Marrow Magnetic Resonance Imaging Research Articles

Quantitative bone marrow magnetic resonance imaging in children with lymphoblastic leukaemia

The aim of the study was to evaluate fat fraction (FF) changes in patients diagnosed with acute lymphoblastic leukaemia (ALL) in comparison with children without haematological disorders. All the patients or their legal representatives gave their informed consent to magnetic resonance imaging (MRI). The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology and was conducted in line with the Ethical Principles of the World Health Organization (the Declaration of Helsinki) for Medical Research Involving Human Subjects. The study included 33 healthy volunteers aged 13.4 ± 2.8 years (the control group) and 34 patients with acute phase ALL whose mean age was 12.2 ± 3.6 years (the group of interest). Imaging of the pelvic bones and lumbar vertebrae was performed on a Philips Achieva 3T scanner using the mDixon-quant sequence, with a subsequent construction of FF maps. The Mann–Whitney U-test was used to compare the FF data of the cases with each other and with the controls. Four regions of interest were selected, 100 mm2 each: in the bodies of the right and the left iliac bones as well as in the bodies of the L4 and L5 vertebras. For each group of subjects and each region of interest, mean FF was calculated. In the group of the patients with acute phase ALL, FF was the lowest: 3.53 ± 2.75% and 3,72 ± 3.09% in the bodies of the left and right iliac bones respectively, and 2.62 ± 1.86% and 2.47 ± 2.17% in the L4 and L5 vertebras respectively. In the control group, FF in the respective regions of interest was 51.3 ± 9.5%; 49.9 ± 11.0%; 31.3 ± 8.73% and 32.4 ± 10.3%. It is obvious that bone marrow FF in the patients with ALL differs significantly from the control group. Quantitative MRI can become a new method for the assessment of changes in the bone marrow of children with leukaemias.

Advantages of digital technology in the assessment of bone marrow involvement in Gaucher's disease.

Gaucher disease (GD) is a genetic lysosomal disorder characterized by high bone marrow (BM) involvement and skeletal complications. The pathophysiology of these complications is not fully elucidated. Magnetic resonance imaging (MRI) is the gold standard to evaluate BM. This study aimed to apply machine-learning techniques in a cohort of Spanish GD patients by a structured bone marrow MRI reporting model at diagnosis and follow-up to predict the evolution of the bone disease. In total, 441 digitalized MRI studies from 131 patients (M: 69, F:62) were reevaluated by a blinded expert radiologist who applied a structured report template. The studies were classified into categories carried out at different stages as follows: A: baseline; B: between 1 and 4 y of follow-up; C: between 5 and 9 y; and D: after 10 years of follow-up. Demographics, genetics, biomarkers, clinical data, and cumulative years of therapy were included in the model. At the baseline study, the mean age was 37.3 years (1-80), and the median Spanish MRI score (S-MRI) was 8.40 (male patients: 9.10 vs. female patients: 7.71) (p < 0.001). BM clearance was faster and deeper in women during follow-up. Genotypes that do not include the c.1226A>G variant have a higher degree of infiltration and complications (p = 0.017). A random forest machine-learning model identified that BM infiltration degree, age at the start of therapy, and femur infiltration were the most important factors to predict the risk and severity of the bone disease. In conclusion, a structured bone marrow MRI reporting in GD is useful to standardize the collected data and facilitate clinical management and academic collaboration. Artificial intelligence methods applied to these studies can help to predict bone disease complications.

Bone marrow magnetic resonance imaging (MRI): morphological and functional features from reconversion to infiltration

Bone marrow magnetic resonance imaging (MRI): morphological and functional features from reconversion to infiltration

Femoral marrow MRI is a non-invasive, non-irradiated and useful tool for detecting bone marrow involvement in non-Hodgkin lymphoma.

Femoral marrow magnetic resonance imaging (MRI) is a non-invasive, non-irradiated and useful modality for evaluating bone marrow (BM) conditions. Human adult femoral BM is almost uniformly fatty marrow and has the largest volume of a single bone. MRI has an extremely high resolution for fat and water, which allows high-contrast imaging of cellular infiltration into fat tissue. In hematological diseases, femoral BM MRI can clearly detect cell infiltration, which is symmetrically imaged from the proximal to the distal direction of abnormal signal areas. Thus, we investigated the significance of femoral MRI for non-Hodgkin lymphoma (NHL). We analyzed the data of 69 NHL patients who received femoral MRI at diagnosis in this single-center retrospective cohort study. The median patient age was 73 years. MRI patterns were mainly classified as uniform patterns or nonuniform patterns. We also classified the range of cellular marrow as high-grade or low-grade based on whether it had spread to over half of the femur. Both overall survival (OS) and progression-free survival (PFS) were significantly influenced by abnormal femoral marrow MRI. In particular, the patients with cellular femoral marrow lesions had a worse OS and PFS based on log-rank tests. Multivariable analyses with the Cox proportional hazards model revealed that OS and PFS were significantly influenced by cellular marrow diagnosed by femoral MRI. We concluded that femoral marrow MRI is a useful tool for detecting BM involvement and an independent prognostic factor in NHL patients.

