Diffuse pulmonary uptake of Indium-111 chloride in idiopathic myelofibrosis.

Unusual indium-111 accumulation and extramedullary hematopoiesis in the lungs of a patient with idiopathic myelofibrosis are described. The bone marrow scan taken 24 hours after intravenous injection of 111InCl3 faithfully depicted the abnormal distribution of marrow elements as assessed histologically at autopsy, thereby supporting the usefulness of 111InCl3 for marrow imaging.     

Relationship between bone marrow cellularity and apparent diffusion coefficient

This study was performed to determine if there is a relationship between apparent diffusion coefficient (ADC) and cellularity of bone marrow of the posterior ilium. Four groups of various marrow cellularity underwent diffusion-weighted echo-planar imaging: 1) adults with normal hypocellularity (21 patients); 2) adults with normal normocellularity (13 patients); 3) young children with normal hypercellularity (5 patients); and 4) adults with lymphoma-related hypercellularity (3 patients). In all adults, marrow cellularity was confirmed by uni-or bilateral bone marrow biopsies. In children, the iliac marrow was presumed hypercellular because of their ages. A total of 66 ADC values of bone marrow calculated from diffusion-weighted images with b-values of 30 and 300 seconds/mm(2) was evaluated. Hypercellular marrow (normal and lymphoma-related) showed the highest mean ADC, and hypocellular the lowest ADC. Statistically significant differences were found between three groups of normal marrow: hypocellular, normocellular, and hypercellular. There is a positive correlation between ADC and cellularity of bone marrow. J. Magn. Reson. Imaging 2001;13:757-760.     

MR imaging of bone marrow in children

The magnetic resonance (MR) images of the knees and hips of children with systemic diseases involving bone marrow were correlated with their marrow histology and compared with the images of asymptomatic normal children. In normal children the intensity of the MR signal from the bone marrow of the knees and hips was uniform throughout the metaphyses and diaphyses. In contradistinction the MR signal was uniformly diminished for the hypercellular marrow of patients with sickle cell anemia, was similar to normal for the hypocellular hyperfatty marrow of untreated aplastic anemia, and was nonuniform and patchy for leukemic marrow.     

Indium-111-labeled leukocyte and technetium-99m-sulfur colloid uptake by a malignant fibrous histiocytoma: phagocytosis by tumor cells?

Indium-111-labeled leukocyte imaging, performed on a patient with a calcified mass in the right thigh, demonstrated labeled leukocyte accumulation in this mass. Technetium-99m-sulfur colloid imaging was performed to differentiate labeled leukocyte uptake in heterotopic bone marrow from uptake in a focus of infection. Leukocyte and sulfur colloid images were virtually identical, and the study was interpreted as without evidence of infection. Excision of the mass revealed an angiomatoid malignant fibrous histiocytoma with metaplastic bone formation. While no marrow elements were present in either the tumor or the metaplastic bone, phagocytosis of leukocytes by tumor cells was identified. Phagocytosis of leukocytes by tumor cells may be another cause of white cell accumulation in uninfected neoplasms.     

Indium-111-labeled white blood cells in the detection of osteomyelitis complicated by a pre-existing condition

Forty-six patients (23M, 23F) ranging in age from 19 to 79 yr with a clinical history of a nonunion fracture, surgery, diabetes or a soft-tissue infection were studied with [111In]oxine WBCs to detect osteomyelitis. There were 27 true-positive, nine true-negative, two false-positive and one false-negative. The false-positives and the false-negative occurred in patients with soft-tissue infections overlying the area of interest. All diagnoses were confirmed by intraoperative bone biopsies and cultures. Bone biopsy and scan were performed within 2 days of each other in 39 patients. The overall sensitivity was 97% (27/28), specificity, 82% (9/11) and the diagnostic accuracy, 92% (36/39). The remaining seven patients had negative [111In]WBC scans several months after positive bone biopsies and definite antibiotic treatment. This suggests that [In]WBC scans become negative after appropriate therapy is undertaken. Interobserver data was obtained from four nuclear physicians of varying experience blinded to clinical information. A high degree of agreement was found in over 90% of the cases. This study demonstrates the utility of [111In]WBC scans in the diagnosis and follow-up of complicated osteomyelitis and a high level of interobserver agreement in scan interpretation.     

