Systemic bone marrow disorders: characterization with proton chemical shift imaging

In a prospective clinical study, 26 patients (22 with malignant lymphoma and 4 with myelofibrosis) and 9 healthy volunteers were examined by conventional magnetic resonance and proton chemical shift imaging (CSI; modified Dixon method). On the basis of the CSI data, a quantitative evaluation of the relative fat and water signal fractions in regions of interest of the femur, pelvis, and spine was performed. In 16 of 17 patients with biopsy-proven bone marrow disorders, CSI revealed a significant reduction in the fat fraction of the bone marrow relative to that of normal volunteers. The visual assessment could detect only 14 of the 17 pathological cases.     

Magnetic resonance imaging of bone marrow changes in Gaucher disease during enzyme replacement therapy: first German long-term results

Objective: . Since 1991, enzyme replacement therapy (ERT) has been available for patients with Gaucher disease in Germany. The aim of this study was to analyse the MR pattern of bone marrow involvement and response to ERT in Gaucher disease type I. Patients and design: . Thirty patients with Gaucher disease type I had MRI examinations prior to initiation of ERT with alglucerase/imiglucerase and during follow-up. Median MR follow-up and duration of ERT were 36 months. Coronal T1- and T2-weighted spin-echo images of the lower extremities were obtained to evaluate changes in the appearance of yellow marrow. MR images were categorized as having either a homogeneous (type A) or non-homogeneous patchy (type B) appearance of bone involvement and response to ERT was assessed by two radiologists. Results: . Overall, 19 of 30 patients (63%) showed an increased signal intensity on T1- and T2-weighted images after 36 months of ERT, consistent with partial reconversion of fatty marrow during treatment. Focal bone lesions surrounded by a low signal intensity (SI) rim did not respond to ERT, suggesting bone infarcts. Of the 11 patients with bone infarcts (low SI rim lesion), 82% had the non-homogeneous type B pattern (P=0.0021). In 86% of patients with splenectomy, bone infarcts were seen (P<0.05). Conclusions: . MRI using T1- and T2-weighted spin-echo sequences is a valuable, non-invasive method for monitoring bone marrow response in patients receiving ERT. A non- homogeneous patchy signal intensity of bone marrow involvement correlates with the presence of bone infarcts (P=0.0021). Received: 27 July 2000 Revision requested: 26 October 2000 Revision received: 9 March 2001 Accepted: 12 March 2001     

Fatty replacement of bone marrow after radiation therapy for Hodgkin disease: Quantification with chemical shift imaging

The authors studied the long-term fatty replacement of bone marrow in 23 patients who had received radiation therapy for Hodgkin disease, with T1-weighted magnetic resonance imaging and quantitative chemical shift imaging. T1-weighted images revealed a mostly homogeneous high-signal-intensity pattern, in contrast to the hypointense pattern of nonirradiated marrow. The degree of fatty replacement was objectively assessed with chemical shift imaging, comparing patients to age-matched healthy volunteers. The authors found an increase in relative fat signal of 37% in the thoracic spine and 34% in the lumbar spine. The relative fat signal of nonirradiated pelvic and femoral marrow was decreased by 8%, indicating marrow reconversion. No radiation dose dependence was found in the range from 25 to 50 Gy. No signs of marrow regeneration were observed 15-126 months after radiation therapy. With chemical shift imaging, the degree of long-term radiogenic fatty replacement of the bone marrow can be quantified, confirming the lack of regeneration after radiation therapy for Hodgkin disease.     

Measurement of temperature dependent changes in bone marrow using a rapid chemical shift imaging technique

Purpose:

To provide quantitative temperature monitoring for thermal therapies in bone marrow by measuring temperature‐dependent signal changes in the bone marrow of ex vivo canine femurs heated with a 980‐nm laser at 1.5T and 3.0T.

Materials and Methods:

Using a multi‐gradient echo (≤16) acquisition and signal modeling with the Stieglitz–McBride algorithm, the temperature sensitivity coefficients (TSC, ppm/°C) of water and multiple lipid components' proton resonance frequency (PRF) values are measured at high spatiotemporal resolutions (1.6 × 1.6 × 4 mm³, ≤5 seconds). Responses in R₂* and amplitudes of each peak were also measured as a function of temperature simultaneously.

