11 Castillo, M, Malko, JA, Hoffman, JC, Jr: The bright intervertebral disk: an indirect sign of abnormal spinal bone marrow on T1-weighted MR images AJNR Am J Neuroradiol. Talk to a doctor now 24/7 visits - just $39! The signal is similar. The long arrow connotes a slightly hypointense poorly defined lesion on T1w (20a) which is quite conspicuous on the T2w (20b) and STIR (20c) that is typical for focal tumor except in its lack of defined borders on the T1w view. 1 What is heterogeneous bone marrow signal? Abstract. Red marrow exhibits intermediate signal and tends toward slightly higher or equal signal compared to muscle on both T1w and T2w sequences. malignant) process, the appearance of the clivus is not a reliable discriminator20. Int J Hematol. Can't tell here. Pluripotent stem cells develop into myeloid blasts (myeloblasts, monoblasts, erythroblasts and . Engineered cellular immunotherapies in cancer and beyond. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. In a patient such as the test case who demonstrates diffusely low T1w marrow signal on MR, the differential diagnosis is long and includes many benign reconversion conditions, malignant myeloproliferative disorders and abnormalities of the supporting reticulum. Chan WP, et al. Physiologic demand for more mature blood cells (especially red blood cells) beyond the bodys normal capacity to produce them acts to reverse the normal pattern of conversion of red marrow to yellow marrow. Focal areas of red marrow may be a challenge to disclose its nature in some clinical scenarios and mandates making use of different MR pulse sequences to disclose its nature. Am. The color of red bone marrow is the result of red blood cell production. Unless pathologic marrow has a much higher signal (e.g. T1w axial image in a normal 26 month-old boy. . Partially or peripherally enhancing lesions are non-specific as post-treatment fibrosis will enhance7,8,25,36,37,39,40. 8 The cellular composition of red marrow is 60% hematopoietic cells and 40% fat cells. Water has a much longer relaxation time compared to fat and is hypointense on T1w and hyperintense on T2w images. Why are the red cells larger than normal in megaloblastic anemia? Br J Haematol 2008;141(1):60-68. Erly, E.S. Pediatric Bone Marrow MR Imaging Magnetic Resonance Imaging Clinics of North America. Diagnosis is made by bone marrow biopsy. The macrophage not only provides iron for developing erythroblasts but also phagocytoses expelled nuclei. Usually it forms in the white blood cells, but it can happen in other types of cells, too. Erythroblastic island consists of a central CD169-expressing macrophage, MeSH Except for the sternum, ribs, proximal aspects of the extremities, and the pelvis, the overwhelming majority of red marrow is in the spine in an adult1,7. But opting out of some of these cookies may affect your browsing experience. 1996;167(2):355358. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. Inflammation is often also heterogeneous on MRI. The T2-weighted fast spin echo sequence is relatively insensitive to the abnormal marrow, and is largely unremarkable. Hematol Oncol Clin NA. What does decreased T1 marrow signal mean? Differences in colour, shape, and size can make a tissue look heterogeneous. Erythroid hyperplasia expands the marrow space and thins trabeculae, weakening bone and contributing to the classic endplate deformity. The persistence of immunophenotypically normal residual Author Manuscript bone marrow plasma cells at diagnosis identifies a good prognostic subgroup of symptomatic multiple myeloma patients. Identification of the niche and mobilization mechanism for tissue-protective multipotential bone marrow ILC progenitors. Around 50% of patients with focal or diffuse MR patterns do not have lytic lesions on conventional x-rays. The development or progression of fractures does not necessarily point to progression of disease as tumor elimination may be followed by loss of structural support. Bone marrow is the spongy tissue in the center of your bones. The https:// ensures that you are connecting to the The fracture of T12 (short arrows) looks superficially benign on T1w images (20a) but has abnormal signal on T2w (Fig 20b) and STIR (20c). Radiology. To learn more, please visit our. The bony spinal canal displays normal width. Visibility can be augmented by suppressing the fat which is present in both red and yellow marrow. The pH of the marrow cavity is not known though the pH of extravascular tissues is generally lower than that of arterial blood (pH 7.4) and venous blood (pH 7.36) (Arnett 2010).The oxygen tension of normal bone marrow is about 52 mmHg (6.6 %) which is lower than that of arterial blood (95 mmHg, ~12 %) and higher than that of veno-capillary blood (40 mmHg, ~5 %) (Arnett 2010). Hematopoietically active marrow is usually referred to as red marrow. 