Magnetic resonance tomography of the bone marrow for the detection of metastases of solid tumors]

The bone marrow is a common site of metastases in patients with solid tumors. Metastatic bone marrow involvement is found much more frequently at autopsy than in routine staging procedures. The purpose of this study was to evaluate the diagnostic efficacy of bone marrow MRI in such patients, and especially in those with small cell lung cancer and female breast carcinoma. MRI is a fast and reliable method for the early detection of bone marrow metastases in patients with carcinoma. In many studies and according to our own experience, it is much more sensitive than radionuclide bone scan, iliac crest biopsy and plain film radiography. However, a clear clinical benefit of its use in the initial staging has so far been proven only for patients with small cell lung cancer. As a consequence, MRI should be applied for the staging of solid tumors only when clinical examination does not yield unambiguous results. Owing to its superiority to biopsy and bone scan, bone marrow MRI should become an integral part of the initial staging procedure in small cell lung cancer and wherever it is sufficiently available it can replace the conventional diagnostic procedures.     

Imaging and clinical spectrum of rhabdomyosarcoma in children

We retrospectively analyzed the MRI findings of rhabdomyosarcoma (RMSA) in 23 patients to evaluate its role in staging and management. Heterogeneous signal abnormalities were noted in the sarcoma lesions with significant contrast enhancement. Seven head and neck cases showed direct bone invasion and destruction; only one had distant bony metastasis. Metastasis was noted in the lymph nodes, lung, bone, abdominoperitoneum, and head and neck soft tissue. MRI findings of RMSA are most helpful in staging and assessing therapeutic response.     

Magnetic resonance imaging of bone marrow disorders

The sensitivity of MRI to marrow infiltration together with the ability to perform multiplanar imaging allows evaluation of the bone marrow in a manner that has never been feasible before. The clinical impact of this has yet to be fully realized. However, detection of focal marrow infiltration by MRI with concurrently normal conventional imaging studies has important clinical implications for staging and therapy. Proper staging of marrow-based neoplasms such as leukemia and lymphoma is fundamental to the determination of treatment and prognosis. MRI can be used to increase diagnostic certainty when a question exists concerning primary or metastatic marrow disease when other imaging studies are inconclusive. Chemical shift imaging may further improve the sensitivity and clinical utility of magnetic resonance imaging in patients with hematologic disorders involving the bone marrow.     

Whole-body FSE STIR MR imaging of lymphoma

Purpose

To evaluate the role of FSE STIR whole body MRI in diagnosis and initial staging of malignant lymphoma, and can FSE STIR whole body MRI replace conventional staging procedures including computed tomography and bone marrow biopsy in initial staging of lymphoma.

Materials and methods

Twenty one newly diagnosed histologically proven lymphoma patients underwent whole body MR imaging and conventional staging procedures including computed tomography and bone marrow biopsy for initial staging of lymphoma using Modified Ann Arbor staging system. Both methods evaluated positive involvement by lymphoma to the nodal and extra-nodal sites including parenchymal organs, serosal cavities and bone marrow. The numbers of involved nodal and extra-nodal sites detected by both methods were compared, then agreement and disagreement between whole-body MRI and conventional procedures regarding lesions detection and staging according to the Ann Arbor staging system were calculated, along with binomial exact 95% confidence intervals (CIs).

Results

Twenty one patients had a total of 145 abnormalities. One hundred and twenty four were correctly diagnosed by conventional staging procedures, however, FSE STIR whole body MRI correctly diagnosed all the 144 abnormalities with 1 false negative and 3 false positive abnormalities with a total of detected abnormalities of 147 lesions. FSE STIR whole body MRI was significantly more accurate than conventional staging procedures in the diagnosis of positive lymphoma lesions [(99.3%; 95% CI: 95.6-100.0%) versus (85.5%; 95% CI: 78.5-90.6%)]. FSE STIR whole body MRI correctly staged 20 out of 21 patients, Kappa test 0.93 (P < 0.001) while conventional staging procedures correctly staged 17 and incorrectly staged 4 cases, Kappa test 0.74 (P < 0.001).

Conclusion

Whole body MR imaging can replace conventional staging procedures in the diagnosis and initial staging of malignant lymphoma as it offers a whole body overview of the lymphoma infiltration through the lymph node stations, parenchymal organs, serosal cavities and bone marrow.     

