Magnetic resonance abnormalities of bone marrow in a case of acute lymphoblastic leukemia

Although magnetic resonance imaging (MRI) is not performed routinely in the diagnostic work-up of children with leukemia, patients may present with a normal peripheral blood cell count and osteological manifestations. For such cases, MRI may be requested in the early workup for a diagnosis. This situation illustrates that a delay in appropriate diagnosis may occur, with the classic features of the disease being uniformly absent. We present a child illustrating the salient features of acute leukemia upon MRI with limb pain and an initial normal peripheral blood cell count.