2008; 190:1156-1160. These cells stimulate the abnormal formation of marrow fibroblasts and incite the release of collagen. Abnormal low signal on T1 images frequently indicates a pathological process such as trauma, infection, or cancer. bone marrow is usually not geographic and more vague in appearance, it is frequently symmetric and located in the metaphyses, the signal is brighter than that of muscle in T1-weighted sequences and both bone scan and FDG PET are negative. On the T1WI, small islands of central high signal can be seen within the red marrow ( arrows, Fig. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. 31 As with other infiltrative disorders, the extent of tumor burden correlates with MRI findings. You also have the option to opt-out of these cookies. For doses greater than 30-40 Gy, the marrow changes are permanent due to ablation of vascular sinusoids. Heterogeneous bone marrow signal means that on MRI Magnetic Resonance Imaging (MRI) A radiologist interprets the results and classifies it as normal, abnormal, or potentially abnormal. Bone marrow involvement by malignant lymphoma is much more common with Non-Hodgkin disease than Hodgkin disease and spreads to the marrow 95% of the time hematogenously. BM cellularity was considered normal if it . What is heterogeneous marrow signal within the axial skeleton mean on an mri of the right hip mean. 1988; 169:799-804, 33 Vande Berg BC, Schmitz PJ, Scheiff JM, Filleul BJ, Michaux JL, Ferrant A, Jamart J, Malghem J, Maldague BE: Acute myeloid leukemia: Lack of predictive value of sequential quantitative MR imaging during treatment. Blood. An official website of the United States government. Three patterns of bone marrow infiltration have been described on MR imaging: diffuse uniform, diffuse patchy, and focal. Rare diagnoses that may present with diffuse T1-weighted hyperintensity include anorexia and aplastic anemia. 40 The diffuse pattern is sometimes missed because of symmetry and homogeneous signal abnormality. Important anatomic and compositional differences exist between these two types of marrow. Since red marrow has a mixture of water, fat and protein it exhibits intermediate signal intensity on both T1w and T2w sequences1,7,8,9. Normal variants and frequent marrow alterations that simulate bone marrow lesions at MR imaging. Red marrow has intermediate signal on T2 fatsat and STIR. In this larger-scale study, we found that bone marrow heterogeneity, assessed by the second-order textural features contrast and dissimilarity, is significantly higher in females compared to males, while PDFF itself showed no significant difference between females and males averaged over all age groups. By clicking Accept All, you consent to the use of ALL the cookies. [4] Moreover, the red marrow shows signal intensity less than that of fat on T2W MR images. 1988; 168:679-693. On this fast spin echo sequence the marrow appears of normal intensity. However some fat is seen centrally along the basivertebral veins (arrows) even at this very young age. 8,14 Red marrow has a rich, arborized vascular network. A T1w sagittal image demonstrates heterogeneous marrow that is generally reduced in signal. These findings may be noticeable on MR when compared to a prior study. AJR Am J Roentgenol. The bone marrow in patients with TN-PMF showed fewer granulocytic elements and more frequent dyserythropoiesis. 41 Kwee TC, Kwee RM, Verdonck LF, et al. Human Bone Marrow Stromal Cells: A Reliable, Challenging Tool for In Vitro Osteogenesis and Bone Tissue Engineering Approaches . Int J Mol Sci. Accessibility Pattern 1 begins in younger patients where central fat is visible along the basivertebral veins. These cookies will be stored in your browser only with your consent. Objective: To describe the magnetic resonance (MR) appearances of the bone marrow of children's feet and to determine their frequency and significance. Diffusely heterogeneous bone marrow signal throughout the pelvis Thyroid is mildly heterogeneous Endometrial stripe is heterogeneous What is heterogeneous echogenicity Connect with a U.S. board-certified doctor by text or video anytime, anywhere. This cookie is set by GDPR Cookie Consent plugin. This pattern may persist for many years (10a,11a). SEATTLE (AP) _ A Soviet hero in the struggle to stop radiation spewing from the Chernobyl nuclear reactor has arrived here for a life-saving bone-marrow transplant. Red Blood Cells (RBCs) Red blood cells, also called erythrocytes, transport oxygen throughout the body . This inborn error of metabolism leads to accumulation of glucocerebrosides within the macrophage-monocyte cell line. For these, please consult a doctor (virtually or in person). The cookies is used to store the user consent for the cookies in the category "Necessary". Moulopoulos reported that in their experience the marrow repopulation gradually becomes more homogeneous over time25. The finding of a diffuse marrow abnormality on MRI, however, is non-specific. 