The Usefulness of T1-Weighted Magnetic Resonance Images for Diagnosis of Acute Leukemia Manifesting Musculoskeletal Symptoms prior to Appearance of Peripheral Blood Abnormalities

Abstract

The patients with acute leukemia occasionally present with musculoskeletal symptoms initially, including bone pain, joint pain, muscular pain, and functional impairment. Without abnormal findings of peripheral blood cell counts or smear, the correct diagnosis tends to be delayed. Magnetic resonance imaging is often performed to examine musculoskeletal abnormalities; it can simultaneously reveal the bone marrow composition with high anatomical resolution and excellent soft tissue contrast. We present 4 pediatric patients who were initially diagnosed with acute pyogenic osteomyelitis or arthritis, based on the elevated white blood cell counts and/or C-reactive protein in addition to the localized high signal intensity on T2-weighted magnetic resonance images. Finally, they were diagnosed with B-cell precursor acute lymphoblastic leukemia by bone marrow examination. The period between the onset of musculoskeletal symptoms and the diagnosis of leukemia ranged from 20 days to 6 months. In all cases, the T1-weighted magnetic resonance images taken prior to detection of peripheral blood abnormality revealed diffuse low signal intensity of the bone marrow in regions adjacent or contralateral to localized musculoskeletal symptoms. These findings should raise the suspicion of leukemia even without abnormalities in peripheral blood.

Prognostic impact of CD200 and CD56 expression in adult acute lymphoblastic leukemia patients

“…This is in accordance with the results of Murakami et al [34] who explained this by malignant cells infiltration of the liver and spleen leading to hepatosplenomegaly. Pain may be due to the low intensity of the bone marrow in regions adjacent to localized musculoskeletal symptoms as reported by Yoshikawai et al [35]. High incidence of the previous clinical data in CD200 + /CD56 + patients could be explained on the basis that CD200 was a key immunosuppressive molecule [36].…”

Humeral Diaphyseal Osteolytic Lesion as the Initial Presentation of Acute Myeloid Leukemia in a Child: A Case Report and Review of the Literature

“…This suggests that bone biopsy should be considered in cases of treatmentresistant osteolysis regardless of whether peripheral leukemic cells are absent. Several previous reports have discussed the utility of MRI for distinguishing AL from osteomyelitis or bone tumor (Table 2) [13][14][15][16][17][18][19][20]. In children older than one year, upon comparison with surrounding muscular intensity, the marrow signal intensity on T1WI appears high in the humerus [13].…”

Magnetic Polymer Colloids for Ultrasensitive Molecular Imaging

“…Moreover, the contrast is due to the difference in T1 recovery times of hydrogen nuclei associated with different molecules like fats and water. Usually, hydrogen nuclei in water molecules have longer T1 relaxation than fats so they appear dark in T1-weighted images (Yoshikawa et al 2016).…”