MRI诊断骨嗜酸性肉芽肿的价值

目的：探讨MRI对骨嗜酸性肉芽肿的诊断及分期价值。方法：回顾性分析经病理证实的27例骨嗜酸性肉芽肿的临床和影像学资料。结果：病灶单发23例,多发4例。4例病灶呈斑片状骨破坏,边缘清但不规则;14例呈类圆形骨质破坏,边界清楚、规则,周围骨髓及软组织明显肿胀;9例呈斑片状骨破坏伴周围硬化,中间伴见分隔。所有病灶T1WI均呈低信号,T2WI呈低于周围骨髓的稍高信号,STIR呈高信号;三维容积快速采集（LAVA）动态增强扫描4例急性期病灶呈持续性环状明显强化,14例肉芽肿期病灶呈均匀持续性强化,9例修复期病灶早期强化不明显而延迟期呈轻度环状、分隔状强化;6例出现骨膜反应。结论：MRI能充分显示骨嗜酸性肉芽肿痛变的范围、细节,能提示病变的分期,对临床诊断、治疗本病具有重要的参考价值。     

The evolving role of MRI in oncohaematological disorders

Magnetic resonance imaging (MRI) has opened new possibilities to current diagnostic radiology in the evaluation of bone marrow. Compared with other imaging modalities, MRI is the only technique able to directly visualise bone marrow with its different components of red and yellow marrow. Other advantages of MRI are high-contrast resolution and multiplanar view, as well as extensive coverage of the skeleton with whole-body MRI (WBMRI). However, specificity of signal alterations of bone marrow is low. Therefore, MRI findings need to be integrated with clinical and laboratory findings as well as with haematological and oncological evaluation. MRI provides information that effectively aids diagnosis, staging and follow-up of various bone marrow disorders. There is increasing interest in the capabilities of MRI in the evaluation of bone marrow, in particular of haematological malignancies. According to some authors much work remains to be done to improve sensitivity and specificity of MRI in order to define the real clinical value of this imaging modality in the multidisciplinary management of patients with a haematological malignancy. This article presents recent developments and perspectives in the use of MRI in oncohaematological diseases.     

Magnetic resonance imaging of primary malignant bone tumors

The authors find that MRI yields more useful information in a single study than CT, Tc scanning or angiography; they use it as the primary local staging procedure in malignant bone tumors.     

Bildgebende Diagnostik im Staging gynäkologischer Karzinome

The prognosis in patients with gynecologic cancers depends not only on the stage but also on a wide spectrum of other findings. Cross-sectional imaging modalities, including sonography, CT and MRI, have increasingly been used for optimal treatment planning in gynecologic cancers. Their staging criteria are based on the well-established FIGO staging system. CT and MRI compete with sonography, which plays a pivotal role in the evaluation of the female pelvis. This paper reviews the role of sonography, CT and MRI in the staging of gynecologic malignancies. It puts the emphasis on MRI, which has been established as imaging modality of choice in the preoperative evaluation of cervical and endometrial cancer, and which seems slightly superior to CT in the staging of ovarian cancer.     

Nuclear medicine in multiple myeloma -- more than diagnosis

Multiple myeloma (MM) is a neoplastic monoclonal proliferation of plasma cells, mainly involving bone marrow. To properly stage and manage patients with MM the clinician needs, at first, a complete skeletal survey, being more rarely present also extra skeletal locations. Today none of the available diagnostic imaging methods is able alone to answer to all the questions regarding staging, treatment, and follow up. Continuing to be alive the role of traditional radiology, implemented information can be added by CT and MRI. Concerning nuclear medicine, bone scintigraphy is affected by its low sensitivity. Tc-99m MIBI has been proposed in staging and in follow up, with most relevant clinical information deriving from the correlation of its whole body uptake's distribution with extent and activity of the disease. The prognostic value of MIBI has also been demonstrated. PET-FDG has been proposed in MM for its ability to detect whole-body metabolic active disease, giving relevant information in staging and prognosis. First studies have demonstrated that PET-FDG is more sensitive than other imaging modalities for localizing extra medullary sites of disease.     

The diagnostic value of 18F-FDG PET and MRI in paediatric histiocytosis

Purpose

To analyse the diagnostic value of ¹⁸F-FDG PET and MRI for the evaluation of active lesions in paediatric Langerhans cell histiocytosis.