2002; 14:35-47. AJR 2007; 188:1443-1445. "Bone marrow edema" can be seen in a number of different conditions. Multiple Myeloma is a plasma cell dyscrasia. In most cases of lymphomatous involvement of bone or bone marrow, the heterogeneous appearance on post-therapy PET scans can usually be reconciled from being malignant in nature . those derived from bone marrow comprise only 0.001 to 0.01 per cent of the cells in the bone marrow taken from part of the largest bone in . Multiple myeloma, Diffuse type. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". Signal intensity can vary considerably with areas of high and low T2w with low T2 signal thought to be attributable to dense clusters with hypercellularity. As in the leukemias, follow-up of diffuse forms may be problematic in differentiating hypercellular reactive marrow, fibrosis and residual or recurrent active tumor7,25,41. Radiology. Hematol Oncol Clin NA. The treatments used in oncology modify pathological marrow but also normal marrow and may sometimes lead to complications. Hemorrhages may occur within a vertebral body raising the T1w signal which might under some circumstances confuse the evaluation of a segment. Would you like email updates of new search results? T2w fatsat, STIR and post enhancement characteristics will differ in most but not all cases. The cookie is used to store the user consent for the cookies in the category "Performance". Such differentiation is better than x-ray, CT, PET, or even radionuclide bone scan with technetium. This tissue includes fat and immature blood cells and creates mature blood cells, white blood cells, which aid in disease-fighting and immunity, as well as red blood cells and platelets. Abnormal remodeling of cranial nerve foramina can result in deafness and blindness. What does the Central High signal on the T1WI mean? In adults spinal bone marrow is best imaged with MRI due to the exquisite contrast differentiation between normal marrow and pathologic infiltration on many pulse sequences. These observations plus the fact that reconversion tends to be focal has contributed to some MR descriptions of aplastic anemia as heterogeneous. Recent advancement in technologies has significantly improved our understanding of the cellular and molecular constituents that contribute to regulation of hematopoiesis and to maintenance of the hematopoietic stem cells (HSCs). An MRI-controlled study of treatment by core decompression. Secondary myelofibrosis is much more common, usually resulting from chemotherapy or radiation therapy. They cause vertebrae fractures and back pain. This focus also demonstrates a bull's eye sign where a tiny focus of fat is surrounded by lower signal red marrow. We studied the properties of MSCs from the bone marrow (BM-MSC) before and after implantation under the renal capsule using a mini pig model. This subjective assessment can be more accurate at qualifying marrow within bone as normal or abnormal than certain quantifying methods20. at L4-5 are suppressed (arrowheads), confirming the presence of fat, not hemorrhage. 1993;188:249-252. A bone marrow edema often referred to as bone marrow lesion occurs when fluid builds up in the bone marrow. at the participating institution. Radiology. I had a bone marrow biopsy looking or myaloma but it was negative. Abnormal bone marrow findings on an MRI should not be ignored. 6 Sze G, Baierl P, Bravo S. Evolution of the infant spinal column: evaluation with MR imaging. Some of these techniques include: chemical shift imaging (also known as opposed phase imaging); diffusion; spectroscopy and dynamic contrast enhancement14,15,16,17,18. A bone marrow biopsy can help diagnose conditions affecting the blood cells or marrow. Sci Adv. Radiology. 2020 Jan 25;21(3):796. doi: 10.3390/ijms21030796. This woman had undergone chemotherapy, but the pattern can not be differentiated from aplastic anemia by MR imaging. Knowledge of the signal on the variety of pulse sequences and pattern of marrow in the normal spine is essential knowledge in deciding what is potentially pathologic and what is not. A T1w sagittal image in a teenage boy demonstrates the Ricci pattern 1 with central fat visible along basivertebral veins. 