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

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Abstract

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.

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Authors and Affiliations

  1. McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX, 77030, USA

    Liang Gu

  2. Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Liang Gu, John E. Madewell, Rizwan Aslam & Bilal Mujtaba

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  1. Liang Gu
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  2. John E. Madewell
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Correspondence to Liang Gu.

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Gu, L., Madewell, J.E., Aslam, R. et al. The effects of granulocyte colony-stimulating factor on MR images of bone marrow. Skeletal Radiol 48, 209–218 (2019). https://doi.org/10.1007/s00256-018-3035-0

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  • DOI: https://doi.org/10.1007/s00256-018-3035-0

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