DISTRIBUTION OF SEROUS LIKE BONE-MARROW CHANGES IN THE LOWER-LIMBS OFPATIENTS WITH ANOREXIA-NERVOSA - PREDOMINANT INVOLVEMENT OF THE DISTAL EXTREMITIES

OBJECTIVE. To assess the distribution of marrow changes in the bones o f the lower limbs of patients with anorexia nervosa (AN) and to correl ate the importance of the extent of marrow changes with clinical and h ematologic data. MATERIALS AND METHODS. The frequency of serouslike ma rrow (low signal intensity on T1-weighted images and very high signal intensity on TP-weighted images) was determined with MR imaging in the bones of the feet, distal tibias, and proximal femurs in 19 patients with AN. RESULTS. Serouslike marrow was found with an increasing frequ ency from proximal to distal in the lower-limb bones (femur, 31%; dist al phalanx of the first toe, 79%). The patients with abnormal femoral marrow (n = 6) were more severely emaciated and had lower leukocyte an d neutrophil counts than the patients with normal femoral marrow (n = 13). Among these patients, the six patients with at least two involved bones in the feet had lower blood cell counts than the seven patients with fewer than two involved bones. CONCLUSION. In the lower limbs of patients with AN, marrow changes predominate in the distal aspects. T his distribution pattern is the reverse of that seen in most bone marr ow disorders but is similar to the normal conversion of hematopoietic to fatty marrow, The importance of the blood cell count changes is cor related with the extent of marrow changes in the limbs.