3 What does decreased T1 marrow signal mean? 4 This heterogeneous marrow signal most likely represents patchy conversion of red to yellow marrow that is a well-described normal variant seen predominantly in older adults. 2005;43(4):761-770. Radiol Clin North Am. 2005; 53:705-710. The band enlarges over time and is easily distinguished from central fat. Curr Opin Hematol. 1987; 162:701-707, 32 Rosen BR, Fleming DM, Kushner DC, Zaner KS, Buxton RB, Bennet WP, Wismer GL, Brady TJ: Hematologic bone marrow disorders: Quantitative chemical shift MR imaging. J Assoc Physicians India. Ghosh J, Koussa RE, Mohamad SF, Liu J, Kacena MA, Srour EF. 2005;237:590-596. The recovery of normal red marrow signal has been reported both as patchy and peripheral band-like with band-like recovery apparently more common in the young. extraprostatic finding with no explanation? 15, Issue 2, Pages 175-198, 9 Mirowitz S, Apicella P, Reinus WR, Hammerman AM: MR imaging of bone marrow lesions: Relative conspicuousness on T1-weighted, fat-suppressed T2-weighted, and STIR images. What is thought to influence the overproduction and pruning of synapses in the brain quizlet? Since marrow is not a homogeneous tissue and changes with age, one should expect that its MR appearance will vary depending on the relative proportion of red and yellow marrow, cellularity and density of trabecular bone in the spine and on the type of sequence used for the acquisition. 35 Vande Berg BC, Michaux L, Scheiff JM, Malghem J, Lecouvet FE, Bourgois MP, Ferrant A, Michaux JL, Maldague BE: Sequential quantitative MR analysis of bone marrow: Differences during treatment of lymphoid versus myeloid leukemia. 4-year-old girl: heterogeneous hyperintensity is evident in the diaphysis and distal metaphysis. Vertebral body fractures occur frequently in myeloma and certainly retropulsion of bone and compression of neural elements are important and easy things to assess. Appearance of Normal Marrow in the Spine on MRI. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. 5.11 and 5.12). from sclerosis) it may not be very conspicuous on T2w views. Importantly, the intensity of marrow in an adult comes with an internal control when viewing T1w sequences. Not normal finding, could be a sign of serious issue ( or not). It usually means that the tissue has either some wear and tear, for example in a hip joint it would most likely imply arthritis. All of these disorders have the same appearance on MR. Epub 2022 Nov 23. 14 Zajick DC, Morrison WB, Schweitzer ME, et al. 5. Oh, and E.K. The corresponding T2w FSE image does not appear particularly abnormal. Recent findings: Young, multilobulated reticulocytes are initially attached to the macrophage surface but later detach. JCAT. This may contribute to the observation that marrow signal can be very high in elderly women on T1w images, whose trabeculae may thin from osteoporosis. Major organ for hematopoiesis at birth; also primary and secondary lymphoid organ. After successful bone marrow transplantation, hematopoietically active stem cells repopulate the bone marrow in a predictable pattern which has been described by Stevens, et al.30. The signal and pattern are abnormal for an adult. Erythroblastic island consists of a central CD169-expressing macrophage and adherent erythroblasts at varying stages of differentiation. 34 Yu S, Rosenbaum A, Poe LB, Fredrickson BE. It usually means that the tissue has either some wear and tear, for example in a hip joint it would most likely imply arthritis. 1990; 14:785-789. However, newer fast spin echo acquisitions (FSE) do not take advantage of this fact in a trade off for speed so that fat is not as hypointense on the T2wFSE most commonly performed today. Most of the vertebral bodies have much less high T1w signal within them than normally seen in an 89 year old person. Yellow marrow is 80% fat1. Finck AV, Blanchard T, Roselle CP, Golinelli G, June CH. Enhancement does occur in pathologic marrow and this difference can be highlighted using post contrast T1w images with fat saturation7. Doctors typically provide answers within 24 hours. The more yellow marrow which is present within a vertebral body the more homogeneously suppressed (hypointense) the body will appear with these techniques. Of those patients who underwent evaluation for the finding, 24% were diagnosed with a malignancy. What is a heterogeneous abnormal marrow signal? While the term "edema . A heterogeneous signal on MRI essentially means that the part of the body shows different brightnesses on MRI. Heterogeneous can be used to describe the way the tissue looks with or without a microscope. 