Red and yellow marrow in the femur: age-related changes in appearance at MR imaging

T1-weighted magnetic resonance (MR) images of the femur in 77 subjects, aged 1 month to 24 years, were retrospectively analyzed for the distribution and appearance of red and yellow marrow. The subjects were divided into six age groups, and the signal intensity and degree of mottling of marrow in the proximal epiphysis, proximal metaphysis, diaphysis, distal metaphysis, and distal epiphysis were observed and assigned a grade. Bone marrow with low or intermediate to slightly increased signal intensity was considered red marrow, while bone marrow with increased signal intensity was considered fatty marrow. An orderly progression of red to yellow marrow conversion in the femur was appreciated first in the diaphysis (ages 1-10 years) and then in the distal metaphysis (ages 10-20 years), with an adult pattern seen by age 24 years. The MR spectrum of red and yellow marrow differs from the existing macroscopic anatomical data because MR imaging is apparently more sensitive to the presence of microscopic fat in bone marrow.