Bone marrow is a vital tissue in our bodies with many physiological roles. It must be comprised of a healthy balance of different cell types to function effectively. When this balance is disturbed, i.e., an overabundance of abnormal or immature cells, bone marrow function is compromised. Bone marrow that displays these imbalances is known as heterogeneous bone marrow and can indicate the presence of diseases, including cancer1.
Being diagnosed with heterogeneous bone marrow may cause distress due to its association with disease. It's crucial to understand that heterogeneous bone marrow can have a range of causes, not all of which are severe or life-threatening2. Educating yourself about this condition will help you maintain realistic expectations and a clear understanding of what it means for your health. This article will explore why heterogeneous bone marrow occurs, how it is diagnosed and managed, and steps to manage the psychological impact of a diagnosis.
Understanding Bone Marrow and Its Function
Bone marrow is a spongy tissue inside bones that produces blood cells, including white blood cells, red blood cells, and platelets3. Thus, bone marrow is essential for immune function, oxygen transport, and clotting. Disruptions to the bone marrow can significantly impact our health and lead to various diseases.
Many cell types naturally reside in the bone marrow4. The ratio between these cell types naturally changes over time, but some changes can indicate disease. There are two broad types of bone marrow5.
- Red bone marrow: Contains more stem cells and blood vessels and is more prominent in infants.
- Yellow bone marrow: Contains fewer stem cells and blood vessels, is comprised mainly of fat and water, and is more prevalent in adult bones.
Heterogeneous bone marrow
Heterogeneous bone marrow is often identified incidentally during magnetic resonance imaging (MRI)2. Generally speaking, heterogeneity describes abnormal signal intensities achieved during MRI scans.
Causes of changes in bone marrow appearance include:
- The normal ageing process
- Cancer, both local and metastasised
- Infection
- Autoimmune disorders
- Sickle cell disease
- Direct damage due to injury
- Certain treatments
What Does Heterogeneous Bone Marrow Mean?
Determining the cause of heterogeneous bone marrow on MRI scans is often challenging for clinicians and may necessitate a comprehensive approach, considering the patient's health history and other diagnostic factors6.
Definition and Characteristics
Heterogeneous bone marrow typically displays a mix of normal and abnormal cells, leading to an irregular distribution of blood cell types. This can include immature or unusually shaped cells and sometimes fibrous tissue. There are many ways in which bone marrow can appear abnormal. Simply put, clinicians expect specific tissues to look a particular way under MRI. When they observe something out of the ordinary, it is a cause for concern2.
Non-Cancerous Causes
There are many non-cancerous causes for bone marrow heterogeneity. These include:
- Ageing: The composition of our bone marrow changes as we age. Infant bone marrow consists mostly of red bone marrow, which is high in stem cells and protein. Over time, this red marrow is mostly replaced by yellow marrow.
- Infection: The body produces extra immune cells during infection, leading to alterations in bone marrow composition. Direct infections of bone marrow tissue can also lead to changes7.
- Sickle cell disease: This is a genetic disorder in which red blood cells become misshapen, resembling a sickle. This causes blockages in blood flow and leads to pain and other serious health problems. Sickle cell disease leads to abnormal signalling on MRI8.
- Cancer treatments: Most chemotherapies cause bone marrow suppression9. This prevents the bone marrow from producing enough blood cells and leads to abnormal MRI signals.
Cancer-Related Causes
Different types of cancer can affect the bone marrow, leading to the appearance of heterogeneous bone marrow during MRI scans.
- Leukaemia is a type of cancer that can arise in the bone marrow and causes an increase in the levels of abnormal white blood cells10. It can present as a diffuse pattern of T1-weighted signal intensities11.
- Multiple Myeloma is a type of cancer that originates in the bone marrow and leads to the overproduction of abnormal plasma cells, which are typically responsible for producing antibodies during infection12. Multiple myeloma usually appears as a round mass with low signal intensity in T1-weighted imaging and higher signal in T2-weighted imaging13.
Beyond these two types, many cancers can spread to the bone marrow from other organs14. Cancers that commonly spread to the bone include breast, lung, and prostate and can show up on MRI scans15.
Diagnostic Process and Next Steps
Once the initial observation is made, further scans and tests are performed to determine the underlying cause. Depending on the diagnosis, treatment may be required. In some cases, follow-up scans may be necessary to monitor disease progression or response to therapy.
Diagnostic Tests
Several tests can be used to diagnose issues that present as heterogeneous bone marrow. These tests generally differ depending on the patterning observed and the patient's medical history. A single test may be insufficient to diagnose the cause of bone marrow heterogeneity accurately.
- MRI: This diagnostic tool utilises strong magnetic fields and radiofrequency pulses to generate detailed images of internal body structures. This technique provides high-resolution images of soft tissues, organs, and other anatomical features without ionising radiation.
- Bone marrow biopsy: This is a medical procedure in which a small sample of bone marrow is removed using a specialised needle16. This sample is then examined under a microscope to diagnose various diseases.
Treatment and Management
Fortunately, many treatment options are available for conditions that cause heterogeneous bone marrow. If you are diagnosed with an infection17, your healthcare provider will likely prescribe an antibiotic, antifungal, or antiviral treatment, depending on the nature of the infection.
There are a variety of treatments for cancers, depending on the specific type of cancer and the stage. For example, multiple myeloma is typically categorised into three distinct stages and can be treated with chemotherapy, targeted therapies, radiation therapy, and bone marrow transplantation18.
Your healthcare provider will tailor your treatment to your specific needs.
Psychological Impact and Support
Being diagnosed with heterogeneous bone marrow can have a significant impact on an individual’s mental health. This is because it could indicate the presence of a severe disease or could be completely benign. It is entirely normal for individuals to experience anxiety in the face of an uncertain diagnosis19.
In these instances, it is essential for individuals and families to be aware of their mental health and to seek support when necessary. Your healthcare provider will be able to direct you to a mental health professional. Other support options can be found on the Macmillan Cancer Support website20. Taking care of your mental health is essential during diagnostic and treatment processes.
Conclusion
Understanding heterogeneous bone marrow is crucial for both medical professionals and patients. While its presence can be alarming due to its potential association with severe conditions like cancer, it is essential to remember that not all causes are life-threatening. Diagnostic approaches, including MRI scans and biopsies, help to determine the underlying reasons for bone marrow heterogeneity. Treatment options vary widely, depending on the specific cause, from antibiotics for infections to targeted therapies for specific cancers. Addressing the psychological impact through support systems and mental health care is essential for overall well-being during diagnosis and treatment. Staying informed and supported can make dealing with heterogeneous bone marrow easier, no matter the outcome.
If you have concerning symptoms21 or went for a scan and were told you have heterogeneous bone marrow, be sure to contact your healthcare provider for more information.
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References
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