MRI gadolinium enhancement of bone marrow: age-related changes in normals and in diffuse neoplastic infiltration

Baur, Andrea; Stäbler, Axel; Bartl, Reiner; Lamerz, R.; Scheidler, J.; Reiser, Maximilian

doi:10.1007/s002560050257

Cited by 135 publications

(81 citation statements)

References 17 publications

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“…21 Circumscribed lesions within the bone marrow with low signal intensity in T1-weighted and high signal intensity in T2-weighted STIR images were rated as focal lesions. 22 Lesions larger than 5 mm in longest diameter were measured in three dimensions.…”

Section: Image Analysismentioning

confidence: 99%

Appearance of monoclonal plasma cell diseases in whole‐body magnetic resonance imaging and correlation with parameters of disease activity

Kloth

Hillengaß

Listl

et al. 2014

Intl Journal of Cancer

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The aim of our study was to assess in which way different infiltration patterns of monoclonal plasma cell diseases in wholebody (wb) magnetic resonance imaging (MRI) are associated with clinical stages, plasma cell content in bone marrow samples and established serum markers of disease activity. Institutional review board approval was obtained. We performed wb-MRI in 547 consecutive, unselected and untreated patients with monoclonal gammopathy of undetermined significance (MGUS, n 5 138), smoldering myeloma (SMM, n 5 157) and multiple myeloma (MM, n 5 252) on two 1.5 T MRI-scanners with body array coils. The studies were evaluated in consensus by two experienced radiologists blinded to the diagnosis. We observed focal lesions in 23.9% (MGUS), 34.4% (SMM) and 81.3% (MM), respectively. A diffuse infiltration pattern was detected in 38.4%, 45.9% and 71%, respectively. The differences between all infiltration patterns were significant (p < 0.0001). The presence of focal lesions and the presence of a diffuse bone marrow infiltration was associated with an increased plasma cell percentage in bone marrow samples (median 22% vs. 14%, 26% vs. 10%, both p < 0.0001) and monoclonal protein concentration (median 18 g/dl vs. 13 g/dl, p 5 0.003, 20 g/dl vs. 11 g/dl, p < 0.0001). Further categorization of the diffuse infiltration patterns in wb-MRI into "salt-and-pepper," moderate and severe identified significant associations with M-protein (median g/dl for S1P/moderate/severe 23/18/25, p 5 0.04), plasma cell percentage in the bone marrow (median 25%/24%/40%, p 5 0.02), and age (median years 67/60/57, p < 0.0001). Bone marrow infiltration in wb-MRI is significantly different between the various stages of plasma cell disease and correlates well with established markers of disease activity.Monoclonal plasma cell diseases like multiple myeloma (MM), monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma (SMM) are a group of hematologic premalignant or malignant disorders associated with monoclonal proliferation of plasma cells mainly in the bone marrow.1,2 Although MGUS, being the most common disorder of plasma cells and occurring in 2% of persons older than 50 years, has an overall annual risk of progression of only 1% per year, the rate of transformation of SMM to MM or systemic amyloidosis (AL) has been shown to be 10% per year in the first 5 years. [3][4][5][6] In the aforementioned monoclonal plasma cell disorders, the bone marrow involvement may be present in different patterns: diffuse bone marrow infiltration and focal lesions. Diffuse bone marrow infiltration is characterized by malignant plasma cells, mixed up with normal bone marrow cells, still preserving the cancellous bone structure. Focal lesions are circumscribed solid foci of plasma cells with the potential of destruction of the cancellous and cortical bone.To image these changes, plain radiographs (PRs), computed tomography (CT) and magnetic resonance imaging (MRI) are currently in routine use. 7 Although PR has been an integral part of...

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Section: Image Analysismentioning

confidence: 99%

Appearance of monoclonal plasma cell diseases in whole‐body magnetic resonance imaging and correlation with parameters of disease activity

Kloth

Hillengaß

Listl

et al. 2014

Intl Journal of Cancer

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“…Major interindividual variations of contrast enhancement in normal individuals (3-59 % increase in SI) have been demonstrated with signifi cantly higher contrast enhancement in younger individuals (Baur et al 1997 ). As a rule of thumb, the authors found an increase >40 % SI, a sign of pathologic bone marrow involvement.…”

Section: Dynamic Contrast-enhanced Imagingmentioning

confidence: 65%

“…11 ). The recolonized red marrow enhances on post-contrast T1w fat-saturated images but in a limited way (<40 %) compared to diffuse neoplastic infi ltration (Baur et al 1997 ;Hillengass et al 2011a ). In a research setting, the lack of ultrasmall-particle superparamagnetic iron ore (USPIO) uptake may indicate a tumor progression or recurrence (Daldrup-Link et al 2009 ).…”

