{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:16:34Z","timestamp":1760235394870,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T00:00:00Z","timestamp":1629849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["211316","BA is supported by NHMRC Fellowship"],"award-info":[{"award-number":["211316","BA is supported by NHMRC Fellowship"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001249","name":"University of Tasmania","doi-asserted-by":"publisher","award":["AS is supported by the International Graduate Research Scholarship"],"award-info":[{"award-number":["AS is supported by the International Graduate Research Scholarship"]}],"id":[{"id":"10.13039\/501100001249","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Residual\/reconverted red bone marrow (RBM) in adult knees is occasionally observed on routine knee magnetic resonance imaging (MRI). We aimed to identify its prevalence, distribution, and associations with lifestyle factors, knee structural abnormalities, and knee symptoms in young adults. Methods: Participants (n = 327; aged = 31\u201341 years) were selected from the Childhood Determinants of Adult Health (CDAH) knee study. They underwent T1-weighted and proton-density-weighted fat-suppressed MRI scans of knees. Residual\/reconverted RBM in distal femur and proximal tibia were graded semi-quantitatively (grades: 0\u20133) based on the percentage area occupied. Knee structural abnormalities were graded semi-quantitatively using previously published MRI scoring systems. Knee symptoms (pain, stiffness, and dysfunction) were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale during CDAH knee study (year: 2008\u20132010) and at 6\u20139-year follow-up during the CDAH-3 study (year: 2014\u20132019). Associations between definite RBM (grade \u2265 2) and lifestyle factors, knee symptoms, and structural abnormalities were described using log-binomial regressions. Results: Definite RBM was seen in females only, in 29 out of 154 cases (18.8%), with femoral involvement preceding tibial involvement. Definite RBM was associated with increased BMI (PR = 1.09\/kg\/m2; 95% CI: 1.03, 1.16), overweight status (PR = 2.19; 95% CI: 1.07, 4.51), and WOMAC knee pain (PR = 1.75; 95% CI: 1.11, 2.74) in cross-section analysis. However, there was no association between RBM and knee-pain after seven years (PR = 1.15; 95% CI: 0.66, 2.00). There were no associations between RBM and knee structural abnormalities. Conclusion: Presence of definite RBM in young adult knees was observed in females only. Definite RBM was associated with overweight measures, and the modest association with knee pain may not be causally related.<\/jats:p>","DOI":"10.3390\/diagnostics11091531","type":"journal-article","created":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T00:19:26Z","timestamp":1629937166000},"page":"1531","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence and Clinical Significance of Residual or Reconverted Red Bone Marrow on Knee MRI"],"prefix":"10.3390","volume":"11","author":[{"given":"Minh Tu","family":"Vo","sequence":"first","affiliation":[{"name":"Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS 7000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4618-7507","authenticated-orcid":false,"given":"Ambrish","family":"Singh","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS 7000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6901-3801","authenticated-orcid":false,"given":"Tao","family":"Meng","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS 7000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasveen","family":"Kaur","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS 7000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7090-1398","authenticated-orcid":false,"given":"Alison","family":"Venn","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS 7000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flavia","family":"Cicuttini","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lyn","family":"March","sequence":"additional","affiliation":[{"name":"Institute of Bone and Joint Research, University of Sydney, Sydney, NSW 2065, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marita","family":"Cross","sequence":"additional","affiliation":[{"name":"Institute of Bone and Joint Research, University of Sydney, Sydney, NSW 2065, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2091-7663","authenticated-orcid":false,"given":"Terence","family":"Dwyer","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS 7000, Australia"},{"name":"The George Institute for Global Health, Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford OX3 9DU, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Halliday","sequence":"additional","affiliation":[{"name":"Department of Radiology, Royal Hobart Hospital, Hobart, TAS 