MR Imaging of Pediatric Bone Marrow

The bone marrow is one of the largest organs in the body and is visible in every magnetic resonance (MR) imaging study. It is composed of a combination of hematopoietic red marrow and fatty yellow marrow, and its composition changes throughout life in response to normal maturation (red to yellow conversion) and stress (yellow to red reconversion). MR imaging is highly sensitive for detection of altered marrow signal intensity, and the T1-weighted spin-echo sequence provides the most robust contrast between yellow marrow and disease. Heterogeneous red marrow and red marrow hyperplasia can mimic marrow disease, but should be distinguished from neoplastic replacement (leukemia, lymphoma, primary bone sarcomas, hematogenous metastases) and expected posttreatment changes (radiation therapy, chemotherapy, colony-stimulating factor, bone marrow transplant). Nonneoplastic edema-like processes can also alter marrow signal intensity, including trauma, infection, inflammation (chronic recurrent multifocal osteomyelitis, juvenile inflammatory arthritis), altered biomechanics, and chronic regional pain syndrome. Unfortunately, MR imaging findings are often nonspecific and overlap among many of these vastly different causes. Therefore, a definitive diagnosis is reliant on a combination of imaging findings, clinical evaluation, laboratory assessment, and occasionally tissue analysis. RSNA, 2016.