Bone marrow scintigraphy using Technetium-99m antigranulocyte antibody in malignant lymphomas

Background: The purpose of this study was to elucidate the clinical reliability of immunoscintigraphy (IS) to detect infiltration of the bone marrow in patients with malignant lymphoma.Patients and methods: Whole body IS was performed in 103 patients with Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) using Tc-99m labelled anti-NCA-95 which allows visualization of the granulopoietic bone marrow. Of these, 52% were studied prior to any therapy. Findings were compared to posterior iliac crest biopsy as well as MRI and/or follow-up examination. Criteria of marrow infiltration were a positive biopsy, positive follow-up, or positive results of MRI.Results: Comparison of IS and biopsy revealed concordant findings in 69 and discordant findings in 34 of 103 patients. Of the 34 patients with discordant results, IS showed lesions suspicious of bone marrow infiltration in 29 patients despite normal biopsy findings. When follow-up and additional examinations were taken into consideration, 10 patients remained with probably false positive and five with false negative IS findings. IS proved to be highly sensitive and specific in patients with HD (100% and 84%, respectively) and high-grade NHL (93% and 84%, respectively). Moderate sensitivity (60%) was found in low-grade NHL. This was possibly due to false negative IS in three to five patients with chemotherapy in contrast to one of five false negative results in patients without chemotherapy.Conclusion: Bone marrow scintigraphy using antigranulocyte antibodies is highly sensitive in HD and high-grade NHL. Positive findings in IS subsequent to a negative biopsy should be followed by guided re-biopsy or MRI.     

Magnetic resonance imaging to detect bone marrow metastases in the initial staging of small cell lung carcinoma and breast carcinoma

BACKGROUND: Bone marrow is a common site of metastases in patients with small cell lung carcinoma (SCLC) and female breast carcinoma (FBC). Metastatic bone marrow involvement is found in approximately 50% of SCLC patients and up to 85% of FBC patients at autopsy. Initial staging procedures detect malignant bone marrow lesions in only 2-30% of patients with these tumors. This study was performed to assess whether MRI can improve the detection rate of bone marrow metastases in tumors with a high incidence of skeletal involvement. METHODS: Fifty-two patients with histologically verified SCLC (25 with limited stage disease and 27 with extensive stage disease) and 33 women with FBC were entered into a prospective study. The MRI protocol was comprised of coronal slices in the pelvic region and sagittal slices of the whole spine utilizing a T1-weighted spin echo sequence with a field of view of 50 cm. All patients underwent initial routine diagnostic staging procedures including bone scintigraphy, unilateral crest biopsy, and plain film radiography of suspicious skeletal areas. RESULTS: Only in two SCLC patients, MRI was positive in 25 cases. All SCLC patients with bone marrow lesions histologically verified, diagnosed by crest biopsy (six patients) or by bone scan (seven patients) had the correct diagnosis of metastases by MRI. In addition MRI revealed hypointense bone marrow foci in 14 cases. In contrast, 28 of 33 FBC patients examined during the initial staging procedure showed no evidence of bone marrow involvement. MRI was not superior compared with bone scintigraphy in FBC patients. CONCLUSIONS: The staging results obtained in SCLC and FBC patients are different, although both tumors have a high incidence of bone marrow metastases. It may be assumed that the biologic behavior of these tumors is reflected by the initial bone marrow involvement. Because of its superiority compared with biopsy and bone scan, the authors believe MRI should become an integral part of the initial staging procedures in patients with SCLC. When staging patients with FBC, MRI should be applied only in clinically indicated cases.     