7000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Graeme","family":"Jones","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS 7000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changhai","family":"Ding","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS 7000, Australia"},{"name":"Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"},{"name":"Clinical Research Centre, Zhujiang Hospital of Southern Medical University, Guangzhou 510280, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8704-6084","authenticated-orcid":false,"given":"Benny","family":"Antony","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS 7000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,25]]},"reference":[{"key":"ref_1","first-page":"792","article-title":"The anatomy of the bone marrow: With special reference to the distribution of the red marrow","volume":"2","author":"Piney","year":"1922","journal-title":"Br. Med. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/s00247-012-2582-0","article-title":"Marrow: Red, yellow and bad","volume":"43","author":"Guillerman","year":"2013","journal-title":"Pediatric Radiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/S0167-7799(03)00076-3","article-title":"Hematopoietic stem cells: From the bone to the bioreactor","volume":"21","author":"Cabrita","year":"2003","journal-title":"Trends Biotechnol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1002\/jcla.20305","article-title":"Bone marrow aspirate and biopsy: A pathologist\u2019s perspective. II. interpretation of the bone marrow aspirate and biopsy","volume":"23","author":"Riley","year":"2009","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Elgazzar, A.H. (2017). Bone marrow imaging. Orthopedic Nuclear Medicine, Springer Nature Switzerland.","DOI":"10.1007\/978-3-319-56167-7"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/j.crad.2004.02.001","article-title":"MRI of the marrow in the paediatric skeleton","volume":"59","author":"Foster","year":"2004","journal-title":"Clin. Radiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1053\/j.semnuclmed.2007.01.002","article-title":"Structural and Functional Imaging of Normal Bone Marrow and Evaluation of Its Age-Related Changes","volume":"37","author":"Blebea","year":"2007","journal-title":"Semin. Nucl. Med."},{"key":"ref_8","first-page":"45","article-title":"Bone marrow reconversion\u2013imaging of physiological changes in bone marrow","volume":"77","author":"Dziedzic","year":"2012","journal-title":"Pol. J. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1148\/radiographics.20.suppl_1.g00oc11s27","article-title":"Evaluation of the marrow space in the adult hip","volume":"20","author":"Andrews","year":"2000","journal-title":"Radiographics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1002\/jmri.26759","article-title":"Whole-body MRI of bone marrow: A review","volume":"50","author":"Hynes","year":"2019","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1148\/radiology.177.1.2399343","article-title":"Normal age-related patterns of cellular and fatty bone marrow distribution in the axial skeleton: MR imaging study","volume":"177","author":"Ricci","year":"1990","journal-title":"Radiology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1148\/radiol.2501071322","article-title":"MR imaging insights into skeletal maturation: What is normal?","volume":"250","author":"Laor","year":"2009","journal-title":"Radiology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1148\/radiology.168.3.3043546","article-title":"Bone marrow imaging","volume":"168","author":"Vogler","year":"1988","journal-title":"Radiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1111\/j.1365-2141.1964.tb00725.x","article-title":"Regression of bone-marrow haemopoiesis from the terminal digits in the foetus and infant","volume":"10","author":"Emery","year":"1964","journal-title":"Br. J. Haematol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1007\/BF02011826","article-title":"MRI \u201croad-map\u201d of normal age-related bone marrow","volume":"25","author":"Taccone","year":"1995","journal-title":"Pediatric Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1148\/radiology.175.1.2315484","article-title":"Red and yellow marrow in the femur: Age-related changes in appearance at MR imaging","volume":"175","author":"Moore","year":"1990","journal-title":"Radiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"333","DOI":"10.2214\/ajr.152.2.333","article-title":"Incidental detection of hematopoietic hyperplasia on routine knee MR imaging","volume":"152","author":"Deutsch","year":"1989","journal-title":"Am. J. Roentgenol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"335","DOI":"10.2214\/ajr.158.2.1729795","article-title":"Hematopoietic bone marrow hyperplasia: High prevalence on MR images of the knee in asymptomatic marathon runners","volume":"158","author":"Shellock","year":"1992","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.2214\/ajr.161.6.8249729","article-title":"Bone marrow reconversion in adults who are smokers: MR Imaging findings","volume":"161","author":"Poulton","year":"1993","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/S1076-6332(96)80217-0","article-title":"Prevalence of red marrow around the knee joint in adults as demonstrated on magnetic resonance imaging","volume":"3","author":"Wilson","year":"1996","journal-title":"Acad. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/BF00197984","article-title":"Hematopoietic bone marrow in the adult knee: Spin-echo and opposed-phase gradient-echo MR imaging","volume":"22","author":"Lang","year":"1993","journal-title":"Skelet. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"300","DOI":"10.12659\/PJR.894118","article-title":"MRI of residual red bone marrow in the distal femur of healthy subjects","volume":"80","author":"Arslan","year":"2015","journal-title":"Pol. J. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1177\/0284185115610932","article-title":"Knee MRI patterns of bone marrow reconversion and relationship to anemia","volume":"57","author":"Gonzalez","year":"2016","journal-title":"Acta Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1002\/jmri.1880070224","article-title":"Useful internal standards for distinguishing infiltrative marrow pathology from hematopoietic marrow at MRI","volume":"7","author":"Carroll","year":"1997","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"335","author":"Altman","year":"2007","journal-title":"BMJ"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1002\/acr.22588","article-title":"Childhood Physical Performance Measures and Adulthood Knee Cartilage Volume and Bone Area: A 25-Year Cohort Study","volume":"67","author":"Antony","year":"2015","journal-title":"Arthritis Rheum."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1136\/annrheumdis-2013-204161","article-title":"Association between childhood overweight measures and adulthood knee pain, stiffness and dysfunction: A 25-year cohort study","volume":"74","author":"Antony","year":"2013","journal-title":"Ann. Rheum. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Smith, R.D., McHugh, G.A., Quicke, J.G., Dziedzic, K.S., and Healey, E.L. (2021). Comparison of reliability, construct validity and responsiveness of the IPAQ-SF and PASE in adults with osteoarthritis. Musculoskelet. Care.","DOI":"10.1016\/j.joca.2020.02.663"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1177\/0163278718819708","article-title":"Validity of the International Physical Activity Questionnaire\u2013Short Form for Application in Asian Countries: A Study in Vietnam","volume":"43","author":"Tran","year":"2020","journal-title":"Eval. Health Prof."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1249\/01.MSS.0000078924.61453.FB","article-title":"International Physical Activity Questionnaire: 12-Country Reliability and Validity","volume":"35","author":"Craig","year":"2003","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Helou, K., El Helou, N., Mahfouz, M., Mahfouz, Y., Salameh, P., and Harmouche-Karaki, M. (2017). Validity and reliability of an adapted arabic version of the long international physical activity questionnaire. BMC Public Health, 18.","DOI":"10.1186\/s12889-017-4599-7"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.jclinepi.2007.06.007","article-title":"Lysholm scale and WOMAC index were responsive in prospective cohort of young general practice patients","volume":"61","author":"Heintjes","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1177\/0363546514524698","article-title":"Reliability and Validity of the IKDC, KOOS, and WOMAC for Patients With Meniscal Injuries","volume":"42","author":"Wolterbeek","year":"2014","journal-title":"Am. J. Sports Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1002\/1529-0131(200110)45:5<453::AID-ART365>3.0.CO;2-W","article-title":"The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): A review of its utility and measurement properties","volume":"45","author":"McConnell","year":"2001","journal-title":"Arthritis Rheum"},{"key":"ref_35","first-page":"1","article-title":"Correlates of knee bone marrow lesions in younger adults","volume":"18","author":"Antony","year":"2016","journal-title":"Arthritis Res."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/9\/1531\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:51:12Z","timestamp":1760165472000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/9\/1531"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,25]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["diagnostics11091531"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics11091531","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2021,8,25]]}}}