Skeletal Radiology

, Volume 48, Issue 2, pp 209–218 | Cite as

The effects of granulocyte colony-stimulating factor on MR images of bone marrow

  • Liang GuEmail author
  • John E. Madewell
  • Rizwan Aslam
  • Bilal Mujtaba
Review Article


Granulocyte colony-stimulating factor (G-CSF) analogs such as filgrastim/pegfilgrastim are increasingly used to enhance neutrophilic recovery after chemotherapy. It is widely known that, physiologically, pegfilgrastim stimulates marrow mitotic activity and induces marrow reconversion from fatty to cellular. However, there is limited literature discussing the effects of pegfilgrastim on musculoskeletal magnetic resonance imaging, with the consensus that marrow reconversion secondary to pegfilgrastim therapy is easily confounded with a malignant process, especially in patients with a history of cancer. We attempt to discuss the expected changes and MRI findings after pegfilgrastim therapy through a summary of current literature. Additionally, we provide images from our own practice to support the previously established findings. G-CSF-stimulated reconversion can appear as patchy expansions of baseline hematopoietic marrow, but can also appear to be diffusely homogeneous, adding to its ambiguity. We conclude that using a baseline MRI, clinical information, and assessing sequential MRI changes in conjunction with pegfilgrastim therapy may aid the differentiation between benign and pathological change. We expand our discussion to include the effects of novel technologies, such as whole-body MRI, chemical shift imaging, and contrast agents in helping the distinction.


MRI Pegfilgrastim G-CSF Marrow Reconversion Neulasta 


Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.


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Copyright information

© ISS 2018

Authors and Affiliations

  1. 1.McGovern Medical SchoolUniversity of Texas Health Science Center at HoustonHoustonUSA
  2. 2.Department of Diagnostic Radiology, Division of Diagnostic ImagingUniversity of Texas MD Anderson Cancer CenterHoustonUSA

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