A positive indium-III bone marrow scan in metastatic breast carcinoma. Case report

Indium is generally presumed to localize in the bone marrow within the erythroid cell line. Fibrosis, inflammation, lymphoma, extended field radiation, chemotherapy, or combinations of both treatment modalities generally depress the uptake of indium by the marrow a complex fashion. We report a case of metastatic breast carcinoma and pancytopenia in which the In-111 scan appeared qualitatively similar to a Tc-99m MDP bone scan. Findings were confirmed by bone marrow biopsy.     

MRI of bone marrow

MRI can visualize bone marrow more clearly than X-CT or RI because the bone generates weak signals whereas the fat in the marrow gives strong signals. We described diagnosis of various bone marrow disorders by MRI technique. Hyperplasia of bone marrow decreased fatty cells and resulted in prolongation of T1, whereas hypoplasia of bone marrow replaced hematopoietic cells with fatty cells and resulted in shortening of T1. In aplastic anemia, the localized hyperplastic areas in abnormal fatty marrow can be visualized. In bone tumor and metastasis to bone marrow, T1-weighted IR image can provide the best contrast between the tumor and normal marrow, although neoplastic and inflammatory lesions can not be differentiated by MRI. In iron storage diseases, MRI can detect early changes by its higher sensitivity to iron than that of X-CT. MRI may be usefull in monitoring bone marrow damages noninvasively to patients under radiation and/or anticancer drug therapy.     

Scintigraphic evaluation of secondary myelofibrosis associated with prostatic cancer before and after hormone therapy

A patient with secondary myelofibrosis associated with prostatic cancer gained hematologic remission after hormone therapy. Before treatment, a bone scan with Tc-99m MDP showed diffuse, increased uptake in the axial skeleton without visualization of the appendicular skeleton; a bone marrow scan with In-111 chloride revealed decreased uptake in the central marrow. Following hormone therapy, a bone scan showed an almost normal distribution with visualization of the appendicular skeleton and bone marrow scan indicating improved uptake of the central marrow. Radionuclide bone and bone marrow imaging was thus useful not only in diagnosing secondary myelofibrosis but also in evaluating the effects of therapy.     

Intracranial extramedullary hematopoiesis. CT and bone marrow scan findings

This case concerns a patient with intracranial extramedullary hematopoiesis (EH) suspected on a CT scan and subsequently confirmed with In-111 chloride and Tc-99m SC bone marrow scans. The bone marrow scans also provided additional information by demonstrating other sites of EH in the paravertebral tissues and bone marrow expansion into the distal extremities.     

Imaging of bone infection with labelled white blood cells: role of contemporaneous bone marrow imaging

The uptake of white blood cells (WBC) into normal bone marrow may lead to difficulty in detecting bone infection. Twenty-one patients in whom the WBC scan was equivocal or positive underwent a technetium 99m colloid scan to show the distribution of bone marrow. Six patients had a positive WBC scan, and in five of them a discordant colloid scan confirmed infection. However, in one the colloid scan was concordant, indicating that the WBC activity was not due to infection but the result of normal bone marrow uptake. Fifteen patients had an equivocal WBC scan. In 14, infection was excluded by a concordant scan, and 1 patient with a discordant scan was lost to follow-up. We conclude that the combination of a WBC scan and a colloid scan is an effective method to distinguish infection from normal bone marrow activity and, in particular, reduces the number of incorrect diagnoses of infection.     

Paget's disease: a cause of photopenic skeletal defect in indium-111 WBC scintigraphy

As an incidental finding in an [111In]WBC scan performed in search of an infectious focus, photon deficient areas were found in several skeletal locations, characterized by bone and gallium scintigraphy and confirmed radiographically as sites of active Paget's disease. The literature concerning cold bone defects in the [111In]WBC scintiscan is reviewed. Loss of marrow component in the bone appears to be the underlying mechanism for such an abnormality.     

