Acute lymphoblastic leukemia was confirmed in this patient after a bone marrow biopsy. It is the most common leukemia in childhood. Characteristically, the vertebral bodies are diffusely T1-hypointense and T2/STIR-hyperintense due to leukemic infiltrates replacing the normal fatty marrow. Pathologic fractures are frequently seen and can mimic non-accidental trauma.
With these types of MR signals, multiple vertebral fractures and hepatosplenomegaly, there is no significant differential diagnosis worth mentioning except for other types of leukemia.