Results:

Calibrations demonstrate that lipid signal may be used to compensate for B₀ errors to provide accurate temperature readings (<1.0°C). Over a temperature range of 17.2–57.2°C, the TSCs after correction to a bulk methylene reference are ?0.87 × 10^?2 ± 4.7 × 10^?4 ppm/°C and ?0.87 × 10^?2 ± 4.0 × 10^?4 ppm/°C for 1.5T and 3.0T, respectively.

Conclusion:

Overall, we demonstrate that accurate and precise temperature measurements can be made in bone marrow. In addition, the relationship of R₂* and signal amplitudes with respect to temperature are shown to differ significantly where conformal changes are predicted by Arrhenius rate model analysis. J. Magn. Reson. Imaging 2011;33:1128–1135. © 2011 Wiley‐Liss, Inc.

     

Iron-oxide-enhanced MR imaging of bone marrow in patients with non-Hodgkin's lymphoma: differentiation between tumor infiltration and hypercellular bone marrow

The aim of this study was to differentiate normal, hypercellular, and neoplastic bone marrow based on its MR enhancement after intravenous administration of superparamagnetic iron oxides in patients with cancer of the hematopoietic system. Eighteen patients with cancer of the hematopoietic system underwent MRI of the spine before and after infusion of ferumoxides ( n=9) and ferumoxtran ( n=9) using T1- and T2-weighted turbo spin-echo (TSE) and short tau inversion recovery sequences (STIR). In all patients diffuse or multifocal bone marrow infiltration was suspected, based on iliac crest biopsy and imaging such as conventional radiographs, MRI, and positron emission tomography. In addition, all patients had a therapy-induced normocellular ( n=7) or hypercellular ( n=11) reconversion of the normal non-neoplastic bone marrow. The MRI data were analyzed by measuring pre- and post-contrast signal intensities (SI) of hematopoietic and neoplastic marrow and by calculating the enhancement as deltaSI(%) data and the tumor-to-bone-marrow contrast as contrast-to-noise ratios (CNR). Changes in bone marrow signal intensity after iron oxide administration were more pronounced on STIR images as compared with T1- and T2-weighted TSE images. The STIR images showed a strong signal decline of normal and hypercellular marrow 45-60 min after iron oxide infusion, but no or only a minor signal decline of neoplastic bone marrow lesions; thus, deltaSI% data were significantly higher in normal and hypercellular reconverted marrow compared with neoplastic bone marrow lesions ( p<0.05). Additionally, the contrast between focal or multifocal neoplastic bone marrow infiltration and normal bone marrow, quantified by CNR data, increased significantly on post-contrast STIR images compared with precontrast images ( p<0.05). Superparamagnetic iron oxides are taken up by normal and hypercellular reconverted bone marrow, but not by neoplastic bone marrow lesions, thereby providing significantly different enhancement patterns on T2-weighted MR images; thus, superparamagnetic iron oxides are useful to differentiate normal and neoplastic bone marrow and to increase the bone marrow-to-tumor contrast.     

Localized in vivo 1H spectroscopy and chemical shift imaging of the bone marrow in leukemic patients

Six healthy volunteers, ten patients with acute leukemia, one patient with hypersplenia and two with bone marrow carcinoris were studied. Nine patients with leukemia were restudied during chemotheraphy. A double spin echo localization method, implemented on a 1.5 T whole body unit was used for ¹H magnetic resonance spectroscopy (MRS). A cubic (13 mm)³ voxel was chosen in a midlumbar vertebra. For chemical shift imaging (CSI) the SENEX sequence was used. We recorded fat and water images in a representative midsagittal plane. Patients with acute leukemia and hypercellular bone marrow a severe reduction or loss bone marrow fat signal and an increased water signal. Water T1 increaed during therapy in three patients. The bone marrow fat reappeared in the spectra and chemical shift images within 2 or 3 weeks in responders and remained unchanged or reappeared later in non-responders. A normal fat signal could be detected in leukemic patients without hypercellular bone marrow. Specificity was missing for ¹H MRS and CSI; marrow carcinosis and benign stimulation (hypersplenia) could not be seperated from leukemia. In clinical routine, CSI may have advantages over ¹H MRS, because a large anatomic field can be examined. Inhomogenous fat signal distrbutions can be detected and were seen in sveral cases during therapy. ¹H MRS and CSI allow non-invasive therapy monitoring of leukemic patients adn might be of prognostic value. Correspondence to: H. Bongers     

