Efficacy of chemical shift MRI for differentiating diffuse red bone marrow reconversion and hematological malignancies

Burcu Akman

doi:10.3906/sag-1812-125

Abstract

Background/aim The main purpose of our study was to determine the efficacy of chemical shift imaging (CSI) for differentiating diffuse red bone marrow reconversion (RBMR) and hematological malignancies. We also aimed to calculate the cut-off value for these entities with similar imaging features in routine magnetic resonance (MR) sequences.Materials and methods A total of 54 patients were included: 17 patients (31.4%) with hematological malignancies (group 1), 16 patients (29.6%) with RBMR (group 2), and 21 patients (38.0%) with no clinical and hematological malignancies (control group). Patients with no pathological data or completed two-year follow-up and children were excluded from the study. An experienced radiologist on MRI evaluated the images blindly for final diagnosis. Pathologic results were determined as gold standard. Regions of interests (ROI) were placed on the vertebrae in CSI and signal intensity ratios (SIR) were calculated. The cut-off value was calculated using receiver operating characteristic (ROC) analysis.Results SIR values were 0.97 ± 0.16, 0.69 ± 0.31 and 0.28 ± 0.35 (P < 0.001) for GI, G2, and G3, respectively. The cut-off value was 0.82 (P < 0.001). The sensitivity rate was 83.3% (AUC: 58%–96%), specificity was 87% (AUC: 58–98).ConclusionCSI may be a valuable diagnostic tool for differentiating diffuse RBMR and hematological malignancies.

Highlights

Normal bone marrow contains water, fat, and cellular elements
When the active bone marrow is not able to meet the increased hematopoiesis required by the body, yellow bone marrow (YBM) converts to red bone marrow (RBM), and this process is called reconversion [3,4,5,6,7]
The main purpose of our study was to determine the efficacy of chemical shift imaging (CSI) in the differential diagnosis of red bone marrow reconversion (RBMR) and diffuse bone marrow involvement in hematological malignancies

Summary

Introduction

Normal bone marrow contains water, fat, and cellular elements. The red bone marrow (RBM) contains 40% of water (free and bound), 20% of protein, and 40% (25%– 50%) of fat. The yellow bone marrow (YBM) contains 15% of water, 5% of protein, and 80% of fat [1,2,3,4]. When the active bone marrow is not able to meet the increased hematopoiesis required by the body, YBM converts to RBM, and this process is called reconversion [3,4,5,6,7]. The causes of reconversion can be classified under medical and nonmedical conditions. Nonmedical conditions include heavy smoking and practicing sports requiring high oxygen such as marathon running or freediving [2,5,6,7]

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Conclusion