Magnetic resonance imaging of disseminated bone marrow disease in patients treated for malignancy

Abstract

Magnetic resonance imaging (MRI) is a sensitive method for the diagnosis of bone marrow abnormalities, but its usefulness in detecting active disseminated cancer in this tissue in treated patients has not been determined. We therefore examined 14 children who had been treated for disseminated bone marrow involvement by neuroblastoma (n = 6), lymphoma (n = 3), Ewing's sarcoma (n = 3), osteosarcoma (n = 1), and leukemia (n = 1). MRI studies were performed at 21 marrow sites to evaluate residual or recurrent tumor and were correlated with histologic material from the same site. T1- and T2-weighted sequences were employed in 21 and 14 studies, respectively; short tau inversion recovery (STIR) in 18; and static gadolinium diethylene triamine pentaacetic acid (Gd-DPTA)-enhanced. T1-weighted sequences in 13. All MRI studies showed an altered bone marrow signal. Technetium 99m methylene diphosphonate (99mTc-MDP) bone scintigraphy was also performed (19 studies). On histologic examination, 7 marrow specimens contained tumor, and 14 did not. Of the 7 tumor-positive lesions, all T1-weighted, 4 of 6 T2-weighted, and all 6 STIR sequences showed abnormal signal; all 5 Gd-DTPA-enhanced. T1-weighted sequences showed enhancement of the lesion. However, abnormal signals were also observed on all T1-weighted, 6 of 8 T2-weighted, 11 of 12 STIR, and 5 of 8 Gd-DTPA-enhanced, T1-weighted images of the tumor-negative sites. In this clinical setting, MRI did not consistently differentiate changes associated with treatment from malignant disease.

Initial experience with FSE STIR whole-body MR imaging for staging lymphoma in children

“…As most pathologic lesions are characterized by prolongation of both T1 and T2 relaxation times, high signal on STIR is relatively non-specific. Areas with therapy-induced marrow changes, such as oedema, necrosis, fibrosis or red marrow hyperplasia, produce high signal and therefore cannot be differentiated from viable lymphoma [35,36]. Because marrow space signal abnormalities can persist after eradication of tumour cells, STIR imaging is of limited value in assessing bone marrow involvement following treatment.…”

Magnetic resonance imaging of bone marrow in oncology, Part 2

“…11) [45,46]. Hanna et al [45] correlated MRI findings in a variety of disseminated marrow diseases with marrow biopsies at 21 sites and found that MRI was nondiscriminatory in differentiating post-treatment changes from malignant disease in all MR sequences obtained.…”

“…11) [45,46]. Hanna et al [45] correlated MRI findings in a variety of disseminated marrow diseases with marrow biopsies at 21 sites and found that MRI was nondiscriminatory in differentiating post-treatment changes from malignant disease in all MR sequences obtained. Seven lesions were found to contain viable tumor at biopsy; the majority of T1-weighted, T2-weighted, and STIR sequences showed abnormal signal in these lesions, and all post-contrast sequences showed lesional enhancement.…”

The clinical importance of bone metabolic markers in detecting bone metastasis of lung cancer

“…While the sensitivity of bone scintigraphy is higher, its specificity is low [6,7]. Computerized tomography (CT), magnetic resonance imaging (MRI), 18 F-fluorodeoxyglucose positron emission tomography (F-18 FDG-PET) are the other methods for detecting small bone lesions [8,9].…”