MR imaging of therapy-induced changes of bone marrow

MR imaging of bone marrow infiltration by hematologic malignancies provides non-invasive assays of bone marrow cellularity and vascularity to supplement the information provided by bone marrow biopsies. This article will review the MR imaging findings of bone marrow infiltration by hematologic malignancies with special focus on treatment effects. MR imaging findings of the bone marrow after radiation therapy and chemotherapy will be described. In addition, changes in bone marrow microcirculation and metabolism after anti-angiogenesis treatment will be reviewed. Finally, new specific imaging techniques for the depiction of regulatory events that control blood vessel growth and cell proliferation will be discussed. Future developments are directed to yield comprehensive information about bone marrow structure, function and microenvironment.     

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

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 GdDTPA-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.     

Quantitative chemical shift imaging of vertebral bone marrow in patients with Gaucher disease.

To evaluate extent of bone marrow involvement and disease severity in Gaucher patients, results of modified Dixon quantitative chemical shift imaging (QCSI) of the lumbar spine were correlated with quantitative analysis of marrow triglycerides and glucocerebrosides and with quantitative determination of splenic volume at magnetic resonance (MR) imaging. High-field-strength MR spectra of surgical marrow specimens were dominated by a single fat and a water peak, validating use of QCSI. QCSI showed average vertebral marrow fat fractions of 10% +/- 8 in Gaucher patients (normal adult averages, 29% +/- 6). Relaxation times for lipid and water approximated normal averages; bulk T1 values were significantly longer, reflecting decreased marrow fat. Glucocerebroside concentrations were higher in Gaucher marrow and inversely correlated with triglyceride concentrations. Extent of marrow infiltration determined by fat fraction measurements correlated with disease severity measured by splenic enlargement. These results show that as Gaucher cells infiltrate bone marrow and displace normal marrow adipocytes, bulk T1 increases due to the higher T1 of water compared with that of fat. QCSI provides a sensitive, noninvasive technique for evaluating bone marrow involvement in Gaucher disease.     

Early MR changes in vertebral bone marrow for patients following radiotherapy

Our study aimed to evaluate the vertebral marrow changes in patients following radiotherapy (RT) by measuring the T2 relaxation times before and during RT. We were mostly interested in evaluating early MR marrow changes during RT. Fifteen patients treated by RT for cervical cancer were submitted to MR examination before and during RT (5-23 days of RT). T2 values were calculated for irradiated and non-irradiated tissues (lumbar and sacral vertebral bone marrow, symphysis pubis marrow, and regional muscle). Fourteen patients presented increased T2 values for irradiated vertebral bone marrow (VBM), and 3 patients showed increased T2 values even for non-irradiated VBM. We found T2 variations for VBM as early as in the fifth day of RT for an absorbed dose as small as 9 Gy. Calculated T2 values in irradiated and also in non-irradiated tissues prove very early tissue alterations.     

