Bone marrow investigation with technetium-99m microcolloid and magnetic resonance imaging in patients with malignant myelolympho-proliferative diseases

In 63 patients with primary extramedullary malignant lymphoma or plasmacytoma, a study was performed in order to evaluate bone marrow involvement. All patients underwent a 99mTc microcolloid bone marrow whole body imaging (scintigraphy), using a gamma camera interfaced with a computer, followed by nuclear magnetic resonance bone marrow imaging (MRI), (1.5 Tesla). MR images were made of the lumbosacral region, the pelvic region, both femoral and other parts of the skeleton, according to focal lesions in the scintigraphy. A posterior iliac crest bone marrow biopsy was used as a standard reference. In the present study, both scintigraphy and MRI showed a dissiminated or focal involvement or a combination of both. In 53 of the 63 patients (84%) the results were in accordance. Pathological MR signals or pathological findings in scintigraphy did not always correspond to tumorous bone marrow involvement, and were shown to reflect reactive changes in the central part of the skeleton in combination with a periphery radionuclide extention interpreted as a periphery compensatory hematopoietic proliferation. The negative predictive value of scintigraphy and MRI was 92% and 100%, respectively. When combining the results of both examinations, the positive predictive value increased from 49% to 58%, if the bone marrow biopsy is accepted as gold standard. The results indicate that bone marrow investigation performed simultaneously using scintigraphy and MRI is superior both to the use of either of the methods alone and to the traditional iliac crest bone marrow biopsy.     

Bone marrow blood supply in gadolinium-enhanced magnetic resonance imaging

A retrospective study was performed to determine whether bone blood supply can be assessed on gadolinium-enhanced magnetic resonance imaging. Lumbar spine magnetic resonance imaging (MRI) examinations of 49 patients attending for post-laminectomy examination were reviewed (30 male, 19 female, mean age 46.4 years, age range 23–84 years). Each study included sagittal T1-weighted spin echo sequences before and after gadolinium administration. Regions of interest were drawn within the L3 vertebral body from a parasagittal slice from each sequence. Signal intensity (SI) values were ascertained and the percentage increase in SI was calculated. For each patient, changes in receiver gain for pre and post-gadolinium images were corrected by an image scaling factor. In all cases, a measurable increase in SI was found (mean 15.3%, range 4.4–55.7) due to bone vascularity. The results give no indication of the quantity or timing of blood supply but provide a basis for further work.     

Scintimammography with technetium-99m methoxyisobutylisonitrile: comparison with mammography and magnetic resonance imaging

The aim of the study was to compare the diagnostic accuracy of scintimammography with technetium-99m methoxyisobutylisonitrile (MIBI; SMM) in the detection of primary breast cancer with that of mammography (MM) and magnetic resonance imaging (MRI). Fifty-six patients with suspected lesions detected by palpation or MM were included in the study. Within the 4 weeks preceding excisional biopsy, MM and MRI were performed in all patients. Between 5 and 10 min after the injection of 740 MBq^99mTc-MIBI, SMM in the prone position was performed. In the total group of 56 patients, 43 lesions were palpable, while 13 were non-palpable but were detected by MM. Breast cancer was confirmed by histopathology in 27 of the patients (22 palpable and 5 non-palpable carcinomas). The tumour size ranged from 6 to 80 mm in diameter. For non-palpable lesions, the sensitivity of SMM, MM and MRI was 60%, 60% and 100%, respectively, while the specificity was 75%, 25% and 50%, respectively. For palpable breast lesions, all methods showed high sensitivity (SMM 91%, MM 95%, MRI 91%) but SMM demonstrated significantly higher specificity (SMM 62%, MM 10%, MRI 15%). In two mammographically negative tumours (dense tissue), SMM showed a positive result. In comparison to MRI, one additional carcinoma could be diagnosed by SMM. It may be concluded that for palpable breast lesions, the diagnostic accuracy of SMM is superior to that of MM and MRI. Through the complementary use of SMM it is possible to increase the sensitivity for the detection of breast cancer and multicentric disease. In patients in whom the status of a palpable breast mass remains unclear, SMM may help to reduce the amount of unnecessary biopsies.     