评价全身FDG-PET/CT在诊断淋巴瘤患者骨髓浸润中的价值

目的:本研究旨在评价PET-CT和骨髓涂片、骨髓活检、免疫分型结果诊断淋巴瘤的一致性和相关性。方法:收集临床确诊淋巴瘤患者的详细临床信息,包括姓名、性别、年龄、淋巴瘤细胞起源、病理分型、临床分期、行为状态、有无B症状、血LDH水平、血β2微球蛋白水平、骨髓涂片结果、免疫分型结果、骨髓活检结果以及详细的PET-CT影像学描述等。根据不同临床信息为患者进行详细分层,评价影响PET-CT中骨髓摄取葡萄糖的因素、影响淋巴瘤骨髓浸润的因素。设定骨髓涂片、骨髓活检、免疫分型阳性为对照,探究PET-CT在诊断淋巴瘤患者骨髓浸润中的价值。分别探讨PET-CT对于诊断不同病理类型淋巴瘤患者骨髓浸润的差异。结果:在性别、病理类型、细胞起源、有无B症状及骨髓浸润等不同分层中,只有淋巴瘤骨髓浸润与PET-CT中骨髓葡萄糖摄取有密切相关性(P=0.002)。而骨髓浸润与年龄(P=0.017)密切相关。设定骨髓涂片、骨髓活检、免疫分型阳性为对照,PET-CT检测淋巴瘤总体骨髓浸润的敏感度为54.3％、特异度为80.5％、准确度为74.5％,并且在不同病理类型中差异显著。PET-CT可以与骨髓涂片、骨髓活检、免疫分型共同指导淋巴瘤临床分期。结论:PET-CT中的骨髓葡萄糖摄取对淋巴瘤骨髓浸润及临床分期有一定的指导意义。不同病理类型的淋巴瘤中,PET-CT与骨髓涂片、骨髓活检、免疫分型的一致性不尽相同。PET仍不能完全取代骨髓涂片、骨髓活检、免疫分型。     

The Value of Bone Marrow Examination in Small Cell Carcinoma of the Lung

Of 668 consecutive patients with SCLC, 472 underwent bone marrow examination for staging. In 330 patients a triple examination (sternal aspiration, iliac crest aspiration and biopsy) was performed, otherwise a single procedure. Bone marrow infiltration (MI) was found in 37% of the patients with extensive disease, and the frequencies of a positive finding in single and triple examinaton were not statistically different. In the group having triple examination performed iliac crest aspiration alone disclosed MI in 32%. When all three procedures were included still more patients with MI were found (42%) but the two values were not significantly different. In 6.6% of patients who would have been classified as 'limited' did bone marrow examination change the stage to extensive disease. Based on these results we recommend iliac crest aspiration, but not triple examination with iliac crest biopsy, in the staging of SCLC.     

Clinical significance of the bone marrow examination in small cell carcinoma of the lung

To study the clinical relevance of bone-marrow metastasis, bone-marrow biopsy and aspiration from the posterior iliac crest were performed in 11 consecutive patients with small cell carcinoma of the lung. Six of the 11 patients (54.5%) showed tumor cell involvement in the bone marrow. In 4 patients with bone-marrow metastasis, myelocytes and metamyelocytes were present in the peripheral blood. Aspiration was diagnostically more valuable than bone-marrow biopsy. Bone scintigrams, using 99mTc-MDP, correlated with the bone-marrow involvement except in one case, where false-negative results were obtained. The areas of bone-marrow metastasis did not match well with the positive lesions detected by bone scintigraphy.     

骨髓涂片免疫组织化学与骨髓活组织检查诊断非霍奇金淋巴瘤骨髓浸润的比较

目的：比较骨髓涂片免疫组织化学和骨髓活组织检查在检测非霍奇金淋巴瘤（NHL）骨髓受累中的优缺点。方法收集60例初治NHL患者,应用骨髓涂片免疫组织化学法和骨髓活组织检查检测是否骨髓受累,并将患者的年龄、临床分期、结外受累、B症状等临床因素与两种检测方法结果进行相关性分析。结果骨髓涂片免疫组织化学和骨髓活组织检查检测出的NHL骨髓受累阳性率分别为10.0%（6／60）、3.3%（2／60）（P＝0.008）;B细胞来源时,两者阳性率分别为6.6%（4／60）和3.3%（2／60）（P＝0.007）,T细胞来源时,阳性率分别为3.3%（2／60）、0（0／60）。经相关性分析,两种检测方法与患者性别、年龄、Karnofsky评分、B症状、结外累及、乳酸脱氢酶、血小板数、血红蛋白含量、中性粒细胞数、淋巴细胞数、分期均无关（均P＞0.05）。结论骨髓涂片免疫组织化学法检测NHL骨髓受累的阳性率高于活组织检查,进一步分析B细胞或T细胞来源时,骨髓涂片免疫组织化学法仍有相对优势。     

18F-FDG PET-CT评价淋巴瘤骨髓浸润的临床价值

淋巴瘤骨髓浸润对疾病的诊断、分期、治疗方案选择及预后评估至关重要,常规部位的骨髓活检为主要检测手段,但假阴性率高.18氟脱氧葡萄糖-正电子发射计算机断层显像(18F-FDG PET-CT)将形态学与功能代谢整合在一起,具有高敏感性、高特异性及功能显像的优点,18F-FDG PET-CT为淋巴瘤骨髓浸润的诊断、疾病分期及预后评估提供了新的途径.     

