol. 48(12):1861-74, 2019
                                                  4. 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
                                                  5. 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
                                                  6. Lee EY et al: Bone marrow uptake of indolent non-Hodgkin lymphoma on PET/CT with histopathological correlation. Nucl Med Commun. 36(10):1035-41, 2015
                                                  7. Mai EK et al: A magnetic resonance imaging-based prognostic scoring system to predict outcome in transplant-eligible patients with multiple myeloma. Haematologica. 100(6):818-25, 2015
                                                  8. 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
                                                  9. 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
                                                  10. Kung JW et al: Bone marrow signal alteration in the extremities. AJR Am J Roentgenol. 196(5):W492-510, 2011
                                                  11. 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
                                                  12. Collins MS et al: T1-weighted MRI characteristics of pedal osteomyelitis. AJR Am J Roentgenol. 185(2):386-93, 2005
                                                  13. 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
                                                  14. Castillo M: Diffusion-weighted imaging of the spine: is it reliable? AJNR Am J Neuroradiol. 24(6):1251-3, 2003
                                                  15. Zanetti M et al: Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. Radiology. 215(3):835-40, 2000