44 Kaplan PA, Asleson RJ, Klassen LW, Duggan MJ: Bone marrow patterns in aplastic anemia: Observations with 1.5-T MR imaging. These cookies ensure basic functionalities and security features of the website, anonymously. Air is an example of a homogeous mixture. Every one states "there is a heterogeneous appearance to marrow, felt to represent a mixture of red and yellow marrow. The cause of this may be a fracture, cancer, tumor, or it may just be nothing to worry about at all. Conditionally pathogenic genetic variants of a hematopoietic disease-suppressing enhancer. 3 Ricci C, Cova M, Kang YS, Yang A, Rahmouni A, Scott WW, Zerhouni EA: Normal age-related patterns of cellular and fatty bone marrow distribution in the axial skeleton: MR imaging study. Other causes include: hyperplastic anemias such as sickle cell disease, thalassemia and spherocytosis(14a,14b,14c,15a); administration of erythrocyte or granulocyte stimulating agents for therapy and polycythemia vera (16a). The most common pathologic infiltration of marrow is metastases from solid organ tumors, but since metastatic disease is much more often multifocal than diffuse in its imaging pattern in the spine, it will only be briefly discussed in this article. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. It is composed of a combination of hematopoietic red marrow and fatty yellow marrow, and its composition changes throughout life in response to normal maturation (red to yellow conversion) and stress (yellow to red reconversion). Magnetic resonance imaging for the detection of bone marrow involvement in malignant lymphoma. This patient exhibits a diffusely abnormal bone marrow pattern due to previously unrecognized leukemia. 8600 Rockville Pike 47 Geremia GK, McCluney KW, Adler SS, et al. Myelodysplastic syndrome (MDS) immunity plays an important role in the proliferation and apoptosis of aberrant cells. Worth talking with your doctor about. Clinical History: A 43 year old male presents with radicular type pain. The T1-weighted sagittal sequence demonstrates diffusely reduced signal of the bone marrow. Bone marrow involvement upstages the patient and may have prognostic and therapeutic implications. Effect of granulocyte-stimulating factors on marrow of adult patients with musculoskeletal malignancies: incidence and MRI findings. Primary myelofibrosis is also a myelodysplasia and therefore predisposes to conversion to leukemia. The relative brilliance of a radiographic image, radioactive tracer, or biological marker. At birth the majority of marrow is hematopoietically active red marrow. PMC 1997; 7: 394-398. Note the fatty replacement of the lower three vertebral bodies (arrowheads). This sequence relatively poorly discriminates red from yellow marrow. Opportunities for such evaluation abound as portions of the marrow can be evaluated on nearly every MR study performed. The .gov means its official. 1997; 90: 2127-2147. It is curious that some areas suggesting degenerative fat persist (arrowheads) despite complete marrow replacement otherwise. Bone marrow is the sponge-like tissue inside the body's larger bones that produces blood cells. As one of the main components of bone tissue engineering . 2009; 23: 159-170. 12 Schweitzer ME, Levine C, Mitchell DG, et al. history:hla-b27 pos w/inflammatory back pain, xr-degenerative changes. This may be a useful sign in differentiating bone metastases from bone marrow edema on T1-weighted images; bone marrow edema shows heterogeneous signal intensity due to coexistence of hyperintense foci of normal fatty marrow with hypointense foci of bone marrow edema (Figs. The MRI appearance of pathological bone marrow is variable: normal red marrow appearance (e.g. The diffuse pattern mimics other replacement disorders such as leukemia and even marrow reconversion. AJR. A severe compression fracture is noted at L3. In early stages of the disease, the MR may appear normal. Prior Radiation Treatment Consequently, heterogeneity of the spinal marrow is a normal phenomenon, especially in adolescence and middle age. MR is a very sensitive technique for evaluating bone marrow. What causes T1 signal hyperintensity in MR imaging? The bone marrow can be viewed as a carrier with subcompartments tailored to support different hematopoietic activities. Radiology. Images obtained with these sequences tend to be grainier and less distinct due to suppression of signal from lipid protons decreasing the signal to noise ratio9. Bone marrow can be essentially divided into three parts: red marrow, yellow marrow and supporting structures such as trabecular bone and reticulum. 