The skeleton in congenital,generalized lipodystrophy: evaluation using whole-body radiographic surveys,magnetic resonance imaging and technetium-99m bone scintigraphy

Congenital generalized lipodystrophy (CGL) is a rare genetic disease characterized by the absence of body fat from birth. Focal bone lesions have also been reported, but their pathophysiology is poorly understood. To characterize skeletal abnormalities further in 3 patients with CGL, we employed whole-body radiographic skeletal surveys, magnetic resonance imaging (MRI, including gadolinium enhancement), and triple phase technetium-99m methylene diphosphonate bone scintigraphy. Radiographs showed numerous focal lesions within the long bones, as described in other reports. MRI showed that the entire marrow space of the long bones was abnormal and was characterized, at least in part, by the absence of marrow fat. Prolonged T1 and T2 times and marked gadolinium enhancement were observed in radiographically normal-appearing long bone. Radiographically lytic lesions occasionally demonstrated fluid-fluid levels on MRI and enhanced peripherally after gadolinium infusion. Bone scintigraphy findings such as periarticular hyperemia were relative subtle. We conclude that the appendicular skeleton of patients with CGL is diffusely abnormal and is predisposed to focal osteolysis and cyst formation.Supported in part by grants from the National Institutes of Health (M01-RR-00633)     

成人急性白血病初诊骨髓MRI及临床应用研究

目的：研究成人急性白血病（acute leukemia,AL)患者初诊自然病程状态下骨髓的MRI表现及其临床应用价值。方法：搜经细胞形态学及免疫表型综合分析确诊的成人AL54例,其中髓细胞白血病（AML）28例、急性淋巴细胞白血病（ALL）26例,行骨盆及股骨中上段骨髓MRI,采用SE序列及短时反转恢复（STIR）序列行冠状面扫描,选取15例正常志愿者作为对照组,搜集AL患者同期骨髓象及血常规结果与MRI对比分析。结果：患者骨髓MRI表现按浸润程度和范围分为5级,AML患者23（82％）例属Ⅰ-Ⅲ级病例,2型患者MRI分级总体的分布差异有非常显著性意义（U＝4．233）,P＜0．01）。分别比较2型AL患者各临床诊断指标,显示2屠 骨髓象白血病细胞计数（BMT）、外周血白血病细胞计数（PBT）、外周血白细胞计数（WBC）之间差异有显著性意义（t值分别为4．336、2．008、3．420,P值均＜0．05）。MRI分级与临床诊断指标比较,两者间具有非常显著的一致性（U＝6．099,P＜0．01）。,MRI分级为Ⅳ级的AML患者,缓解率较Ⅰ-Ⅲ级者低（P＜0．05）,MRI分级为Ⅴ级的ALL患者与Ⅳ级患者缓解率的差异无显著性意义（P＞0．1）。结论MRI能反映2型AL不同的骨髓浸润特征,能为AL确诊提供影像学依据。初诊AML患者骨髓MIR对病情的评估,缓解的预测有重要的临床应用价值。     

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。     

腰椎骨髓信号在高、低场磁共振的对比

目的：通过对比腰椎骨髓信号在高、低场磁共振各序列上的差异,找出高、低场磁共振对病灶检查的局限性,避免不同场强磁共振的不足,以积累诊断经验。方法收集2012年9月～2012年12月腰椎退变14例,腰椎外伤8例,腰椎骨转移瘤5例,在Siemens verio 3．0T和日立Airis‐Ⅱ0．3T磁共振仪上分别做检查,两次检查在同一天完成,期间未做任何治疗,两名副主任医师单盲法阅片,分析14例腰椎退变中30处局灶性黄骨髓,8例腰椎外伤中10处骨髓水肿,5例腰椎转移瘤中16处转移灶及2例瘤周水肿的信号在高、低场磁共振各序列的表现差异。结果在Siemens verio 3．0T磁共振仪上,各序列信号清晰,但T2加权像对水肿显示不清;在Airis‐Ⅱ0．3T磁共振仪,各序列图像较模糊,尤其 T2加权像对局灶性黄骨髓显示不清,但对水肿信号的显示明显优于高场T2加权像。结论高场磁共振,各序列图像清晰,低场磁共振图像模糊;低场T2加权像对于局灶性黄骨髓的显示明显差于高场;而对于水肿的显示明显优于高场 T2加权像,高场磁共振的T2压脂序列是不可缺少的。     

Negative scintigraphy with positive magnetic resonance imaging in bone metastases

We report three patients with known primary tumor in whom radionuclide skeletal imaging for metastatic disease was normal with or without clinical symptomatology referable to this area. Magnetic resonance imaging (MRI) of the spine demonstrated focal areas of abnormal signal intensity in the vertebral bodies of these patients. In all three patients, biopsy confirmed metastatic disease. All the patients received radiation or chemotherapy depending upon the etiology. These preliminary data suggest that MR imaging may be useful in evaluating patients with known primary tumor in whom clinical suspicion persists despite a negative radionuclide bone scan.     

