Devoted to diagnostic and interventional spine imaging and therapeutics


MRI of Vertebral Bone Marrow: A Pictorial Review of Pathophysiologic Conditions 2012

General Spine

Asif, Abdullah, M.D.
Augusto, Elias, M.D., Non ASSR Member
Ahmad, Aouthmany, M.D., Non ASSR Member
Haitham, Elsamaloty, M.D., Non ASSR Member



Magnetic resonance imaging is widely considered the modality of choice for investigation of vertebral bone marrow disorders. Accurate interpretation of MR examinations of vertebral bone marrow requires a thorough understanding of anatomy, physiology, distribution, and conversion patterns of bone marrow. Technical factors of MR examination are also an important consideration. Common pathophysiologic pathways allow a useful classification of spine bone marrow disorders. The purpose of this review is to demonstrate normal physiologic conversion of spine marrow through life, from hematopoietic to fat bone marrow. A systematic imaging based review of vertebral bone marrow of pathological conditions will also be provided. Identifying principal radiological findings allows for reasonable differential diagnosis.

Methods & Materials

The vertebral body bone marrow can be affected by a wide variety of pathologic processes such as myeloproliferative diseases, osteomyelitis, and hemochromatosis, but metastatic disease and multiple myeloma are the most common causes of bone marrow disease. The bone marrow conditions have been categorized according to common pathophysiological patterns based on imaging. The major diseases affecting the vertebral bone marrow can be classified into traumatic, infectious, neoplastic, ischemic and degenerative. An imaging based review of various forms of post treatment changes will also be provided.


MRI is ideally suited for evaluation of both diffuse and focal bone marrow diseases of the spine. Physiologic conversion from red to fat marrow manifests as a normal and gradual increase in T1 signal of vertebral marrow. In pathological bone marrow, distribution of vertebral body edema, cortical margins, pattern of contrast enhancement, presence of soft tissue mass, characteristics of intervertebral disc and signal alterations on various MR sequences in correlation with pertinent clinical history provide a systematic approach to differential diagnoses.


MRI assessment of the vertebral bone marrow requires thorough understanding of physiological changes during life and recognizing various patterns of pathological and post treatment changes. Magnetic resonance imaging is a powerful tools in suggesting differential diagnosis in correlations with clinical history.

References/Financial Disclosures

The authors have nothing to disclose and have no conflict of interest