Imaging of bone infection with labelled white blood cells role of contemporaneous bone marrow imaging

The uptake of white blood cells (WBC) into normal bone marrow may lead to difficulty in detecting bone infection. Twenty-one patients in whom the WBC scan was equivocal or positive underwent a technetium 99m colloid scan to show the distribution of bone marrow. Six patients had a positive WBC scan, and in five of them a discordant colloid scan confirmed infection. However, in one the colloid scan was concordant, indicating that the WBC activity was not due to infection but the result of normal bone marrow uptake. Fifteen patients had an equivocal WBC scan. In 14, infection was excluded by a concordant scan, and 1 patient with a discordant scan was lost to follow-up. We conclude that the combination of a WBC scan and a colloid scan is an effective method to distinguish infection from normal bone marrow activity and, in particular, reduces the number of incorrect diagnoses of infection.     

Magnetic resonance imaging of femoral marrow cellularity in hypocellular haemopoietic disorders

AIM: Magnetic resonance imaging (MRI) of the femora was used to investigate the marrow cellularity during the evolution of non-transplanted aplastic anaemia (AA) and hypocellular myelodysplastic syndrome (h-MDS) in order to investigate the relationship between this cellularity and disease progression.METHODS: Magnetic resonance imaging was performed in adult patients with pancytopaenia and hypocellular bone marrow. Coronal T1 weighted and STIR images were obtained, and analysed semiquantitatively. These data were compared with diagnosis, peripheral blood counts and bone marrow histology at diagnosis and at the time of the MRI examination.RESULTS: Patients were examined 2-84 months after diagnosis (median, 16 months). In AA, 11/13 patients showed a fatty, faint or nodular pattern. In h-MDS, the majority of the patients (10/14) had a scattered or uniform signal pattern. In AA, a significant correlation was found between the degree of femoral cellularity and disease duration. Only three cases had diffuse high signal on STIR: among them, one had paroxysmal nocturnal haemoglobinuria and the other developed acute leukaemia 3 months after MRI examination. Four patients have died: three with h-MDS presenting a scattered (two cases) or a uniform (one case) MRI signal and one with AA (with a nodular pattern)CONCLUSION: In AA, femoral haemopoiesis is usually not pronounced, and if present, does not contribute to the improvement of blood counts. In h-MDS, patients with discrete femoral haemopoiesis had an improvement in their blood counts with disease duration, similar to that found in AA. Conversely, in patients with pronounced femoral cellularity, blood counts remained stable or had deteriorated since diagnosis. This favours the hypothesis that, as is observed in MDS with a hypercellular marrow, scattered or uniform marrow patterns in femoral MRI are signs of more aggressive disease.     

Evaluation of bone-marrow scanning with technetium-99m sulfur colloid in pediatric oncology.

Eighty-six technetium-99m sulfur colloid (Tc-SC) bone-marrow scans in 56 pediatric oncology patients were reviewed. The distribution of the sulfur colloid was similar to that in adult bone marrow in normal children older than 10 yr, and involved progressively more marrow of the extremities in normal children under 10 years of age. After irradiation or chemotherapy there was an extension of the Tc-SC to peripheral marrow sites. There was also diminished uptake of the tracer in sites corresponding to irradiated areas. In most patients there was recovery of these defects by 6 mo after completion of therapy. Tumor replacement of the marrow was reflected in the scans, and the extent of the scan defect paralleled the course of the disease. In four patients, despite normal bone scans and radiographs, marrow-scan abnormalities due to tumor replacement were present and confirmed by needle aspiration and/or biopsy. In two other patients, the marrow-scan abnormality preceded radiographic and histologic evidence of tumor metastasis. Two patients who responded clinically showed persistent defects; biopsy in one revealed fibrosis. Technetium-99m sulfur colloid bone-marrow scanning appears to be a sensitive monitor of marrow alteration caused by metastases, irradiation damage, or tissue fibrosis in children receiving treatment for cancer.     

