Skeletal Radiology

, Volume 45, Issue 9, pp 1205–1212 | Cite as

Utilization of chemical shift MRI in the diagnosis of disorders affecting pediatric bone marrow

  • Matthew Winfeld
  • Shivani Ahlawat
  • Nabile Safdar
Scientific Article



MRI signal intensity of pediatric bone marrow can be difficult to interpret using conventional methods. Chemical shift imaging (CSI), which can quantitatively assess relative fat content, may improve the ability to accurately diagnose bone marrow abnormalities in children.


Consecutive pelvis and extremity MRI at a children’s hospital over three months were retrospectively reviewed for inclusion of CSI. Medical records were reviewed for final pathological and/or clinical diagnosis. Cases were classified as normal or abnormal, and if abnormal, subclassified as marrow-replacing or non-marrow-replacing entities. Regions of interest (ROI) were then drawn on corresponding in and out-of-phase sequences over the marrow abnormality or over a metaphysis and epiphysis in normal studies. Relative signal intensity ratio for each case was then calculated to determine the degree of fat content in the ROI.


In all, 241 MRI were reviewed and 105 met inclusion criteria. Of these, 61 had normal marrow, 37 had non-marrow-replacing entities (osteomyelitis without abscess n = 17, trauma n = 9, bone infarction n = 8, inflammatory arthropathy n = 3), and 7 had marrow-replacing entities (malignant neoplasm n = 4, bone cyst n = 1, fibrous dysplasia n = 1, and Langerhans cell histiocytosis n = 1). RSIR averages were: normal metaphyseal marrow 0.442 (0.352–0.533), normal epiphyseal marrow 0.632 (0.566–698), non-marrow-replacing diagnoses 0.715 (0.630–0.799), and marrow-replacing diagnoses 1.06 (0.867–1.26). RSIR for marrow-replacing entities proved significantly different from all other groups (p < 0.05). ROC analysis demonstrated an AUC of 0.89 for RSIR in distinguishing marrow-replacing entities.


CSI techniques can help to differentiate pathologic processes that replace marrow in children from those that do not.


Chemical shift imaging Bone marrow Magnetic resonance imaging 


Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived due to the retrospective nature of the study.


  1. 1.
    Foster K, Chapman S, Johnson K. MRI of the marrow in the paediatric skeleton. Clin Radiol. 2004;59(8):651–73.CrossRefPubMedGoogle Scholar
  2. 2.
    Dreizin D, Ahlawat S, Del Grande F, Fayad LM. Gradient-echo in-phase and opposed-phase chemical shift imaging: role in evaluating bone marrow. Clin Radiol. 2014;69(6):648–57.CrossRefPubMedGoogle Scholar
  3. 3.
    Vogler 3rd JB, Murphy WA. Bone marrow imaging. Radiology. 1988;168(3):679–93.CrossRefPubMedGoogle Scholar
  4. 4.
    Laor T, Jaramillo D. MR imaging insights into skeletal maturation: what is normal? Radiology. 2009;250(1):28–38.CrossRefPubMedGoogle Scholar
  5. 5.
    Guillerman RP. Marrow: red, yellow and bad. Pediatr Radiol. 2013;43 Suppl 1:S181–92.CrossRefPubMedGoogle Scholar
  6. 6.
    Outwater EK, Mitchell DG. Differentiation of adrenal masses with chemical shift MR imaging. Radiology. 1994;193(3):877–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Pokharel SS, Macura KJ, Kamel IR, Zaheer A. Current MR imaging lipid detection techniques for diagnosis of lesions in the abdomen and pelvis. Radiographics. 2013;33(3):681–702.CrossRefPubMedGoogle Scholar
  8. 8.
    Ream JM, Gaing B, Mussi TC, Rosenkrantz AB. Characterization of adrenal lesions at chemical-shift MRI: a direct intraindividual comparison of in- and opposed-phase imaging at 1.5 T and 3 T. AJR Am J Roentgenol. 2015;204(3):536–41.CrossRefPubMedGoogle Scholar
  9. 9.
    Hood MN, Ho VB, Smirniotopoulos JG, Szumowski J. Radiographics. 1999;19(2):357–71.CrossRefPubMedGoogle Scholar
  10. 10.
    Ma J. Dixon techniques for water and fat imaging. J Magn Reson Imaging. 2008;28:543–58.CrossRefPubMedGoogle Scholar
  11. 11.
    Costa DN, Pedrosa I, McKenzie C, Reeder SB, Rofsky NM. Body MRI using IDEAL. AJR Am J Roentgenol. 2008;190(4):1076–84.CrossRefPubMedGoogle Scholar
  12. 12.
    Gerdes CM, Kijowski R, Reeder SB. IDEAL Imaging of the musculoskeletal system: robust water-fat separation for uniform fat suppression, marrow evaluation, and cartilage imaging. AJR Am J Roentgenol. 2007;189:W284–91.CrossRefPubMedGoogle Scholar
  13. 13.
    Wismer GL, Rosen BR, Buxton R, et al. Chemical shift imaging of bone marrow: preliminary experience. AJR Am J Roentgenol. 1985;145:1031–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Sepponen RESJ, Tanttu JI. A method for chemical shift imaging: demonstration of bone marrow involvement with proton chemical shift imaging. J Comput Assist Tomogr. 1984;8:585–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Fayad LM, Jacobs MA, Wang X, et al. Musculoskeletal tumors: how to use anatomic, functional, and metabolic MR techniques. Radiology. 2012;265:340–56.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Disler DG, McCauley TR, Ratner LM, et al. In-phase and out-of-phase MR imaging of bone marrow: prediction of neoplasia based on the detection of coexistent fat and water. AJR Am J Roentgenol. 1997;169:1439–47.CrossRefPubMedGoogle Scholar
  17. 17.
    Zajick DC, Morrison WB, Schweitzer ME, et al. Benign and malignant processes: normal values and differentiation with chemical shift MR imaging in vertebral marrow. Radiology. 2005;237:590–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Erly WK, Oh ES, Outwater EK. The utility of in-phase/opposed-phase imaging in differentiating malignancy from acute benign compression fractures of the spine. AJNR Am J Neuroradiol. 2006;27:1183–8.PubMedGoogle Scholar
  19. 19.
    Zampa V, Cosottini M, Michelassi M, et al. Value of opposed-phase gradient-echo technique in distinguishing between benign and malignant vertebral lesions. Eur Radiol. 2002;12:1811–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Thawait SK, Marcus MA, Morrison WB, et al. Research synthesis: what is the diagnostic performance of magnetic resonance imaging to discriminate benign from malignant vertebral compression fractures? Systematic review and meta-analysis. Spine. 2012;37:E736–44.CrossRefPubMedGoogle Scholar

Copyright information

© ISS 2016

Authors and Affiliations

  • Matthew Winfeld
    • 1
  • Shivani Ahlawat
    • 2
  • Nabile Safdar
    • 3
  1. 1.University of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  2. 2.The Russell H. Morgan Department of Radiology and Radiological ScienceThe Johns Hopkins Medical InstitutionsBaltimoreUSA
  3. 3.Department of Radiology and Imaging SciencesEmory University School of MedicineAtlantaUSA

Personalised recommendations