MR imaging characteristics of cranial bone marrow in adult patients with underlying systemic disorders compared with healthy control subjects

BACKGROUND AND PURPOSE: In young adults, hematopoietic bone marrow has usually converted to fatty marrow. Fat hyperintensity on TI-weighted MR images facilitates the evaluation of marrow abnormalities. Our purpose was to compare cranial marrow signal intensity patterns in adults with systemic disorders and in healthy subjects. METHODS: MR images in 25 adults with underlying systemic disorders (chronic anemia, lymphoma, leukemia, or other infiltrative processes) and 44 healthy aged-matched individuals were retrospectively reviewed. Calvarial and clival marrow signal intensity on sagittal T1-weighted images was graded relative to that of orbital fat, white matter (WM), and gray matter (GM). Marrow was classified as homogeneous (uniformly isointense), diffusely heterogeneous (mottled), or focally heterogeneous (generally isointense with a focal lesion). RESULTS: In 84% of the control subjects, bone marrow was iso- or hyperintense relative to WM. Patients had abnormal diploic (n = 22) or clival (n = 17) marrow; 22 had calvarial marrow that was hypointense relative to WM compared with that in seven healthy subjects (P < .001). Marrow hypointensity relative to WM was a sensitive (93%) and specific (86%) marker of pathologic abnormality. Although marrow hypointensity relative to GM was specific (96%), it was not sensitive (67%). Calvarial and clival marrow patterns, respectively, were homogeneous in 81% and 64% of control subjects and 76% and 60% of patients. Clival marrow intensity varied more than did calvarial intensity; therefore, clival criteria were less sensitive and accurate in systemic disease detection. CONCLUSION: Homogeneous diploic marrow hypointense relative to WM on non-contrast-enhanced T1-weighted images suggests an underlying systemic or hematologic disorder and requires appropriate clinical correlation and evaluation.