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Detection of lymphomatous bone marrow involvement with magnetic resonance
imaging [see comments]
BR Hoane, AF Shields, BA Porter and HM Shulman
Department of Medicine, University of Washington, Seattle.
We reviewed magnetic resonance (MR) staging examinations of 98 patients
with malignant lymphoma who failed other therapy and were under evaluation
for bone marrow transplantation. MR scan results were compared with blind
posterior iliac crest aspirations and biopsies. Images of vertebral,
pelvic, and femoral marrow were obtained using a standard T1-weighted,
short repetition time (TR), short time to echo (TE) (TR700/TE22), spin-echo
(T1-SE) method in 92 patients and short TI inversion recovery (STIR)
technique (TR1,500/TE36/TI100) in all. On standard T1-SE sequence, normal
marrow is bright due to the predominance of marrow fat, and tumor is dark.
With STIR images, water containing tumor has a very high signal intensity
in a dark (fat suppressed) background. Thirteen patients had positive MR
scans and marrow biopsies, whereas 49 had negative MR scans and biopsies.
Of 36 discordant MR/histology results, 10 had positive biopsies and
negative MR exams; eight of these had microscopic infiltration (less than
or equal to 5%) with tumor. MR detected marrow tumor either in the crests
or elsewhere in 25 of 75 (33%) patients with negative study biopsies. We
could confirm marrow involvement in 15 of these 25 (60%) by clinical
methods. Therefore, up to one third of the patients evaluated with routine
biopsies may have occult marrow tumor detectable by MR exam. In patients
with negative marrow biopsies, especially those with Hodgkin's disease or
intermediate to high-grade non-Hodgkin's lymphomas, MR scans found focal
lesions distant from the crests. Biopsy better detected lower grade
microscopic involvement. We conclude that optimal marrow staging of
lymphoma patients incorporates both biopsy and MR imaging.
Volume 78,
Issue 3,
pp. 728-738,
08/01/1991
Copyright © 1991 by The American Society of Hematology
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