Radiation-induced MRI signal changes in bone marrow

Last revised by Dr Mostafa El-Feky on 01 Oct 2021

Radiation-induced MRI signal changes in bone marrow are the earliest detectable changes in bone. Their severity correlates with increasing radiation dose.


  • 1st week: decreased marrow cellularity with edema and hemorrhage
  • 2nd week: increased marrow cellularity due to influx from non-irradiated areas
  • 1-3 months: marrow sinusoids and cellularity is decreased
  • after 6 months: regeneration of hematopoietic tissue and sinusoids

Radiographic features


Little changes in signal intensity during the first 3 weeks of radiation therapy on spin echo sequences. STIR shows increased signal intensity during this period.

After 3 weeks heterogenous mottled appearance of marrow is seen.

During 3-6 weeks marrow cellularity is replaced by central fat predominantly surrounding the basivertebral veins.

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Cases and figures

  • Case 1: chronic radiation induced fatty marrow replacement
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  • Case 2
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  • Case 3
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