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Increased or Decreased Marrow Cellularity
Sandra Moore, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Synonyms

          • Hematopoietic repopulation: Red marrow reconversion, red marrow recruitment
        • Definitions

          • Red and yellow marrow ratios fluctuate in response to
            • Hematopoietic stress
            • Oxygen demand
            • Treatment/medications
            • Exposure to myelotoxins
          • Increased red marrow seen with
            • Marrow reconversion
              • Otherwise normal patients confronting new stress
              • e.g., new athletic training, high altitude
            • Marrow repopulation
              • e.g., severe sickle cell anemia, thalassemia
            • Marrow stimulation
              • Treatment with granulocyte stimulating factor (GCSF) &/or red cell stimulating factors
          • Decreased red marrow seen with
            • Advanced age: Diffuse marrow depletion
            • Severe depletion
              • Aplastic anemia: Global cellular marrow depletion
              • Radiation: Focal cellular marrow depletion
            • Serous atrophy
              • Related to starvation
                • Marrow fat usually sequestered from energy metabolism, except in starvation states
              • Depletion of both red and yellow marrow
              • Gelatinous transformation of marrow

        IMAGING

        • General Features

          • Imaging Recommendations

            • Radiographic Findings

              • MR Findings

                • Nuclear Medicine Findings

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Microscopic Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. 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
                                    2. Kung JW et al: Bone marrow signal alteration in the extremities. AJR Am J Roentgenol. 196(5):W492-510, 2011
                                    3. Sager S et al: The value of FDG PET/CT in the initial staging and bone marrow involvement of patients with multiple myeloma. Skeletal Radiol. 40(7):843-7, 2011
                                    4. 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
                                    5. Thomas J et al: Mechanisms of mobilization of hematopoietic progenitors with granulocyte colony-stimulating factor. Curr Opin Hematol. 9(3):183-9, 2002
                                    6. Böhm J: Gelatinous transformation of the bone marrow: the spectrum of underlying diseases. Am J Surg Pathol. 24(1):56-65, 2000
                                    7. Vande Berg BC et al: Anorexia nervosa: correlation between MR appearance of bone marrow and severity of disease. Radiology. 193(3):859-64, 1994
                                    8. Poulton TB et al: Bone marrow reconversion in adults who are smokers: MR Imaging findings. AJR Am J Roentgenol. 161(6):1217-21, 1993
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Diagnostic Checklist

                                          TERMINOLOGY

                                          • Synonyms

                                            • Hematopoietic repopulation: Red marrow reconversion, red marrow recruitment
                                          • Definitions

                                            • Red and yellow marrow ratios fluctuate in response to
                                              • Hematopoietic stress
                                              • Oxygen demand
                                              • Treatment/medications
                                              • Exposure to myelotoxins
                                            • Increased red marrow seen with
                                              • Marrow reconversion
                                                • Otherwise normal patients confronting new stress
                                                • e.g., new athletic training, high altitude
                                              • Marrow repopulation
                                                • e.g., severe sickle cell anemia, thalassemia
                                              • Marrow stimulation
                                                • Treatment with granulocyte stimulating factor (GCSF) &/or red cell stimulating factors
                                            • Decreased red marrow seen with
                                              • Advanced age: Diffuse marrow depletion
                                              • Severe depletion
                                                • Aplastic anemia: Global cellular marrow depletion
                                                • Radiation: Focal cellular marrow depletion
                                              • Serous atrophy
                                                • Related to starvation
                                                  • Marrow fat usually sequestered from energy metabolism, except in starvation states
                                                • Depletion of both red and yellow marrow
                                                • Gelatinous transformation of marrow

                                          IMAGING

                                          • General Features

                                            • Imaging Recommendations

                                              • Radiographic Findings

                                                • MR Findings

                                                  • Nuclear Medicine Findings

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        • Microscopic Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. 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
                                                                      2. Kung JW et al: Bone marrow signal alteration in the extremities. AJR Am J Roentgenol. 196(5):W492-510, 2011
                                                                      3. Sager S et al: The value of FDG PET/CT in the initial staging and bone marrow involvement of patients with multiple myeloma. Skeletal Radiol. 40(7):843-7, 2011
                                                                      4. 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
                                                                      5. Thomas J et al: Mechanisms of mobilization of hematopoietic progenitors with granulocyte colony-stimulating factor. Curr Opin Hematol. 9(3):183-9, 2002
                                                                      6. Böhm J: Gelatinous transformation of the bone marrow: the spectrum of underlying diseases. Am J Surg Pathol. 24(1):56-65, 2000
                                                                      7. Vande Berg BC et al: Anorexia nervosa: correlation between MR appearance of bone marrow and severity of disease. Radiology. 193(3):859-64, 1994
                                                                      8. Poulton TB et al: Bone marrow reconversion in adults who are smokers: MR Imaging findings. AJR Am J Roentgenol. 161(6):1217-21, 1993