Methods

We compared 21 ¹⁸F-FDG PET scans with 21 MRI scans (mean time interval 17 days) in 15 patients (11 male, 4 female, age range 4 months to 19 years) with biopsy-proven histiocytosis. Primary criteria for the lesion-based analysis were signs of vital histiocyte infiltrates (bone marrow oedema and contrast enhancement for MRI; SUV greater than the mean SUV of the right liver lobe for PET). PET and MR images were analysed separately and side-by-side. The results were validated by biopsy or follow-up scans after more than 6 months.

Results

Of 53 lesions evaluated, 13 were confirmed by histology and 40 on follow-up investigations. The sensitivity and specificity of PET were 67 % and 76 % and of MRI were 81 % and 47 %, respectively. MRI showed seven false-positive bone lesions after successful chemotherapy. PET showed five false-negative small bone lesions, one false-negative lesion of the skull and three false-negative findings for intracerebral involvement. PET showed one false-positive lesion in the lymphoid tissue of the head and neck region and two false-positive bone lesions after treatment. Combined PET/MR analysis decreased the number of false-negative findings on primary staging, whereas no advantage over PET alone was seen in terms of false-positive or false-negative results on follow-up.

Conclusion

Our retrospective analysis suggests a pivotal role of ¹⁸F-FDG PET in lesion follow-up due to a lower number of false-positive findings after chemotherapy. MRI showed a higher sensitivity and is indispensable for primary staging, evaluation of brain involvement and biopsy planning. Combined MRI/PET analysis improved sensitivity by decreasing the false-negative rate during primary staging indicating a future role of simultaneous whole-body PET/MRI for primary investigation of paediatric histiocytosis.     

Magnetic resonance in the staging of bladder neoplasms: results of the use of JKA1, a ferrous contrast solution

The authors report the results of the staging of urinary bladder cancers by means of MRI using a new ferrous contrastographic solution called JKA1. Eighteen patients with proved bladder neoplasms were examined by means of MRI: the bladder was filled with physiological solution first, and then with JKA1. Six patients were studied also after filling their bladders with Gd-DTPA solution (1:50). The results show that the use of JKA1, a T2-positive contrast medium, improved MR capabilities in the evaluation of small lesions (phi less than 1 cm) with minimal invasion of bladder wall; MR staging accuracy was 66.6% with the physiological solution and 77.8% with JKA1. The authors confirm the need for a wider MR study, in particular of T2 lesions (a critical subject for staging and surgical management) to assess MR diagnostic capabilities.     

Radiological appearances of appendicular osteosarcoma: a comprehensive pictorial review

Osteosarcoma is the most common primary malignant tumour of bone in adolescents and young adults. Hence, a comprehensive knowledge of the common and unusual imaging appearance of this tumour is essential. Correct diagnosis of the various varieties of osteosarcoma is important for optimal clinical management including staging, biopsy, treatment and follow-up of patients. This review article provides a comprehensive approach to the radiological diagnosis of the different types of appendicular osteosarcoma and illustrates the role of CT and MRI in further characterisation.     

Diagnostic value of MRI in comparison to scintigraphy, PET, MS-CT and PET/CT for the detection of metastases of bone

The initial localization of metastases in the bone in patients with solid tumors has a relatively good prognosis in comparison with visceral metastasization. The early detection of bone marrow metastases allows for a rapid initiation of therapy and a subsequent reduction in the morbidity rate. Modern MRI is superior to the 30-year-old skeletal scintigraphy and bone marrow scintigraphy with respect to sensitivity, specificity, as well as the extent of osteal metastasis. MRI provides substantial, therapy-relevant additional information. MSCT plays an important role in the management of cancer patients in clinical routine and gives an excellent survey of the axial skeleton by demonstrating osteolytic and osteoblastic metastases. Extensive comparative studies of MRI with 18F-FDG-PET and 18F-fluoride-PET have not yet been carried out. Whole body MRI is a very promising new staging method for the oncological diagnosis of solid tumors and the detection of osteal metastases. The adoption of 18F-FDG-PET and 18F-fluoride-PET FDG as well as the side by side PET-CT image fusion and the two in one PET/CT examinations appears to be slightly less sensitive to whole body MRI in the detection of osteal metastases. Larger, prospective multicenter studies are necessary to establish these as new, promising methods for the detection of osteal metastases.     