Acquisition of metastatic tissue from patients with bone metastases from breast cancer

Biopsies of metastatic tissue are increasingly being performed. Bone is the most frequent site of metastasis in breast cancer patients, but bone remains technically challenging to biopsy. Difficulties with both tissue acquisition and techniques for analysis of hormone receptor status are well described. Bone biopsies can be carried out by either by standard posterior iliac crest bone marrow trephine/aspiration or CT-guided biopsy of a radiologically evident bone metastasis. The differential yield of these techniques is unknown. Results from three prospective studies of similar methodology were pooled. Patients underwent both an outpatient posterior iliac crest bone marrow trephine/aspiration and a CT-guided biopsy of a radiologically evident bone metastasis. Samples were assessed for the presence of malignant cells and where possible also for estrogen (ER) and progesterone receptor (PgR) expression. 40 patients were enrolled. Bone marrow aspiration/trephine biopsy was completed in 39/40 (97.5%) and CT-guided biopsy was completed in 34/40 (85%) of patients. Sufficient tumor cells for hormone receptor analysis were available in 19/39 (48.8%) and 16/34 (47%) of and bone marrow aspiration/trephine and CT-guided biopsies, respectively. Significant discordance in ER and PgR between the primary and the bone metastasis was also seen. Nine patients had tissue available from both bone marrow and CT-guided bone biopsies. ER and PgR concordance between these sites was 100 and 78%, respectively. Performing studies on human bone metastases is technically challenging, with relatively low yields regardless of technique. Given resource issues and similar success rates when comparing both techniques, bone marrow examination may be utilized first and if inadequate tissue is obtained, CT-guided biopsies can then be used.     

恶性淋巴瘤骨髓受累的免疫表型特征

目的:探讨淋巴瘤骨髓受累的免疫表型特征。方法:采用流式细胞仪CD45/SSC设门方法对34例恶性淋巴瘤患者的骨髓标本进行检测,以骨髓涂片细胞学检查作阳性对照。收集骨髓受累患者的CD分子表达数据。结果:①对34例恶性淋巴瘤患者的骨髓应用流式细胞仪进行检测,发现23例阳性,阳性率67.65%(23/34),95%可信区间(51.92%,83.37%)。②该23例阳性患者中,非霍奇金淋巴瘤(NHL)19例,霍奇金淋巴瘤(HL)4例。NHL患者中B细胞来源免疫荧光单克隆抗体标记抗原出现频率最高的为CD19,CD20;T细胞来源标记抗原出现频率最高的为CD7。而在HL患者中出现频率最高的为CD9。结论:采用流式细胞仪CD45/SSC设门方法,发现非霍奇金淋巴瘤骨髓受累患者免疫表型特征为:B细胞来源:CD19、CD20;T细胞来源:CD7。霍奇金淋巴瘤为:CD9。     

骨髓涂片、骨髓活检对弥漫性大B细胞淋巴瘤临床分期的价值

目的:探讨骨髓涂片、骨髓活检对弥漫性大B细胞淋巴瘤(DLBCL)临床分期的价值.方法:对44例累及骨髓的病例回顾性分析骨髓涂片及骨髓活检切片,分别比较细胞学形态、组织形态、增生程度、纤维组织增生程度、检出率和敏感性.结果:骨髓涂片中可见中到大型的异型细胞骨髓,切片中瘤细胞以灶型最常见.按Manoharm改良法评估,骨髓切片中网状纤维含量有不同程度增多.骨髓涂片与骨髓切片增生程度的比较,差异有统计学意义(P＜0.05),切片组增生程度高于涂片组.骨髓涂片与骨髓切片检出率的比较,差异有统计学意义(P＜0.05),切片组检出率高于涂片组.骨髓涂片与骨髓切片敏感性的比较,差异有显著统计学意义(P＜0.01),切片组敏感性明显高于涂片组.结论:骨髓涂片简单易行,骨髓切片在骨髓组织状况、优势增生细胞等方面有优势,同时开展涂片和切片的检测,提高检出率,可以修正临床分期,如能同时进行流式细胞免疫表型分析,则更能提高检出率.     

Bone marrow involvement by non-Hodgkin's lymphoma: the clinical significance of morphologic discordance between the lymph node and bone marrow. Nebraska Lymphoma Study Group.