MR imaging in adults with Gaucher disease type I: evaluation of marrow involvement and disease activity

An investigation was conducted to determine the usefulness of magnetic resonance imaging (MRI) in the evaluation of bone marrow involvement in patients with Gaucher disease type I. T1- and T2-weighted images were obtained of the lower extremities of 29 adult patients. Patients were classified into one of three groups based on marrow signal patterns on T1- and T2-weighted images as well as change in signal intensity from T1- to T2-weighted images. An increase in signal intensity from T1- to T2-weighted images was the criterion for an active process within the bone marrow. Classification of the 29 patients produced the following results: group A: normal, 4 patients; group B: marrow infiltration, 16 patients; group C: marrow infiltration plus active marrow process, 9 patients. Correlation with clinical findings revealed that all nine patients with evidence of an active marrow process on MRI (group C) had acute bone pain. Conversely, only one of the remaining 20 patients (groups A and B) had bone pain. There was no correlation between disease activity and findings on conventional radiographs. We conclude the MRI provides an excellent noninvasive assessment of the extent and activity of marrow involvement in type I Gaucher disease.     

宫颈癌术后调强放疗中骨髓抑制与骨髓照射剂量体积的关系

目的 观察宫颈癌患者术后三维适形调强放疗（IMRT）过程中骨髓抑制程度与骨髓照射剂量及体积的关系。 方法 收集 2013年1月至2016年1月中国人民解放军联勤保障部队第九〇〇医院放疗科收治的宫颈癌根治术后行全盆腔IMRT的患者109例,按随机数字表法将患者分为对骨髓进行限量的IMRT（BMS-IMRT）组[共56例（其中,行单纯放疗的有31例,行同步放化疗的有25例）,年龄（43.03±4.49）岁]和未限量的IMRT组[共53例（其中,行单纯放疗的有21例,行同步放化疗的有32例）,年龄（42.72±5.23）岁],2组均在放疗计划系统勾画照射范围内的骨髓,包括腰骶椎、髂骨、坐骨、耻骨及近端的股骨。观察2组患者治疗计划靶区剂量分布情况、骨髓照射体积与剂量及放疗过程中骨髓照射体积、剂量与骨髓抑制程度的关系。2组间的计划靶体积剂量学、危及器官剂量体积参数的比较采用t检验;骨髓抑制程度、白细胞计数（WBC）和中性粒细胞减少程度及其他不良反应情况比较采用χ2检验。 结果 宫颈癌患者术后IMRT过程中骨髓抑制程度与骨髓照射体积、照射剂量相关,BMS-IMRT组与IMRT组计划靶体积剂量学比较,差异无统计学意义（t=−4.220~2.923,均P>0.05）,在2组危及器官剂量体积参数对比中,骨髓的V20（≥20 Gy体积占总体积的百分比）、V40（≥40 Gy体积占总体积的百分比）,直肠V45（≥45 Gy体积占总体积的百分比）、D2%（近似最大剂量）及小肠D2%比较,差异均有统计学意义（t=−12.696~2.917,均P< 0.05）。2组间WBC及中性粒细胞的减少程度比较,差异有统计学意义（χ2=6.728、6.813,P=0.035、0.033）,血小板、RBC及血红蛋白的减少程度比较,差异无统计学意义（χ2=0.385、0.006、1.419,P=0.825、0.938、0.492）。对于行单纯放疗的患者,2组的WBC减少程度比较,差异有统计学意义（χ2=9.709,P=0.008）,而对于行同步放化疗的患者,2组的WBC减少程度比较,差异无统计学意义（χ2=0.073,P=0.786）。中性粒细胞减少的程度无论是在行单纯放疗还是行同步放化疗的患者中,2组之间的差异均无统计学意义（χ2=4.741、1.523,P=0.093、0.217）,2组患者其他不良反应情况比较,差异均无统计学意义（χ2=0.369、1.845、1.158、0.610,P=0.544、0.398、0.560、0.558）。 结论 宫颈癌患者术后在行全盆腔IMRT的过程中,WBC和中性粒细胞减少程度与骨髓照射剂量及体积呈正相关,在行IMRT时应对骨髓进行保护及限量。     

白血病骨髓移植的MRI研究

目的 研究ＭＲＩ对白血病骨髓移植（ＢＭＴ）患者骨髓变化的评估作用和价值。方法 共２０例白血病ＢＭＴ患者,分别在ＢＭＴ前后行ＳＥ序列Ｔ１ＷＩ和脂肪抑制成像;并测量腰椎骨髓Ｔ１弛豫时间。结果 １７例ＢＭＴ后骨髓在Ｔ１ＷＩ上信号强度升高复发率５．８８％;３例信号无变化者,复发率６６．７０％;两组间复发率差异具有显著性意义（Ｐ〈０．０５）;ＢＭＴ后腰椎骨髓Ｔ１值低于正常值（Ｐ〈０．０５）;与ＢＭＴ前相比,     