1: Normal bone marrow in a The appearance of marrow depletion disorders on MR can overlap with normal. AJR Am J Roentgenol. Bone marrow: The soft blood-forming tissue that fills the bone cavities is referred to as bone marrow. government site. Firstly, MSCs obtained from various parts of the body differ in their biological characteristics. MRI in the detection of malignant infiltration of bone marrow-a commentary. Heterogeneous is a word pathologists use to describe tissue that looks very different from one area of the tissue to the next. There is great variability among patients and some differences in the patterns between the cervical, thoracic and lumbar segments. 14 The intervertebral discs appear brighter or isointense to the diseased marrow. 4 Ishijima H, Ishizaka H, Horikoshi H, et al. Epub 2021 Dec 10. The T1w sagittal image demonstrates diffusely low signal within marrow, not only within the spine but also within the clivus. What are the likely diagnoses? Whole body MR has found some use in staging and following this disorder7,8,25,36,37,38. T1w sagittal image demonstrates a poorly circumscribed central area of low signal intensity (arrows) which might mimic a pathologic lesion in this adult male. 18 Griffith JF, Yeung DK, Antonio GE, et al. 7 Alyas F, Saifuddin A, Connell D: MR Imaging Evaluation of the Bone Marrow and Marrow Infiltrative Disorders of the Lumbar Spine. 36 Hanrahan CJ, Christensen CR, Crim JR. Current Concepts in the Evaluation of Multiple Myeloma with MR Imaging and FDG PET/CT: RadioGraphics. Epub 2013 Feb 24. WB Saunders, 1994, pp 127-172. Other imaging techniques have been utilized in attempts to differentiate normal from abnormal marrow but are not in clinical use on a day to day basis and are beyond the scope of this article. @misc{etde_352373, title = {Heterogeneous signal in bone marrow on MRI of children`s feet: a normal finding?} (1a) T1- and (1b) T2-weighted sagittal and (1c) T1-weighted axial images are provided. Diffuse bone marrow disorder which in this case led to an eventual diagnosis of Chronic Myelogenous Leukemia (CML). These MRI findings led to a new diagnosis of lymphoma in an 89 year old man with an unusual display of signal abnormalities likely related to a mixture of pathologies. The bone marrow niche is increasingly recognized as heterogeneous with specific subtypes of mesenchymal niche cells governing the development or homeostasis of selective parenchymal hematopoietic subsets. 1994; 162:215-221. The patterns may seem to overlap in clinical practice but their descriptions are a useful teaching tool. AJR Am J Roentgenol. Other diffuse marrow diseases and conditions are possible based on the images and will be discussed. An HCT, also known as a bone marrow or stem cell transplant, is a potential treatment option for patients with blood cancers such as leukemia, lymphoma or multiple myeloma. That is not the case in the reported therapeutic response in aplastic anemia. 17 Castillo M. Diffusion-weighted imaging of the spine: is it reliable? Any system of stratifying pathologies could be criticized but in an attempt at simplicity I divide the diffuse disorders of the spinal marrow into: Reconversion or Hyperplasia; Replacement Disorders; Depletion Disorders; and Reticulum Disorders or disorders of Supporting Structures. T1 signal hyperintensity of various degrees is observed at MR imaging of the sellar region. Bone marrow edema is. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Only a minority of patients with chronic renal failure have spinal marrow with this appearance. It is uniformly found throughout the skeleton at birth. 42 Stevens SK, Moore SG, Kaplan ID: Early and late bone-marrow changes after irradiation: MR evaluation. 7 What causes T1 signal hyperintensity in MR imaging? 2003;17:1211-1226. STIR is widely used for bone marrow imaging because it offers excellent delineation of marrow abnormalities . doi: 10.1126/sciadv.abk3521. Hemosiderosis likely contributes to the decreased marrow signal. 15, Issue 2, Pages 199-219. Gap Junctions in the Bone Marrow Lympho-Hematopoietic Stem Cell Niche, Leukemia Progression, and Chemoresistance. "Gestalt" of marrow is normal as the vertebral body centrum is of overall higher signal than the adjacent intervertebral discs. Am J Roentgenol 1991;157(1):87-92. Initially edema and necrosis occur which can be followed by hypocelluarity if a positive tumoral response is elicited.
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