Dear OCADers,
Thank you to everyone who shared their expertise with me. I really appreciate it.
I share with you the responses I got:
Dr. Monjardim: Hey Laith definitely infiltrated bone marrow. T1 too dark (darker than muscle) and there is enhancement.
Dr. Braithwaite: although it is following the reversal pattern of normal red to white conversion, its more extensive than typical for red marrow reconversion
Looks like the proximal femoral epiphyses are still fatty – which are usually replaced in leukemia
but Id still recommend biopsy
Not typical pattern for scurvy
Dr. Farber:
You need to perform GRE in and out of phase images to determine if it’s red marrow.
Dr. Atul Taneja: The extensive and confluent aspect with very low signal intensity on T1 sequence, is suggestive of marrow infiltration. Given the pancytopenia found, lymphoproliferative disorders (including leukemia) is the main differential.
For such cases IP and OP sequences are interesting.
Dr.Vande Berg:
this differential (infiltration vs hypercellular marrow) can occasionally be impossible…
In your case I would favor infiltration because very low on T1 and to bright on fat sat Gd et on Stir.
However, I would not bet a lot of money
Dr. Stein: It looks infiltrative with inflammation of bone and muscle suggesting acute leukemia or viral infection (like COVID-19).
Biopsy results: Leukemia
Attached is ChatGPTs response
Laith Alhyari M.D.
Attending Musculoskeletal Radiologist
University of Oklahoma Health Sciences Center
Oklahoma City, OK
On Jul 25, 2025, at 4:44 PM, Laith wrote:
Dear OCADers,
Happy Friday. I would like to get your opinion on this 14 year old female who presented with left lower extremity pain. Pancytopenia was incidentally noted on her work up. She had myositic changes and a fluid collection in her left anterior muscle compartment. I am sharing 4 coronal images of her femora with attention to her bone marrow. Would you call this red marrow reconversion or infiltrated bone marrow? And why?
I will share consensus and final diagnosis soon.
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