Purpose or Case Report: Marrow signal changes in the pediatric population are often complex and can appear nonspecific to the inexperienced radiologist. Normal physiological marrow changes from birth to adulthood play a confounding role. A good understanding for diffuse marrow replacing processes that demonstrate T1 hypointense signal on MRI is crucial for the radiologist to correctly identify pathology, provide early and pathology-specific treatment, and ultimately play a profound role in patient care. The purpose of this educational exhibit is to review the various pathological etiologies of diffuse T1 hypointense marrow signal changes in the pediatric patient, including sickle cell anemia, gaucher’s disease, leukemia, diffuse marrow metastasis, osteomyelitis, thalassemia, juvenile inflammatory arthritis, and bone marrow edema syndromes. Additionally, potential pitfalls will be discussed including red marrow hyperplasia, treatment related changes, immobilization/stress reaction, and normal residual red marrow. Case examples will be provided along with pearls that will aid the radiologist in narrowing their differential diagnosis when faced with specific clinical scenarios.
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