Solitary abnormalities in bone scintigrams of cancer patients are a finding causing special diagnostic problems. In a prospective study the value of MRI imaging of the bone marrow was to be ascertained when compared to recognized X-ray studies, as a method of clarifying suspect bone scintigraphy findings. 25 cancer patients presenting with a solitary suspect abnormality in bone scintigrams were examined by X-rays and MRI. In 15 patients, MRI showed that metatases were the probable cause of the hot spot. In 7 patients, radiography, the routinely used method to confirm or exclude the presence of metastases, failed to detect these metastases. In the remaining 10 patients other causes of increased activity in the bone scintigrams could be demonstrated, e.g. fracture, degenerative disease, benign tumour. The results were confirmed by biopsy, operation, autopsy or follow-up. Considering the clinical consequences of the diagnosis of bone metastases, we suggest that a bone marrow MRI of the affected region should be performed to clarify the cause of a solitary hot spot in bone scintigrams of cancer patients, especially if X-ray studies are inconclusive.
31P magnetic resonance spectroscopy allows non-invasive evaluation of phosphorus metabolism in man. The purpose of the present study was to assess the influence of hyper- and hypothyroidism on the metabolism of resting human skeletal muscle. The present data show that quantitative measurement of phosphate metabolism by NMR is possible as also demonstrated by other studies. Using a quantitative evaluation method with an external standard, significant differences in the levels of phosphocreatine, adenosintriphosphate, and phosphodiesters were found. In hypothyroid patients a TSH-dependent increase in phosphodiesters and a decrease in adenosintriphosphate and phosphocreatine was observed. In hyperthyroidism a similar decrease in adenosintriphosphate but a considerably higher decrease in phosphocreatine occurred. In the light of the results of other studies of muscle metabolism, these changes appear to be non-specific so that further studies are required to assess the clinical value of such measurements.
In 62 patients with thyroid carcinoma 79 MRI bone marrow examinations and 48 bone marrow scintigraphies were recorded before or following radioiodine therapy, to study the extent of bone marrow expansion. The results of both methods were the same. In 34/79 investigations normal findings were seen, in 18 the bone marrow expanded to the middle third and in 26 to the distal third of the femur. One patient showed bone marrow expansion to the tibia. These results were compared with the following data: histology of tumor, TNM- staging, time passed since thyroidectomy, accumulated doses of radioiodine therapy, results of131I scintigraphy, hematological changes, thyroglobulin level, age and sex. No significant correlations were found between these and the bone marrow imaging results. Bone marrow changes in patients before radioiodine therapy were similar to those in patients treated with up to 48 GBq 131I. Blind biopsy of the posterior iliac crest in five patients showed slightly pathological reactive changes. In only 2/17 follow-up studies an increase of bone marrow expansion was seen. In 8 patients localized findings indicating malignant infiltration were observed. In 4/8 patients metastases of thyroid carcinoma were known or confirmed by pathological radioiodine uptake and in 2/8 metastatic involvement was assumed because of an increased thyroglobulin level.
In 21 patients with breast cancer (pT1–4, N0, M0) internal mammary lymphoscintigraphy and magnetic resonance imaging (MRI) were performed to evaluate retrosternal lymph node metastases. In 6 patients normal findings of lymphoscintigraphy were confirmed by MRI. In the 15 patients with focal defects seen by lymphoscintigraphy no lymph nodes were found by MRI in 5 in the corresponding area, 5 showed normal-sized lymph nodes (<1 cm) and 5 enlarged lymph nodes indicating metastatic infiltration. In addition to internal mammary lymphoscintigraphy MRI may offer the possibility to improve TNM staging in patients with breast cancer.
One hundred and seven patients with malignant Hodgkin and non-Hodgkin lymphoma were examined by bone marrow scintigraphy, MRI of bone marrow and bone marrow biopsy to detect bone marrow infiltration. The study included 2 patients where autopsy findings were subsequently available, 3 patients with blind rebiopsy and one patient with guided rebiopsy. The findings of bone marrow imaging and biopsy were classified as normal (grade 0), suggesting reactive changes of bone marrow (grade 1) or suspicious for infiltration (grade 2). About half of all results of biopsy and imaging methods agreed completely. There was a difference of two steps in the classification in only 2 cases (MRI) and 5 cases (scintigraphy). In patients with chronic lymphocytic leukemia false negative findings by both bone marrow imaging techniques were frequent. Unilateral blind bone marrow biopsy is usually accepted as the golden standard for the presence or absence of tumor infiltration. Although a positive biopsy result must be accepted as proof of bone marrow infiltration, our results indicate that a negative biopsy does not exclude tumor involvement. In all 4 patients with infiltration suspected on MRI or scintigraphy results but with normal findings or reactive changes in the first blind biopsy, blind rebiopsy or guided rebiopsy confirmed the results of the imaging methods. In both patients evaluated at autopsy the preceding MRI and scintigraphy results were confirmed completely, although in both of these patients antemortem biopsy had indicated different findings. Based upon these observations, bone marrow scintigraphy and MRI should be routinely included in the staging of malignant lymphoma as an adjunct to blind bone marrow biopsy in the complete evaluation of bone marrow status.
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