Bone marrow specimens from 317 patients with non-Hodgkin's lymphoma (NHL) obtained at initial staging were evaluated for the presence of lymphoma or benign lymphoid aggregates. Thirty-two percent (102 patients) had lymphoma in their bone marrow, and 9% had benign lymphoid aggregates. Bone marrow lymphoma was present in 39% of low-grade, 36% of intermediate-grade, and 18% of high-grade lymphomas. The bone marrow was involved in 25% of patients with diffuse large-cell or immunoblastic NHL (ie, diffuse histiocytic lymphoma of Rappaport). Bone marrow involvement did not affect survival of patients with low-grade NHL, but survival was significantly shorter (P = .03) for patients with intermediate- and high-grade NHL with bone marrow involvement. Bone marrow involvement was equally common in B-cell and T-cell NHL (31% v 32%). However, patients with T-cell NHL and bone marrow involvement had shorter survival than B-cell NHL with marrow involvement (P = .02) or T-cell NHL without marrow involvement (P = .05). A high incidence of morphologic discordance between lymph node and bone marrow was observed (ie, 40%), always with a more aggressive subtype in the lymph node than in the bone marrow. Presence of large-cell lymphoma in the bone marrow predicted for short survival. Survival for patients with small-cell lymphoma in their bone marrow did not differ significantly from patients with negative bone marrows. We conclude that bone marrow involvement in large-cell NHL, especially in those of T-cell origin, portends a poor prognosis. However, the subgroup of patients with an aggressive histologic subtype of NHL in a lymph node biopsy and small-cell NHL in the bone marrow do not have a poorer outlook than those without bone marrow involvement.     

133 例恶性淋巴瘤骨髓细胞学分析

目的:探讨恶性淋巴瘤骨髓浸润的临床特点。方法:回顾性分析133 例经病理确诊的恶性淋巴瘤病例,分析其骨髓浸润情况。结果:133 例恶性淋巴瘤患者中骨髓受累率为21.8%（29/133）;在骨髓受累的病例中,淋巴肉瘤性白血病、骨髓侵犯、淋巴瘤细胞比例未达5% 的病例分别占31.0%（9/29）、55.2%（16/29）和13.8%（4/29）。 在29例骨髓受累病例中,B 细胞淋巴瘤占55.2%（16/29）,T/NK细胞淋巴瘤占41.4%（12/29）,霍奇金病占3.4%（1/29）。 T/NK细胞淋巴瘤的骨髓受累率为37.5%（12/32）,比B 细胞淋巴瘤要高18.2%（16/88）,两组具有统计学差异。结论:恶性淋巴瘤骨髓浸润比例高,不同的病理学类型骨髓受累的风险不一,总体而言T 细胞淋巴瘤的骨髓浸润率更高,而且以淋巴肉瘤性白血病多见,骨髓细胞学检查对恶性淋巴瘤的正确分期、治疗方案的选择和预后判断有重要的意义。      

Clinical and radiologic characteristics of bone metastases in breast cancer

Metastatic bone disease was evaluated in 380 consecutive patients at the time of first metastasis of breast cancer. Studies included radiographic examination, radionuclide examination, and bone marrow biopsy. Radiographs of the skeleton demonstrated metastases in 120 patients (32%), and in 40 of these patients (13%) the bone was the only site of metastases. The diagnostic efficiency was 82% for bone scanning, 80% for pain evaluation, 59% for s-calcium analyses, and 77% for s-alkaline phosphatase analyses. Bone scanning is an effective method to exclude metastatic bone disease (sensitivity: 96%). A positive scan, however, requires radiologic confirmation (specificity: 66%). Bone scanning of the skeleton should be the initial staging procedure in all patients with recurrent breast cancer with no clinical or biochemical signs of bone metastases. Bilateral posterior iliac crest bone marrow aspirations and bone biopsies were positive in 82 out of the 320 patients who underwent biopsy. The frequency of positive bone marrow biopsy was significantly correlated with both the site of radiographic metastases and with the total number of involved bone regions. Routine bone marrow biopsies are indicated in patients with a positive bone scan, but a negative x-ray examination. In these cases biopsies should be performed bilaterally.     

Bone marrow evaluation in small cell carcinoma of the lung

Bone marrow examination is commonly included in the staging of small cell lung carcinoma (SCLC). We reviewed marrow samples of 103 patients. Marrow examination was mainly performed by unilateral or bilateral biopsy of iliac crests, using a Jamshidi needle. Only 6 of 97 evaluable cases (6.2 per cent) were positive for marrow metastases at staging, and in 3 cases (3 per cent) bone marrow was the only metastatic site. No focal metastases were found in additional sections made from the blocks of negative samples. In our experience bone marrow biopsy was of little value in staging SCLC. Bilateral biopsy plus aspirate, with the addition of more sophisticated staining techniques might, however, provide a higher yield of positive marrow involvement.     

