Introduction Normal bone marrow contains water, fat, and cellular elements. The red bone marrow (RBM) contains 40% of water (free and bound), 20% of protein, and 40% (25%-50%) of fat. In contrast, the yellow bone marrow (YBM) contains 15% of water, 5% of protein, and 80% of fat (1-4). In newborns, the bone marrow consists mainly of active RBM. After the infantile period, the RBM begins to transform into YBM. When the active bone marrow is not able to meet the increased hematopoiesis required by the body, YBM converts to RBM, and this process is called reconversion (3-7). The causes of reconversion can be classified under medical and nonmedical conditions. Medical conditions include obesity, respiratory disorders, diabetes, anemias, patients receiving granulocyte colony stimulating factor therapy, chemotherapy, and radiotherapy. Nonmedical conditions include heavy smoking and practicing sports requiring high oxygen such as marathon running or freediving (2,5-7). Magnetic resonance imaging (MRI) is an ideal noninvasive imaging modality for evaluating bone marrow Background/aim: The main purpose of our study was to determine the efficacy of chemical shift imaging (CSI) for differentiating diffuse red bone marrow reconversion (RBMR) and hematological malignancies. We also aimed to calculate the cutoff value for these entities with similar imaging features in routine magnetic resonance (MR) sequences. Materials and methods: A total of 54 patients were included: 17 patients (31.4%) with hematological malignancies (group 1), 16 patients (29.6%) with RBMR (group 2), and 21 patients (38.0%) with no clinical and hematological malignancies (control group). Patients with no pathological data or completed two-year follow-up and children were excluded from the study. An experienced radiologist on MRI evaluated the images blindly for final diagnosis. Pathologic results were determined as gold standard. Regions of interests (ROI) were placed on the vertebrae in CSI and signal intensity ratios (SIR) were calculated. The cutoff value was calculated using receiver operating characteristic (ROC) analysis. Results: SIR values were 0.97 ± 0.16, 0.69 ± 0.31 and 0.28 ± 0.35 (P < 0.001) for GI, G2, and G3, respectively. The cutoff value was 0.82 (P < 0.001). The sensitivity rate was 83.3% (AUC: 58%-96%), specificity was 87% (AUC: 58-98). Conclusion: CSI may be a valuable diagnostic tool for differentiating diffuse RBMR and hematological malignancies.