Perfusion of subchondral bone marrow in knee osteoarthritis: A dynamic contrast-enhanced magnetic resonance imaging preliminary study

The role of inflammation in the pathogenesis of osteoarthritis is being given major interest, and inflammation is closely linked with vascularization. It was recently demonstrated that dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) could identify the subchondral bone marrow vascularization changes occurring in osteoarthritis in animals. These changes appeared before cartilage lesions were visible and were correlated with osteoarthritis severity. Thus the opportunity to obtain an objective assessment of bone vascularization in non-invasive conditions in humans might help better understanding osteoarthritis pathophysiology and finding new biomarkers.We hypothesized that, as in animals, DCE-MRI has the ability to identify subchondral bone marrow vascularization changes in human osteoarthritis. We performed knee MRI in 19 patients with advanced knee osteoarthritis. We assessed subchondral bone marrow vascularization in medial and lateral femorotibial compartments with DCE-MRI and graded osteoarthritis lesions on MR images. Statistical analysis assessed intra- and inter-observer agreement, compared DCE-MRI values between the different subchondral zones, and sought for an influence of age, sex, body mass index, and osteoarthritis garde on these values.The intra- and inter-observer agreement for DCE-MRI values were excellent. These values were significantly higher in the femorotibial compartment the most affected by osteoarthritis, both in femur and tibia (p < 0.0001) and were significantly and positively correlated with cartilage lesions (p = 0.02) and bone marrow oedema grade (p < 0.0001) after adjustment.We concluded that, as in animals, subchondral bone marrow vascularization changes assessed with DCE-MRI were correlated with osteoarthritis severity in humans.     

Magnetic resonance imaging of the bone marrow in hematological malignancies

Despite its lack of specificity, magnetic resonance imaging (MRI) of the bone marrow has the potential to play a role in the management of patients with primary neoplastic disorders of the hematopoietic system, including lymphomas, leukemias and multiple myeloma. In addition to its use in the assessment of suspected spinal cord compression, bone marrow MRI could be used as a prognostic method or as a technique to assess the response to treatment. The current review addresses the common patterns of bone marrow involvement observed in primary neoplasms of the bone marrow, basic technical principles of bone marrow MRI, and several applications of MRI in selected clinical situations. Received 22 May 1997; Revision received 27 January 1998; Accepted 29 January 1998     

Localization of ectopic parathyroid glands using technetium-99m sestamibi imaging: Comparison with magnetic resonance and computed tomographic imaging

The aim of the study was to compare the accuracy of technetium-99m sestamibi imaging for localization of ectopic parathyroid glands in patients with hyperparathyroidism with that of magnetic resonance (MR) and computed tomographic (CT) imaging. Eleven patients with primary (n=3) or secondary (n=8) hyperparathyroidism were studied with^99mTc sestamibi parathyroid imaging CT and MR imaging. Images of the neck were acquired at 10 min and 2–3 after tracer injection. The three patients with primary hyperparathyroidism and five patients with secondary hyperparathyroidism underwent parathyroidectomy. The ectopic glands were confirmed by histopathological examination of the resected specimens. In respect of 20 parathyroid glands in the eight patients explored surgically, the sensitivity and specificity of sestamibi imaging were 70% (14/20) and 88%, respectively, those of CT, 40% (8/20) and 88%, and those of MR imaging, 60% (12/20) and 88%. Of these patients, three had parathyroid adenomas while five had hyperplasia (17 glands). Sestamibi imaging localized eight ectopic parathyroid glands, which were surgically confirmed (six were located in the thymus and two in the mediastinum). In one patient explored surgically, the ectopic gland was located outside the field of the MR coil. Although the remaining three cases of secondary hyperparathyroidism were not confirmed surgically, these patients demonstrated sestamibi uptake in five parathyroid glands, including three ectopic glands. MR images demonstrated abnormal parathyroid glands in the same regions as sestamibi imaging. Our data indicate that^99mTc-sestamibi imaging should be used initially to localize the ectopic parathyroid glands in patients with hyperparathyroidism for anatomical guidance prior to MR or CT imaging.     

Health technology assessment of magnetic resonance imaging of the spine and bone marrow

The high spatial resolution and the lack of ionizing radiation, makes magnetic resonance imaging the method of choice for imaging most spinal pathology, especially if associated with neurological symptoms. However, due to the high sensitivity of MR imaging, careful correlation between imaging findings and clinical findings is important to ensure appropriate treatment. Substituting radiographic evaluations for rapid MRI in the primary care setting may offer little additional benefit to patients. It may even increase the costs of care but the decisions about the use of imaging depend on judgments concerning whether the small observed improvement in outcome justifies additional cost. Because the presence of an abscess is a major factor in deciding between conservative and surgical treatment, MRI plays an essential role in the decision-making process concerning the treatment of spondylodiscitis. MR is also the method of choice for quantitative evaluation of bone marrow in lymphoma patients when a crucial therapeutic decision has to be made or for the qualitative evaluation of the spinal cord if compression is suspected in primary spinal malignancy or metastatic disease.     

