Bone marrow reconversion in adults who are smokers: MR Imaging findings. Am J Roentgenol

Department of Radiology, Aultman Hospital, Canton, OH 44710-1702.
American Journal of Roentgenology (Impact Factor: 2.73). 01/1994; 161(6):1217-21. DOI: 10.2214/ajr.161.6.8249729
Source: PubMed


Conversion of bone marrow in the extremities from red to yellow is a normal maturation process. Marrow reconversion is present when expected yellow marrow is replaced with active red marrow, and it tends to occur at times of physiologic stress. The significance of this finding on MR imaging is not always clear. Accordingly, we studied the prevalence of bone marrow reconversion in adults undergoing MR imaging of the knee for reasons other than marrow disorders. Possible relationships between marrow reconversion and age, sex, weight, and smoking were sought.
Fifty-nine outpatients over 24 years of age who had no evidence of hematopoietic disorders and for whom MR images of the knee were available for review were selected for study. Patients younger than 25 years old were eliminated to ensure that all patients in the study were old enough to have achieved normal adult marrow conversion. The 59 subjects were classified according to their smoking histories. Twenty-eight were nonsmokers, 10 were intermediate smokers, and 21 were heavy smokers. The MR images were classified as showing either red marrow (reconverted from yellow to red) or yellow marrow (converted) by two independent observers who had no knowledge of the patients' smoking histories.
MR images of six heavy smokers, two intermediate smokers, and one nonsmoker showed evidence of reconversion. A statistically significant association between marrow reconversion and heavy smoking (p = .02) was found. Reconversion also was found to be more prevalent in patients less than 39 years old and in obese women who smoked. No association was found between weight, sex, or obese male smokers and reconversion.
Our results show marrow reconversion at the knee is most prevalent in heavy smokers, younger patients, and especially obese women who smoke heavily. In these patients, marrow reconversion can be a normal finding on MR imaging. In other patients, other causes should be considered.

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    • "Reconversion to hematopoietically active marrow can occur in the setting of malignancy, necrosis, fibrosis, edema secondary to trauma or stress, replacement, infiltration, or infection, but the patient may be asymptomatic clinically [3] [4]. In addition, heavy smoking history has been significantly associated with marrow reconversion [5]. While reconversion can be seen noninvasively on MRI, the exact etiology is difficult to determine from imaging alone. "
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    ABSTRACT: Purpose: The increased use of magnetic resonance imaging (MRI) has resulted in reports of incidental abnormal bone marrow (BM) signal. Our goal was to determine the evaluation of an incidental abnormal BM signal on MRI and the prevalence of a subsequent oncologic diagnosis. Methods: We conducted a retrospective cohort study of patients over age 18 undergoing MRI between May 2005 and October 2010 at Tufts Medical Center (TMC) with follow-up through November 2013. The electronic medical record was queried to determine imaging site, reason for scan, evaluation following radiology report, and final diagnosis. Results: 49,678 MRIs were done with 110 patients meeting inclusion criteria. Twenty two percent underwent some evaluation, most commonly a complete blood count, serum protein electrophoresis, or bone scan. With median follow-up of 41 months, 6% of patients were diagnosed with malignancies including multiple myeloma, non-Hodgkins lymphoma, metastatic non-small cell lung cancer, and metastatic adenocarcinoma. One patient who had not undergone evaluation developed breast cancer 24 months after the MRI. Conclusions: Incidentally noted abnormal or heterogeneous bone marrow signal on MRI was not inconsequential and should prompt further evaluation.
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    • "Reconversion is a physiological response to increased hematopoietic needs of the body, including [6–8]: "
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