Quantitative magnetic resonance imaging in autologous bone marrow transplantation for Hodgkin's disease

Fifteen consecutive patients with refractory or relapsed Hodgkin's disease (HD) referred for autologous bone marrow transplantation (ABMT) underwent quantitative magnetic resonance (MR) studies of the lumbar vertebral bone marrow. Markedly elevated lumbar vertebral marrow T1 values suggestive of bone marrow involvement with HD were seen in four patients, two of whom had no evidence of HD on bilateral iliac crest bone marrow biopsy. Serial studies showed normalisation of T1 values in the post-transplant period. T1 relaxation rate correlated positively with time to engraftment following ABMT and a significant correlation (r = 0.73, 0.02 greater than P greater than 0.01) between T2 relaxation rate and granulocyte and macrophage colony forming units (CFU-GM) of processed bone marrow was seen. This preliminary study illustrates the potential role of quantitative MRI both in the pre-transplant assessment of patients considered for ABMT and in the post-transplant evaluation of tumour response when marrow involvement with HD is present.     

伴PET/CT骨髓弥漫性糖代谢增高的淋巴瘤患者骨髓浸润情况及相关因素分析

背景与目的：正电子发射计算机断层显像技术(positron emission tomography-computed tomography,PET/CT)在淋巴瘤的诊断、治疗和随访中发挥着越来越重要的作用。该研究旨在探索PET/CT显示骨髓弥漫性糖代谢异常增高的淋巴瘤患者骨髓有无浸润、淋巴瘤病理类型以及其他临床特点。方法：回顾性分析复旦大学附属中山医院62例经病理确诊为淋巴瘤且PET/CT显示骨髓弥漫性糖代谢增高患者的临床资料、病理以及PET/CT详细数据,并行统计学分析。结果：PET/CT显示有骨髓弥漫性糖代谢异常增高的患者,其淋巴瘤病理类型分布与国内所报道各亚型淋巴瘤发病比例基本一致;侵袭性与惰性淋巴瘤之间［标准摄取值(standard uptake value,SUV)分别为8.43与5.38,P=0.048］、有或无B症状之间(SUV分别为8.30与5.72,P=0.033)、有或无骨髓浸润之间(SUV分别为8.78与6.96,P=0.020),SUV的差异均有统计学意义。32例(51.6%)患者经骨髓活检病理证实骨髓受累。骨髓受累者其淋巴瘤病理类型的分布上与未受累者差异有统计学意义(P=0.001);骨髓受累者套细胞淋巴瘤、结内边缘区B细胞淋巴瘤、伯基特淋巴瘤和间变大细胞淋巴瘤者比例较高,而骨髓未受累者弥漫大B细胞淋巴瘤、外周T细胞淋巴瘤、肠病相关性T细胞淋巴瘤和NK/T细胞淋巴瘤(鼻型)者比例较高。PET/CT骨摄取假阳性可能与发热、贫血等有关。结论：PET/CT骨髓弥漫性糖代谢异常增高虽然对临床诊疗有一定的提示,但应结合PET/CT骨糖代谢异常增高的特点、患者的临床因素及病理亚型综合分析,以减少误诊与漏诊,更精确地指导分期及治疗。     

Exploring the role of FDG-PET in the assessment of bone marrow involvement in lymphoma patients as interpreted by qualitative and semiquantitative disease metabolic activity parameter