小儿贫血及白血病骨髓的脂肪抑制（STIR）MRI

目的：本文试就ＳＴＩＲ法对小儿贫血及白血病的骨髓改变的ＭＲＩ诊断价值加以讨论。材料和方法：本组病例包括经骨穿检查的贫血患儿１２例（缺铁性贫血３例，巨细胞贫血２例，再障贫血７例）；白血病１２例。同年龄对照组２０例。扫描方法：ＳＴＩＲ序列，ＴＲ＝１５００ｍｓｅｃ，ＴＩ＝１００ｍｓｅｃ，ＴＥ＝３０ｍｓｅｃ；部位：腰骶部及胸腰段椎体的矢状位。结果：正常组在ＳＴＩＲ序列中骨髓信号为边缘高信号，中心低信号，中心低信号区随年龄的增加扩大和明显，是脂肪髓化的部位，边缘的高信号区为造血细胞存在部位。缺铁性贫血的３例和巨细胞贫血的２例均可见骨髓边缘的高信号区明显扩大，但仍保持正常的分布状态；再障贫血的７例出现骨髓边缘的高信号区消失，但１例骨髓低信号中可见星点状高信号，为残存的造血组织。１２例白血病病例中１０例可见骨髓信号明显升高且信号混杂，中心区亦可见高信号，失去了正常的分布；另２例化疗后的病例，骨髓信号虽高而不均，但中心部的低信号已见。结论：ＳＴＩＲ法对小儿贫血及白血病骨髓改变的评价有意义     

Can [18F]fluorodeoxyglucose positron emission tomography imaging complement biopsy results from the iliac crest for the detection of bone marrow involvement in patients with malignant lymphoma?

OBJECTIVES: To assess the usefulness of [18F]fluorodeoxyglucose positron emission tomography in the detection of bone marrow involvement in malignant lymphoma, and its impact in clinical management. METHODS: One hundred and six consecutive patients with a confirmed diagnosis of lymphoma, referred for staging or restaging of Hodgkin's lymphoma (n=18) or non-Hodgkin's lymphoma (n=88), were reviewed retrospectively. A positron emission tomography scan and bone marrow biopsy of the iliac crest were performed in all patients. The assessment of bone marrow involvement by lymphoma was confirmed by histology and/or progression of bone marrow lesions in clinical follow-up. RESULTS: In 28 of 106 patients, bone marrow involvement was found. Positron emission tomography was more sensitive (86%) than bone marrow biopsy (57%). Positron emission tomography and bone marrow biopsy were concordant by positive correlation in 12 of 28 cases (43%) and by negative correlation in 77 of 78 cases (99%). Ten cases of non-Hodgkin's lymphoma and two cases of Hodgkin's lymphoma with positive positron emission tomography results and an initial negative bone marrow biopsy showed clinical progression of the bone marrow lesions and/or subsequent positive histology. These were considered as false-negative results for bone marrow biopsy. In seven of the 12 positive cases with negative bone marrow biopsy, positron emission tomography uptake distant from the site of the biopsy was seen. In four cases of follicular lymphoma, the bone marrow biopsy was positive and the positron emission tomography scan was normal. CONCLUSIONS: Positron emission tomography and bone marrow biopsy are complementary in assessing the presence of bone marrow involvement in patients with malignant lymphoma. In our series, positron emission tomography was more sensitive than bone marrow biopsy in Hodgkin's and non-Hodgkin's lymphoma, except in follicular lymphoma.     

The clinical utility of prostate-specific antigen and bone scintigraphy in prostate cancer follow-up.

To assess the value of serum prostate-specific antigen (PSA) in prostate cancer follow-up, we prospectively studied 107 consecutive patients with: (1) pathologically confirmed prostate cancer; (2) definitive prostatectomy and/or radiation therapy greater than or equal to 3 mo prior to bone scanning; and (3) one bone scan and serum PSA sampling within 3 mo of each other. The mean and range of patient follow-up since definitive therapy was 1.6 and 0.5-8 yr, respectively. Abnormal bone scans were correlated with pertinent radiographs. Of 107 bone scans, 16 demonstrated metastatic bone disease. A PSA value of less than or equal to 8 ng/ml excluded bone metastases with a predictive value of a negative test of 98.5%. Without radiographic correlation, abnormal bone scans rarely represented metastases if the PSA value was less than or equal to 8 ng/ml. In summary, serum PSA concentration determines the need for follow-up bone scanning and assists in scan interpretation in patients status post definitive therapy for prostate cancer.     