Quantitative bone marrow magnetic resonance imaging through apparent diffusion coefficient and fat fraction in multiple myeloma patients.

Quantitative bone marrow (BM) MR sequences, as DWI and CSI, were used to evaluate BM water-fat composition. The aim of the study was to assess the potential usefulness of fat fraction (FF) and ADC, calculated by CSI or DWI, in diagnosing and classifying myeloma (MM) patients according to their different BM infiltration patterns. The study group included 43 MM patients (19F; 24M; mean age 64years), 15 asymptomatic, 15 symptomatic with diffuse BM infiltration and 13 symptomatic with focal lesions (FLs). The control group was made up of 15 healthy subjects (7F; 8M; mean age 64years). MRI examinations consisted of sagittal T1w TSE on the spinal column, axial DWI (b 50-400-800mm2/s) and coronal T2 Dixon, on the whole body. Mean ADC and FF were calculated placing 1 ROI on 6 vertebras and 2 ROIs on either the pelvis or FL. ANOVA with Bonferroni's correction showed a significant difference in ADC values among the different groups of MM patients (P < 0.05), while FF was only significantly different between patients with diffuse infiltration and patients with FL (P = 0.002). ADC allowed distinguishing MM patients from normal BM patients with diffuse BM infiltration (cutoff value: 0.491 × 10-3mm2/s; sensitivity 73%, specificity 80%). FF helped better discriminate healthy controls from normal BM patients (cutoff = 0.33, sensitivity 73%, specificity 92%) and patients with diffuse BM infiltration from those with FL (cutoff = 0.16, sensitivity 82%, specificity 92%). ADC and FF are potentially useful parameter for the quantitative evaluation of BM infiltration in MM patients.

Bone marrow magnetic resonance imaging: physiologic and pathologic findings that radiologist should know.

Magnetic resonance imaging (MRI) plays a leading role in the non-invasive evaluation of bone marrow (BM). Normal BM pattern depends on the ratio and distribution of yellow and red marrow, which are subject to changes with age, pathologies, and treatments. Neonates show almost entirely red marrow. Over time, yellow marrow conversion takes place with a characteristic sequence leading to a red marrow persistence in proximal metaphyses of long bones. In adults, normal BM is composed of both red (40% water, 40% fat) and yellow marrow (15% water, 80% fat). Due to the higher content of fat, yellow marrow normally appears hyperintense on T1-weighted (T1w) fast spin echo (FSE) sequences and hypo-/iso-intense in short tau inversion recovery (STIR) T2-weighted (T2w); red marrow appears slightly hyperintense in T1w FSE and hyper-/iso-intense in STIR T2w. Pathologic BM has reduced fat and increased water percentages, resulting hypointense in T1w FSE and hyperintense in STIR T2w. In oncologic patients, BM MRI signal largely depends on the treatment (irradiation and/or chemotherapy) and its timing. BM fat and water amount and location in normal red/yellow and pathologic marrow are responsible for different signals in MRI sequences whose knowledge by radiologists may help to differentiate between normal and pathologic findings. Our aim was to discuss and illustrate the MRI of BM physiologic conversion and pathologic reconversion occurring in malignancies and after treatments in cancer patients.

Bone marrow MRI after autologous transplantation and the effect of residual tumor on progression-free survival of multiple myeloma patients

Background . The study of influence of residual tumor mass, determined by magnetic resonance imaging (MRI), on the progression-free survival (PFS) remains an actual problem. Since the visual assessment of tumor bone marrow lesion can be one of the criteria for the subsequent personalized treatment choice in multiple myeloma patients.The objective of study was to determine the effect of bone marrow lesions detected by MRI after autologous hematopoietic stem cells transplantation (auto-HSCT) on PFS in multiple myeloma patients.Materials and methods . The prospective study included 60 patients who underwent spine and pelvic bones MRI on the 100 th day after autoHSCT.Results . Focal bone marrow changes were found in 47 of them – from 1 to 56 lesions (mean 6 ± 9). Significant (p = 0.01) differences of PFS in multiple myeloma patients depending on the presence or absence of tumor mass on 100 th day after auto-HSCT were revealed: with MRI negative status, 2-year PFS was 89 % versus 50 % in a group of patients with residual tumor mass.Conclusion . MRI-negative status after auto-HSCT is a favorable prognostic factor contributing to prolonged disease-free survival.