Staging of untreated nasopharyngeal carcinoma with PET/CT: comparison with conventional imaging work-up

Purpose  We prospectively compared PET/CT and conventional imaging for initial staging of nasopharyngeal carcinoma (NPC). Methods  A total of 111 patients with histologically proven NPC were investigated with PET/CT and conventional imaging (head-and-neck MRI, chest X-ray, abdominal ultrasound, and bone scan) before treatment. The respective findings were reviewed independently and then compared with each other. Results  With regard to T staging, PET/CT showed a discrepancy with head-and-neck MRI in 36 (32.4%) of the study subjects. With regard to N staging, PET/CT showed a discrepancy with head-and-neck MRI in 15 (13.5%) patients. Among the discordant cases, MRI was superior in demonstrating tumor involvement in the parapharyngeal space, skull base, intracranial area, sphenoid sinus, and retropharyngeal nodes while PET/CT was superior in demonstrating neck nodal metastasis. PET/CT disclosed 13 of 16 patients with distant malignancy compared with four patients disclosed by conventional imaging work-up. The false-positive rate of PET/CT was 18.8%. PET/CT correctly modified M staging in eight patients (7.2%) and disclosed a second primary lung malignancy in one patient (0.9%). Conclusion  In NPC patients, MRI appears to be superior to PET/CT for the assessment of locoregional invasion and retropharyngeal nodal metastasis. PET/CT is more accurate than MRI for determining cervical nodal metastasis and should be the better reference for the neck status. PET/CT has an acceptable diagnostic yield and a low false-positive rate for the detection of distant malignancy and can replace conventional work-up to this aim. PET/CT and head-and-neck MRI are suggested for the initial staging of NPC patients. An erratum to this article can be found at     

多发性骨髓瘤MRI和X线诊断价值

目的　进一步研究多发性骨髓瘤 (multiplemyeloma ,MM )的MRI表现特点并与X线检查相比较其优缺点 ,同时探讨MRI分型与临床分期的联系。材料与方法　选择 19例经骨髓穿刺证实的MM患者的下胸椎至股骨上段行X线与MRI检查 ,对相同患者相同时间相同部位的X线平片与MRI表现、临床分期、MRI分型与骨髓浆细胞百分比进行比较。结果　MM的MRI据T1 WI骨髓信号减低的形态分为以下类型 :正常型 ,弥漫型 ,局灶型 ,混合型 ,“盐和胡椒”型。腰椎以弥漫型多见占 47.3% ,局灶型、混合型各占15 .8% ;骨盆及股骨近段以局灶型多见占 5 7.9% ,弥漫型占 2 1.1% ,无混合型。MM的X线表现 :未见异常 7例 ,骨质疏松的基础上病理性骨折或骨质破坏 12例。腰椎、骨盆及股骨近段各部位检查的阳性率MRI均为 84.2 % ,X线平片分别为 63.2 %、42 .1%和31.6%。MRI表现 :正常型及“盐和胡椒”型的病例其骨髓浸润较轻 ,均见于临床Ⅰ期MM ,其骨髓浆细胞的百分比较低 ( 8.4± 2 .5 ) ;而弥漫型、局灶型、混合型均见于Ⅱ、Ⅲ期MM ,其骨髓浸润程度相对较重 ,骨髓浆细胞的百分比较高 ( 30 .5± 6.7、45 .2± 11.2 )。结论　MM的MRI表现可分为正常型、弥漫型、局灶型、混合型、“盐和胡椒”型。MRI对MM的敏感性明显高于X线检查 ,但两者的特异性较差     

Aplicaciones de la técnica de difusión por resonancia magnética en el manejo de la patología tumoral osteomuscular

Magnetic resonance imaging (MRI) is the technique of choice in the diagnosis, staging, and follow-up of musculoskeletal tumors. Diffusion imaging is a new functional MRI technique that provides information that is complementary to that obtained in conventional MRI sequences. Diffusion imaging has proven useful in different clinical situations like the characterization of disease involving the bone marrow (bone metastases, benign fractures, or hematological disease), the evaluation of tumors of the bones and soft tissues, and the monitoring of the response to treatment in patients with tumors. The aim of this article is to review the diffusion technique in MRI and its current clinical applications in the management of musculoskeletal tumors.     

