High Signal in Bone Marrow on Diffusion‐Weighted Imaging of Female Pelvis: Correlation With Anemia and Fibroid‐Associated Symptoms

Background The diffusion‐weighted imaging (DWI) signals of the female pelvic bone marrow show great variability and are usually high in female patients with fibroid‐associated symptoms and anemia. Purpose To ascertain clinical factors contributing to high signal intensity in the bone marrow of the female pelvis on DWI. Study Type Retrospective case–control study. Subjects A single‐institution review of 221 female patients underwent a pelvic magnetic resonance study from December 2012 to July 2014. Field Strength/Sequence 1.5T/DWI (b = 0 and 1000) and apparent diffusion coefficient (ADC). Assessment The ADC of pelvic bone marrow and the muscle‐normalized signal intensity (SI) on DWI (mnDWI) were measured. A brightness grading scale ranging from 0 to 4 was used for pelvic bone assessment. Clinical factors, namely, age, the lowest hemoglobin level in the last 6 months, the presence of large uterine fibroids, and/or adenomyosis and fibroid‐associated symptoms were recorded. Statistical Tests The relationships between the brightness grade and clinical factors were evaluated through multinomial logistic regression, and correlations of mnDWI and the ADC with the clinical factors were analyzed through the Kruskal–Wallis test, Jonckheere's trend test, and the Mann–Whitney U‐test with Bonferroni correction. Results Age and the hemoglobin level were inversely associated with the bone marrow brightness grade on DWI (both P