Section: G-csf and Bone Marrow Reconversionmentioning

confidence: 99%

Female Pelvis: Genital Organs

Forstner

Cunha²

2015

Imaging of Complications and Toxicity Following Tumor Therapy

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Medical Radiology-Diagnostic Imaging is a unique series that aims to document the most innovative technologies in all fi elds within diagnostic imaging and interventional radiology, thereby informing the physician in practice of the latest advances in diagnostic imaging and percutaneous imageguided minimally invasive procedures. Th e contents are intended to cover all organs, and all modern imaging techniques and image-guided treatment modalities, with special emphasis on applications in clinical practice. Each volume is a comprehensive reference book on a topical theme, and the editors are always experts of high international standing. Contributions are included from both clinicians and researchers, ensuring wide appeal. Medical Radiology -Radiation Oncology is a unique series that aims to document the most innovative technologies in all fi elds within radiology, thereby informing the physician in practice of the latest advances in diagnostic and treatment techniques. Th e contents range from contemporary statements relating to management for various disease sites to explanations of the newest techniques for tumor identifi cation and of mechanisms for the enhancement of radiation eff ects, with the emphasis on maximizing cure and minimizing complications. Each volume is a comprehensive reference book on a topical theme, and the editors are always experts of high international standing. Contributions are included from both clinicians and researchers, ensuring wide appeal. This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. AbstractA precise knowledge of antineoplastic drugs is an indispensable basis for the care of patients with cancer. The mechanisms of action and resistance, cross-resistance patterns, pharmacodynamics and pharmacokinetics, pharmacological interaction, and last but not least potential adverse effects should be part of this knowledge. As contemporary cancer care requires interdisciplinary and multiprofessional structures, the radiologist is an important a...

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“…Compared to the large number of studies exploring the bone-vascular connect at a cellular level, relatively few clinical imaging studies have been performed. MR perfusion imaging studies have shown that vertebral marrow perfusion is reduced in older subjects [11]. In small animals, appendicular blood flow tends to reduce more in the diaphyses (↓45%) with aging than the metaphyses (↓21-28%) [10] paralleling the marrow conversion from hematopoietic to fatty marrow seen in humans.…”

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confidence: 99%

Hard arteries, weak bones

2011

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Given the close association between bone and blood, it is not that surprising how the two common diseases of artery and bone, namely atherosclerosis and osteoporosis, may in part share a common pathogenesis. Although atherosclerosis and osteoporosis are both clearly more prevalent in later years, there is nonetheless increasing evidence of a bone-vascular connect independently linking osteoporosis with atherosclerosis beyond the occurrence of shared risk factors such as age, gender, smoking, lifestyle factors, alcohol, and diabetes.Several studies have shown how atherosclerosis is more common in both men and women with osteoporosis or low bone mass ('osteopenia'). Regarding cerebrovascular disease, a study of over 9,500 women aged more than 65 years, showed how low areal bone mineral density (BMDa) at baseline increased the relative risk of stroke by 1.7 with low BMDa at baseline proving to be an even stronger predictor of subsequent stroke than systolic blood pressure [1]. In over 4,300 middle-aged to elderly men and women followed-up for an average 5.6 years, relative risk of both stroke and death from any cause was almost twice as high in those with osteoporosis at baseline even after adjusting for confounding variables such as age, smoking, diabetes, and hypertension [2]. In post-menopausal women, the decrease in lumbar BMDa is associated with an increase in carotid intimal thickness (p<0.01) [3].Regarding cardiovascular disease, low BMDa independently predicts coronary artery disease in women undergoing coronary angiography better than traditional risk factors such as age, hypertension, diabetes, smoking, family history, or dyslipidemia [4]. In a study of over 2,500 postmenopausal women followed-up for more than 4 years, not only did women with osteoporosis have a 3.9-fold increased risk for cardiovascular events compared to women with low bone mass, it was also seen that the more severe the impairment of bone strength, as evidenced by the frequency and severity of vertebral fracture, the greater the risk of a subsequent cardiovascular event [5].For peripheral vascular disease, a study of almost 6,000 elderly male subjects, followed-up for more than 5 years, showed how BMD loss was almost twice as pronounced in those with peripheral arterial disease as those with no peripheral arterial disease while the relative risk of nonspinal fracture was also increased by 1.47 [6]. Although low-energy fractures are a more reliable indicator of osteoporosis than BMD, when addressing the link between osteoporosis and atherosclerosis, BMD or other structural bone parameters may be more apt as vascular disease per se will increase the risk of fall and thereby the likelihood of fracture.Osteoporosis is linked to atherosclerosis and probably even more so to the occurrence of vascular calcification, which is a very frequent accompaniment of atherosclerosis. For example, in both sexes, lower lumbar vertebral trabecular BMD is more strongly associated with increasing calcification and severity of carotid atherosclerotic plaque

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MRI gadolinium enhancement of bone marrow: age-related changes in normals and in diffuse neoplastic infiltration

Cited by 135 publications

References 17 publications

Appearance of monoclonal plasma cell diseases in whole‐body magnetic resonance imaging and correlation with parameters of disease activity

Appearance of monoclonal plasma cell diseases in whole‐body magnetic resonance imaging and correlation with parameters of disease activity

Female Pelvis: Genital Organs

Hard arteries, weak bones

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