Skeletal lesions are the most serious complications of Gaucher disease (GD). The pathological changes of skeletal system are complex, which seriously affects the quality of life. The aim was to investigate whether the skeletal system improved in quantitative imaging after treatment with enzyme replacement therapy (ERT). Magnetic resonance imaging (MRI) of the vertebrae and femur was performed in 40 patients and 34 healthy volunteers. The scan sequences include iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation (IDEAL-IQ) and intravoxel incoherent motion imaging (IVIM). Statistical data were analyzed by using t-test. As for the fat fraction (FF) and R2*, there were significant differences in FF and R2* of vertebrae and left femur. As for the standard apparent diffusion coefficient (sADC), slow apparent diffusion coefficient (D), fast apparent diffusion coefficient (D*) and fraction of fast apparent diffusion coefficient (f) of vertebrae and femur. Only D of vertebrae, sADC and f of left femur and sADC of right femur had statistical difference. The quantitative imaging of skeletal system lesions have certain characteristics. The lesions in the skeletal system of patients treated with ERT has been improved to some extent, but it is still different from that in normal people. Copyright © 2020 Elsevier B.V. All rights reserved.