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,     

骨髓增生异常综合征的MRI研究进展

骨髓增生异常综合征（MDS）是一组以无效造血为特征的骨髓疾病,特点是向急性髓系白血病（AML）转化风险高。MDS一旦转化为AML,病人将面临治疗难度增加、预后变差等诸多问题,故了解MDS向AML转化的征象、预测MDS向AML的转化具有重要意义。MRI能够从整体上显示骨髓结构并具有无创性,其有助于MDS的诊断、病情评估及预测MDS转化为AML的风险。就MRI在MDS中的研究进展进行综述。     

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     

经治重型β地中海贫血的股骨骨髓MR成像分析

目的探讨经治重型β地中海贫血（以下简称地贫）股骨骨髓的MRI特征。方法对35例重型β地贫行股骨近段MR检查，同时选取年龄、性别匹配的正常儿童45例作为对照。对股骨骨髓进行SE、快速场回波序列（fast field echo，FFE）冠状面成像。在SE T1WI上判断红黄骨髓并将骨髓分布分为5组，在FFE序列上判断骨髓内的铁沉积，并进行临床相关性分析。结果35例地贫，FFE序列上15例股骨近端骨髓出现铁沉积，红黄骨髓表现为极低信号。骨髓的铁沉积与年龄有关（P=0．032）。T1WI上，30例重型地贫骨髓分布为Ⅲ和Ⅳ组，而正常儿童为Ⅰ和Ⅱ组，两者之间差异有统计学意义（P〈0．001），且重型地贫骨髓分组与输血量相关（P=0.049）。结论经治重型地贫股骨近段骨髓红骨髓增生，骨髓内可出现铁沉积。骨髓的增生与输血治疗、铁沉积及年龄有一定的关系。     

常见血液病的骨髓磁共振成像

磁共振成像(MRI)以其无创伤性、直接显示骨髓、检测异常骨髓的能力而成为评价骨髓病变的首选影像学检查方法。随着年龄的增长，正常人红骨髓按照一定规律转换为黄骨髓，MRI表现也发生相应的变化。多种原发血液病可引起骨髓MRI信号异常，甚至骨髓T1的变化。白血病骨髓典型表现为弥漫性的T1WI低信号，T1延长；白血病治疗后缓解，T1缩短接近正常范围。淋巴瘤及多发性骨髓瘤的MRI表现多种多样，取决于病变的恶性程度，但骨髓的T1均延长。再生障碍性贫血具有特征性的T1WI、T2WI高信号。增生性贫血由于红骨髓增生，黄骨髓逆转为红骨髓，贫血严重时甚至骨骺内的黄骨髓逆转为红骨髓。     

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.     

Bone marrow oedema associated with benign and malignant bone tumours

Bone marrow oedema is associated with a wide variety of pathological processes including both benign and malignant bone tumours. This imaging finding in relation to intraosseous tumours can aid in providing a more focused differential diagnosis. In this review, we will discuss the MR imaging of bone marrow oedema surrounding intraosseous neoplasms. The different pulse sequences used in differentiating underlying tumour from surrounding oedema are discussed along with the role of dynamic contrast enhanced MRI. Benign lesions commonly associated with bone marrow oedema include osteoid osteoma, osteoblastoma, chondroblastoma and Langerhan's cell histiocytosis. Metastases and malignant primary bone tumours such as osteosarcoma, Ewing's sarcoma and chondrosarcoma may also be surrounded by bone marrow oedema. The imaging findings of these conditions are reviewed and illustrated. Finally, the importance of bone marrow oedema in assessment of post chemotherapeutic response is addressed.     

Infiltration patterns in monoclonal plasma cell disorders: correlation of magnetic resonance imaging with matched bone marrow histology

Objectives

To investigate how plasma cell infiltration patterns detected by MRI match the plasma cell distribution in bone marrow biopsy.

Methods

We assessed 50 patients with monoclonal plasma cell disorders of all clinical stages. MRI infiltration pattern was compared with matched BM histology from the same anatomic region.

Results

MRI revealed a minimal (n = 11, 22%), focal (n = 5, 10%), diffuse (n = 14, 28%) and mixed (n = 20, 40%) infiltration pattern. Diffuse MRI pattern was predominant in smoldering myeloma patients whereas the MRI patterns with “focal component” (i.e. focal and mixed) were most common in symptomatic myeloma (p < 0.01). In histology an interstitial (n = 13, 26%), nodular (n = 23, 46%) and packed marrow (n = 14, 28%) was found respectively. All three histological types of infiltration were observed in patients with diffuse and mixed MRI patterns. Minimal MRI pattern was found in all MGUS patients and was associated with an interstitial BM infiltration. In two patients with minimal MRI pattern an extensive micro-nodular BM infiltration was found in histology.

Conclusions

Infiltration patterns in MRI represent different histological growth patterns of plasma cells, but the MRI resolution is not sufficient to visualize micro-nodular aggregates of plasma cells.