恶性血液病骨髓动态增强磁共振成像特征的初步研究

目的探讨利用动态增强MR成像技术检测恶性血液病患者骨髓构成的变化，判定其骨髓浸润程度，以减少血液病患者治疗随访过程中穿刺活检的次数。方法25例恶性血液病患者经动态增强MPJ（DCE-MR）及髂嵴穿刺活检，测定骨髓灌注的最大强化率（PER），最大强化斜率值（Slopemax），峰值时间（TTP），平均时间（MT），以及骨髓活检分析细胞构成、肿瘤分数（TF）。结果25例恶性血液病患者骨髓的PER、Slopemax、TTP、MT的中位值分别为0．27、0．21s^-1。、79．08s、84．43s。不同细胞构成（低、正常、高）骨髓的灌注特征性变量的中位数值分别为PER（0．29、0．24、1．15）、Slopemax（0．20s^-1、0．21s^-1、1．28s^-1）、TTP（96．67s、83．49s、25．52s）、MT（77．52s，86．25s，84．34s）。肿瘤浸润组首次灌注值（PER0．32，Slopemax0．28s。）高于肿瘤缓解组，（PER0．20，Slopemax0．20s^-1），而对比剂到达峰值时间（TTP68．66s）低于缓解组（TTP85．85s）。肿瘤浸润组与缓解组骨髓的PER差异有统计学意义（P=0．02），而Slopewmax、TTP、MT差异无统计学意义（P值均＞0．05）。PER（r=0．564，P=0．003）、Slopemax（r=0．478，P=0．016）、MT（r=0．186，P＞0．05）与骨髓细胞构成状态（低、正常、高）呈正相关，而TTP（r=-0．222）与骨髓细胞构成状态呈负相关。PER（r=0．561，P=0．004）、Slopemax（r=0．318，P=0．121）、MT（r=0．207，P＞0．05）与TF呈正相关，而TTP（r=-0．305，P＞O．05）与TF呈负相关。结论动态增强MR成像能够监测恶性血液病骨髓肿瘤细胞浸润和细胞构成的变化。     

Diffusion-weighted imaging of bone marrow: current status

Diffusion-weighted imaging allows for measurement of tissue microstructure and reflects the random motion of water protons. It provides a new method to study bone marrow and bone marrow alterations on the basis of altered water-proton mobility in various diseases. Different diffusion-weighted methods have proved to be capable of differentiating between benign edema and tumorous involvement of bone marrow. It is especially useful for the distinction of acute benign osteoporotic and malignant vertebral compression fractures. Diagnosis is based on the contrast to normal bone marrow. Hypo- or isointensity reflects acute benign collapse, whereas hyperintensity is indicative of the tumorous nature of a fracture. Apparent diffusion coefficients (ADC) are significantly lower in metastatic disease than in bone marrow edema. Furthermore, bone marrow cellularity can be estimated by ADC measurements. Diffusion-weighted imaging might be helpful for monitoring response to therapy in metastatic disease.     

The value of bone scintigraphy,bone marrow scintigraphy and fast spin-echo magnetic resonance imaging in staging of patients with malignant solid tumours: a prospective study