Whole-body MRI in the detection of bone marrow infiltration in patients with plasma cell neoplasms in comparison to the radiological skeletal survey

To compare the diagnostic value of whole-body MRI versus radiological skeletal survey (RSS) in staging patients with plasma cell neoplasms (PCN) and to evaluate the possible therapeutic impact of the replacement of RSS by whole-body MRI. Fifty-four patients with PCN [multiple myeloma (MM), n=47; monoclonal gammopathy of unknown significance (MGUS), n=7] were studied by whole-body MRI and RSS in a monocenter prospective analysis from August 2002 to May 2004. The MRIs were performed using a rolling table platform “AngioSURF” for unlimited field of view with a 1.5-T system (Magnetom Sonata/Maestro Class, Siemens Medical Solutions, Erlangen, Germany). A coronal STIR sequence (TR5500-4230/TE102-94/TI160) was used for imaging of the different body regions, including the head, neck, thorax, abdomen, pelvis and upper and lower extremities. The RSS consisted of eight different projections of the axial and appendicular skeleton. In 41/54 (74%) patients, the results of the whole-body MRI and RSS were concordant. In 11/54 (20%) patients, both imaging techniques were negative. Bone involvement was observed in 30/54 (55%) patients; however, whole-body MRI revealed this more extensively than the RSS in 27/30 (90%) patients with concordant positive imaging findings. In 3/30 (10%) patients, both imaging techniques demonstrated a similar extent of bone marrow infiltration. In 10/54 (19%) patients, the whole-body MRI was superior to RSS in detecting bone marrow infiltration, whereas the RSS was negative. In 3/54 (6%) patients, the RSS was proven to be false positive by the clinical course, whereas the whole-body MRI was truly negative. Whole-body MRI is a fast and highly effective method for staging PCN patients by the use of a rolling table platform. Moreover, it is more sensitive and specific than RSS and reveals bone marrow infiltration and extensive disease more reliably. Therefore, whole-body MRI should be performed as an additional method of exactly staging PCN patients and - with more data in the field - may even prove to be an alternate and more sensitive staging procedure than RSS in PCN patients.     

MRI与骨扫描诊断前列腺癌骨转移的比较

目的 通过比较MRI与核素骨扫描对前列腺癌骨转移的诊断,以选择最优的无创成像手段来明确前列腺癌的分期。材料与方法 回顾性分析2011年1月-2013年6月经病理证实为前列腺癌的病人252例。年龄57~88岁,平均年龄（73±7.98）岁,分别获取并比较MRI和骨扫描对前列腺癌骨转移诊断的敏感度、特异度、准确度、阳性预测值（PPV）、阴性预测值（ＮＰＶ）。结果 54例病人诊断为骨转移（成骨性骨转移48例,混合性骨转移6例）。80%（41/54）的前列腺癌骨转移病人的前列腺特异性抗原（PSA）>50 ng/mL,而92%（182/19８）的前列腺癌无骨转移病人的PSA<50 ng/mL。MRI诊断前列腺癌骨转移的敏感度、特异度、准确度、PPV、NPV分别为85.1%、100%、96.8%、100%、96.1%;全身骨扫描诊断前列腺癌骨转移的敏感度、特异度、准确度、PPV、NPV分别为92.5%、84.3%、86.1%、61.7%、97.6%。结论 MRI对前列腺癌骨转移的诊断特异度、准确度及PPV较高,骨扫描的敏感度较高。MRI与骨扫描可以实现优势互补,利于前列腺癌的准确临床分期。     

Local staging of rectal cancer: a review of imaging

During the past decades the management of patients with rectal cancer has substantially changed, with a significant reduction in local recurrence rates following the introduction of better imaging, better surgery, and more efficient neoadjuvant therapy. This review discusses the clinically relevant information radiologists should know on staging of rectal cancer patients. The crucial role of the radiologist in patient management is explained. Furthermore, the evidence for the use of magnetic resonance imaging (MRI) in staging and restaging of rectal cancer patients as well as the main features that need to be evaluated when interpreting rectal cancer MRI are given. New diagnostic challenges as a result of new treatment options are also discussed.     

Magnetic resonance imaging of primary tumours and tumour-like lesions of bone

The experience with magnetic resonance imaging (MRI) of 81 patients with primary bone tumours and tumour-like lesions is reported. MRI proved to be a sensitive method of detecting primary bone tumours. Intramedullary and extraosseous parts of bone tumours were, delineated better than by plain films and computed tomography (CT). Surgical clips and Harrington rods did not appreciably limit the estimation of tumour recurrence. MRI provided definite advantages compared to CT in the surgical staging of bone tumours and tumour-like lesions. MRI was found to be an imaging method with low specificity. Differentiation of tissue components, such as haematoma, fat, necrosis, and cystic areas, led to a specific diagnosis only in rare cases. Plain films and CT were found to be superior to MRI in assessing the biological activity and the differential diagnosis of bone tumours and tumour-like lesions.