Abnormal pulmonary accumulation of indium-111 chloride in pneumocystis carinii pneumonia as detected by bone marrow scintigraphy

PURPOSE: Unusual pulmonary uptake of In-111 chloride in a patient with Pneumocystis carinii pneumonia and autoimmune hepatitis is described. METHOD: In-111 chloride bone marrow scintigraphy was performed to evaluate the bone marrow activity associated with pancytopenia in a 56-year-old woman with autoimmune hepatitis. RESULTS: An In-111 chloride bone marrow scan showed increased pulmonary uptake predominantly in both upper lung fields. P. carinii pneumonia was seen to be developing as an immunocompromised complication after treatment for autoimmune hepatitis. CONCLUSION: When In-111 chloride bone marrow scintigraphy shows increased uptake in the lungs of immunocompromised patients, a combined opportunistic inflammatory disease such as P. carinii pneumonia should be considered in the diagnosis.     

Comparative whole-body 201Tl and bone scintigraphies for the detection of bone marrow involvement in multiple myeloma

The objectives of this study were to investigate the role of whole-body 201Tl-chloride scintigraphy in comparison with bone scintigraphy in the detection of bone marrow involvement in patients with multiple myeloma and to assess the follow-up evaluation using 201Tl-chloride. Twenty-one patients with untreated multiple myeloma were evaluated. 201Tl-chloride images were acquired 10 min (early) and 2 h (delayed) after the injection of 111 MBq 201Tl-chloride. Bone images were acquired 3 h after the intravenous injection of 740 MBq 99mTc-hydroxymethylene diphosphonate (HMDP). The 201Tl-chloride scan patterns were classified as normal, diffuse (presence of bone marrow), focal (localized areas of uptake) and diffuse+focal. The bone scan patterns were classified as normal and abnormal. Eight of the 21 patients also underwent 201Tl-chloride scintigraphy after chemotherapy for the evaluation of the therapeutic response. On the early 201Tl-chloride image, two patients showed a normal, 13 a diffuse, two a focal and four a diffuse + focal pattern. On the delayed 201Tl-chloride image, nine patients showed a normal, six a diffuse, four a focal and two a diffuse + focal pattern. Bone scintigraphy showed an abnormal accumulation in only five of the 21 patients. Of the eight patients who underwent follow-up 201Tl-chloride studies, the abnormal diffuse pattern was changed to a normal pattern on post-treatment scintigraphy in three, and the degree of abnormal 201Tl-chloride accumulation decreased in comparison with the pre-treatment scan in three. These six patients were considered to be in clinical remission. In the two remaining patients, the degree of abnormal 201Tl-chloride accumulation increased in comparison with the pre-treatment scan, and they were considered to be in clinical progression. 201Tl-chloride scintigraphy is a non-invasive tool, which may be more useful than bone scintigraphy for the diagnosis of multiple myeloma, and may be helpful in the follow-up of multiple myeloma.     

Disseminated bone marrow metastases from gastric cancer: detection and monitoring the effectiveness of chemotherapy by bone marrow scintigraphy]

Disseminated bone marrow metastasis of cancer is a critical condition, frequently complicated by disseminated intravascular coagulation (DIC). A 32-year-old man with gastric cancer was diagnosed as having disseminated bone marrow metastases. Bone scintigraphy demonstrated many abnormal radionuclide accumulations in the whole body. Bone marrow aspiration revealed cancer cells. Bone marrow scintigraphy with 111In-Cl3 demonstrated central marrow failure and peripheral expansion. The remission of DIC was observed after sequential methotrexate and 5-FU therapy, then uptake of radionuclide in the central bone marrow was remarkably improved by bone marrow scan. After thirteen anti-cancer chemotherapies, recurrence of DIC was suspected because of the reduction of blood platelet count. Nevertheless, repeated bone marrow scan still demonstrated the central bone marrow clearly. The patient discharged from our hospital without the recurrence of DIC. We considered bone marrow scintigraphy is useful in the detection of disseminated bone marrow metastases of cancer and monitoring the effectiveness of chemotherapy.