The purpose of this prospective study was to define the value of bone scintigraphy (BS), bone marrow scintigraphy (BMS) and the new fast spin-echo (FSE) magnetic resonance imaging (MRI) sequences in screening for bone metastases in patients with solid malignant tumours. It was our particular interest to classify patients into a group with and a group without bone metastases, and not only to compare the absolute number of metastases detected by each method. Thirty-two patients were examined using technetium-99m dicarboxy propane diphosphonate bone scintigraphy, ^99mTc-labelled monoclonal anti-granulocyte antibodies for bone marrow scintigraphy and 1.5 T MRI using T1-weighted and FSE T2-weighted sequences. Against a reference standard obtained by re-evaluation of all clinical and imaging data 1 year after prospective BS, BMS and MRI had been performed, the three imaging modalities were falsely positive in two, eight and two cases and falsely negative in zero and four cases, respectively. BMS was falsely positive in eight patients because of vertebral marrow degeneration which caused photopenic defects which could not be differentiated from metastases. MRI showed these lesions to unequivocally contain fat. BMS and MRI were falsely negative in four cases because of the limited field of examination. In our study the key factor in classifying a patient as bone MI or MO was the possibility of surveying the entire skeleton, as is the case in BS, and not that MRI had a higher sensitivity compared to BS when analysis was on a lesion-by-lesion basis. BMS had the same limitations as MRI because the usual bone marrow distribution resulted in a physiologically limited field of view. We conclude that BS remains the method of choice in staging patients with solid tumours despite the fact that MRI is no longer a time-consuming method using FSE sequences. MRI has a complemantary role if special questions remain. BMS appears to have little value in the detection of bone metastases because of its poor specificity, its limited spatial resolution and its restriction to those areas of the skeleton containing haematopoietic marrow. Correspondence to: G.K. v. Schulthess     

血液病骨髓MR磁化转移成像初步研究

目的:本实验旨在研究MR磁化转移成像技术(magnetic transfer,MT)与血液病治疗中骨髓的微结构变化的相关性。方法:35例确诊的恶性血液病患者通过MR磁化转移成像及髂嵴穿刺活检进行对照分析,测定骨髓磁化转移率(mag-netic transfer ratio,MTR),细胞构成(cellularity)变化和肿瘤浸润分数(tumor fraction,TF)。同期30例无血液系统疾病患者进行了髂骨的磁化转移成像及MTR测定。对血液病组和对照组分别进行定量均值计算及相关分析。结果:血液病组MTR为0.105±0.034,对照组MTR为0.103±0.059,MTR血液病组与对照组间差异无显著性(P>0.05),血液病组中不同组织学类型的骨髓MTR组间差异亦无显著性(P>0.05);肿瘤复发组与肿瘤缓解组组间MTR差异亦无显著性(P>0.05)但不同细胞构成比MTR组间差异有统计学意义(P<0.05)。结论:血液病骨髓磁化转移的变化可能与骨髓有形细胞数目变化有关。     

低场磁共振的化学位移及相关技术在骨关节病变中的应用初探

目的 :探讨低场磁共振的化学位移及相关技术在骨关节中的应用价值。方法 :2 1例骨关节病变均作常规SET1WI、FSET2 WI及GRET1WI、T2 WI扫描 ,并对图像作对比分析。结果 :GRET1WI、T2 WI均较SET1WI、FSET2 WI对病灶的检出、病灶与正常组织信号对比、病灶边缘和范围显示有明显的优势。结论 :低场磁共振的化学位移及相关技术简单 ,成像时间短 ,不受静磁场不均匀性的影响 ,在骨关节病变的诊断中具有较高的应用价值。     

Usefulness of FDG PET for diagnosis and radiotherapy of the patient with malignant lymphoma involving bone marrow

We experienced a case of relapsed malignant lymphoma with multiple bone marrow or bone lesions. The case was diagnosed as follicular lymphoma by cytological biopsy of the right iliac bone, with ⁶⁷Ga scintigraphy showing abnormal, intense uptake in multiple bones. After about 10 months of systemic chemotherapy, a relapse was suspected because of pain in the bilateral legs and a high level of lactate dehydrogenase. Assessment of the lesions in the patient was difficult by computed tomography because the affected sites were localized mainly in the bone marrow. ¹⁸F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) was useful for detecting accurately the relapse sites in the bone marrow and enabled us to determine the field for radiotherapy. There are only a few reports of FDG-PET findings for such bone marrow malignant lymphomas. Therefore, we report the findings of FDG-PET for this case and review some of the literature about bone marrow lymphomas.