Bone marrow biopsy (BMB) is currently the standard method to evaluate marrow involvement in malignant lymphomas. However, there exist a number of pitfalls in this technique that can have important implications for initial staging, prognostification, and treatment of the disease. The present study was undertaken to investigate the utility of FDG-PET imaging in the detection of bone marrow involvement in untreated lymphoma patients. Forty untreated patients (36 males and 12 females) with either Hodgkin's disease (HD) (n = 17) or non-Hodgkin's lymphoma (NHL) (n = 31) underwent whole body FDG-PET study for disease evaluation. Bone marrow uptake of FDG was graded as absence or presence of disease activity at marrow sites by qualitative assessment. Semiquantitative analysis involved deriving disease metabolic index (DMI) using the following formula: DMI = SUV max of suitable circular ROI over PSIS or trochanteric region/ SUVmax of similar ROI over adjoining background. Findings of BMB and FDG-PET were compared for final analysis. Eleven out of 17 HD patients (12 males and 5 females) demonstrated concordance between FDG PET findings and BMB reports. Remaining 6 cases showed discordance of FDG-PET demonstrating presence of marrow involvement at marrow sites and uninvolved marrow on BMB. Twenty six of the 31 NHL cases (24 males and 7 females) demonstrated concordance between FDG PET findings and BMB reports. Remaining 5 cases showed discordance of FDG-PET demonstrating presence of marrow involvement at marrow sites and uninvolved marrow on BMB. All the BMB positive patients (2 of HD and 5 of NHL) demonstrated disease activity in bone marrow on FDG-PET study. All patients with absence of disease activity at marrow sites on FDG-PET scan (9 of HD and 21 of NHL) had histology proven uninvolved marrow. The quantitative assessment by DMI showed a mean of > 2.5 in HD and NHL patients at the PSIS region and the trochanteric region bilaterally in cases of bone marrow involvement by the disease. FDG-PET is a useful adjuvant to BMB for the evaluation of bone marrow involvement in lymphoma patients. The disease metabolic index of > 2.5 at the marrow sites can serve as a semiquantitative parameter for such diagnosis on FDG-PET in untreated patients of lymphoma.     

Enhanced marrow [18F]fluorodeoxyglucose uptake related to myeloid hyperplasia in Hodgkin's lymphoma can simulate lymphoma involvement in marrow

[18F]Fluorodeoxyglucose (FDG) positron emission tomography (PET) is increasingly used for the clinical staging of lymphomas and for assessment of response to therapy. We report the case of a woman with classic Hodgkin's lymphoma who had marked FDG uptake by tumor and bone marrow suggestive of diffuse marrow involvement by lymphoma. However, iliac crest bone marrow examination showed marked myeloid hyperplasia without evidence of lymphoma involvement. We discuss the implications for interpretation of FDG-PET imaging of bone marrow in lymphomas.     

骨髓涂片、骨髓活组织检查及流式细胞术在淋巴瘤骨髓侵犯诊断中的比较

目的 比较骨髓涂片、骨髓活组织检查和流式细胞术三种方法对淋巴瘤患者骨髓受累的检测情况,为临床检测骨髓受累提供选择.方法 收集68例恶性淋巴瘤初治患者,观察骨髓涂片、骨髓活组织检查和流式细胞术三种方法检测淋巴瘤患者骨髓受累的阳性率.结果 68例恶性淋巴瘤患者检测骨髓受累时,骨髓涂片、骨髓活组织检查和流式细胞术的阳性率分别为16.2％（11/68）、33.8％（23／68）和10.3 ％（7/68）,骨髓活组织检查阳性率高于涂片和流式细胞术检查,三种方法阳性率差异有统计学意义（P＜0.05）.对三种检测方法进行相关性分析,骨髓涂片与骨髓活组织检查存在相关性（P=0.002）,与流式细胞术没有相关性（P=0.270）.结论 骨髓涂片细胞形态学检查是检测淋巴瘤患者是否有骨髓受累的基础方法,骨髓活组织检查阳性率较高,有明显的优势,但需与骨髓涂片互为补充.     

Detection of bone marrow abnormalities in patients with Hodgkin's disease by T1 mapping of MR images of lumbar vertebral bone marrow.

Pixel by pixel T1 mapping of MR images has been used in conjunction with image analysis techniques to study the lumbar vertebral bone marrow of 20 patients with refractory or relapsed Hodgkin's disease prior to salvage chemotherapy, or high dose chemotherapy with autologous bone marrow rescue. Compared to 18 age matched controls, seven patients had significantly abnormal lumbar vertebral marrow T1 histograms with median, 5% and 95% centile T1 values that lay outside a three dimensional 95% probability region obtained for the normals. Six of these patients had increased areas of high T1 consistent with bone marrow involvement with lymphoma; although, only in two of them had Hodgkin's disease been detected by bilateral iliac crest bone marrow biopsy. Post-treatment studies were performed in four patients who had abnormal areas of high T1 in the lumbar vertebral bone marrow. All showed normalisation of the T1 histogram, with a reduction of T1 values to within the normal range as defined by the studies of age matched controls. T1 mapping of bone marrow offers potential for detecting bone marrow infiltrates in patients with lymphoma, and also for the assessment of treatment response.