Change in liver, spleen and bone marrow magnetic resonance imaging signal intensity over time in children with solid abdominal tumors.

Reticuloendothelial system MRI signal hypointensity is common in pediatric oncology patients with solid abdominal tumors. To assess changes in liver, spleen and bone marrow T2-weighted MRI signal intensity over time and their relationship to blood transfusion history in children with solid abdominal tumors. In this retrospective study we measured liver, spleen and bone marrow signal intensity on axial T2-weighted MR images obtained December 2009 through February 2016 in children with hepatoblastoma, neuroblastoma, ganglioneuroblastoma and Wilms tumor. All signal intensity measurements were normalized to paraspinal muscle signal intensity. We used linear mixed models (including a day*day quadratic term) to determine whether organ signal intensity changed over time and whether change was associated with blood transfusion volume or tumor type. We included 133 children (mean age at diagnosis =2.9years); 56 had neuroblastoma, 42 hepatoblastoma, 28 Wilms tumor and 7 ganglioneuroblastoma. Seventy-nine (59.4%) children received transfusions (median: 8 transfusions, range: 1-30; mean volume: 1,148.5mL). Hepatic, splenic and bone marrow signal intensity ratios changed quadratically over time for the study population, initially decreasing and then increasing (P<0.0001). Children receiving less than the mean blood transfusion volume showed no significant change in tissue signal intensity, while those receiving more than the mean volume showed significant changes in signal intensity over time (P<0.0001). Compared to children with Wilms tumor, those with neuroblastoma exhibited significantly lower hepatic (P=0.03) signal intensity ratios. Liver, spleen and bone marrow T2-weighted MRI signal intensity ratios change over time in some pediatric patients with solid abdominal tumors, likely from tissue iron deposition related to blood transfusions and perhaps because of tumor type.

Quantitative MRI and spectroscopy of bone marrow.

Bone marrow is one of the largest organs in the human body, enclosing adipocytes, hematopoietic stem cells, which are responsible for blood cell production, and mesenchymal stem cells, which are responsible for the production of adipocytes and bone cells. Magnetic resonance imaging (MRI) is the ideal imaging modality to monitor bone marrow changes in healthy and pathological states, thanks to its inherent rich soft‐tissue contrast. Quantitative bone marrow MRI and magnetic resonance spectroscopy (MRS) techniques have been also developed in order to quantify changes in bone marrow water–fat composition, cellularity and perfusion in different pathologies, and to assist in understanding the role of bone marrow in the pathophysiology of systemic diseases (e.g. osteoporosis). The present review summarizes a large selection of studies published until March 2017 in proton‐based quantitative MRI and MRS of bone marrow. Some basic knowledge about bone marrow anatomy and physiology is first reviewed. The most important technical aspects of quantitative MR methods measuring bone marrow water–fat composition, fatty acid composition, perfusion, and diffusion are then described. Finally, previous MR studies are reviewed on the application of quantitative MR techniques in both healthy aging and diseased bone marrow affected by osteoporosis, fractures, metabolic diseases, multiple myeloma, and bone metastases. Level of Evidence: 3 Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2018;47:332–353.

Imaging of gout: New tools and biomarkers?

While joint aspiration and crystal identification by polarizing microscopy remain the gold standard for diagnosing tophaceous gout, agreement among medical and ancillary health personnel examining synovial fluid using polarizing microscopy for the detection of monosodium urate (MSU) crystals appears to be poor. Imaging modalities, including conventional radiography (CR), ultrasonography (US), magnetic resonance imaging (MRI), and dual-energy computed tomography (DECT), have been found to provide information on the deposition of MSU crystals in tissues, and the consequences of such deposition. CR can demonstrate typical "punched out lesions" with marginal overhangs, but the sensitivity for erosion detection is better for DECT and US. US is inexpensive and can identify tophus deposition in and around joints, erosions, and tissue inflammation if power Doppler US is used. MRI can show tophi, bone marrow edema, and inflammation, but MRI findings of tophi may be nonspecific. DECT can identify and color-code tophaceous material, and provide an overview of the tophus burden of a joint area. Because of the lower number of available studies, the strength of evidence for the newer imaging can be improved through further research.

Bone marrow magnetic resonance imaging of the clivus in pediatric leukemia patients and normal controls.

An MRI-based pre-test to determine the probability of pediatric leukemia prior to bone marrow aspiration would be useful to prevent unnecessary exposure to this invasive test. We aimed to evaluate the clivus-to-pons signal intensity ratio (CPR) and visual scoring (VS) on T1-weighted images (T1WI) and diffusion-weighted images (DWI) to distinguish pediatric leukemia patients from normal controls. We retrospectively reviewed 1.5-T brain MR images of 13 consecutive leukemia patients (3 girls, 10 boys; mean age, 8.23 years; range, 1-17 years) and 40 age- and gender-matched normal controls. We evaluated differences between leukemia patients and normal controls using Wilcoxon rank-sum and Mann-Whitney U tests with respect to the following parameters: (1) CPR on T1WI (CPRT1WI); (2) CPR on DWI (CPRDWI); (3) VS on T1WI (VST1WI); and (4) VS on DWI (VSDWI). The CPRT1WI values for leukemia patients and normal controls were 0.77 ± 0.12 and 1.39 ± 0.47, respectively (P < 0.001). The corresponding CPRDWI values were 1.03 ± 0.38 and 0.50 ± 0.17, respectively (P < 0.001). VST1WI and VSDWI were significantly different between the groups (P < 0.001 for both). MRI-based quantitative and qualitative analyses of clival bone marrow on T1WI and DWI can distinguish pediatric leukemia patients from normal subjects.

Magnetic resonance imaging of the spinal marrow: Basic understanding of the normal marrow pattern and its variant

For now, magnetic resonance (MR) is the best noninvasive imaging modality to evaluate vertebral bone marrow thanks to its inherent soft-tissue contrast and non-ionizing nature. A daily challenging scenario for every radiologist interpreting MR of the vertebral column is discerning the diseased from normal marrow. This requires the radiologist to be acquainted with the used MR techniques to judge the spinal marrow as well as its normal MR variants. Conventional sequences used basically to image marrow include T1W, fat-suppressed T2W and short tau inversion recovery (STIR) imaging provides gross morphological data. Interestingly, using non-routine MR sequences; such as opposed phase, diffusion weighted, MR spectroscopy and contrasted-enhanced imaging; may elucidate the nature of bone marrow heterogeneities; by inferring cellular and chemical composition; and adding new functional prospects. Recalling the normal composition of bone marrow elements and the physiologic processes of spinal marrow conversion and reconversion eases basic understanding of spinal marrow imaging. Additionally, orientation with some common variants seen during spinal marrow MR imaging as hemangiomas and bone islands is a must. Moreover, awareness of the age-associated bone marrow changes as well as changes accompanying different variations of the subject's health state is essential for radiologists to avoid overrating normal MR marrow patterns as pathologic states and metigate unnecessary further work-up.

False positivity of magnetic resonance imaging under the effect of granulocyte-colony stimulating factor in a child with leukemia

Granulocyte-colony stimulating factor (G-CSF) increases the proliferation and maturation of committed polymorphonuclear leukocyte precursors, as well as the function of mature polymorphonuclear leukocytes. It has previously been shown in pediatric patients that G-CSF induces reconversion of fatty bone marrow to hematopoietic bone marrow in the pelvis and lower extremities that is detectable by magnetic resonance imaging (MRI). Here, we report a 13-year-old Burkitt leukemia patient with bone pain while he was in remission. He was on G-CSF after cessation of high-dose and low-dose cytarabine chemotherapy. He was suspected to have a leukemia relapse. Pelvic MRI was consistent with leukemic infiltration. However, the pathology of bone marrow biopsy resulted in normal findings. Thus it was suggested that concurrent administration of G-CSF could be the causative agent for both bone pain and false-positive MRI findings. The control MRI after interruption of G-CSF revealed normal findings. In conclusion, radiologists should be informed about the type of therapy, including G-CSF administration, in order to overcome misinterpretation of bone marrow MRI.

Diffuse MRI Marrow Pattern Correlates with Increased Angiogenesis, Advanced Disease Features and Poor Prognosis in Newly-Diagnosed Patients with Multiple Myeloma Treated with Novel Agents.

Abstract 829The aim of this study was to evaluate the prognostic value of bone marrow magnetic resonance imaging (MRI) in newly-diagnosed myeloma (MM) patients who received novel agent-based therapy and to explore possible correlations of MRI pattern with clinical and laboratory data. Eighty-two consecutive MM patients (43M/39F, median age: 65 years) at diagnosis were studied. MRI of the spine was performed within 1-2 weeks following diagnosis. T1-weighted, STIR and contrast-enhanced T1-weighted sagittal MR images of the thoracic and lumbar spine were obtained with a 1.5 T unit (Phillips, Eindhoven, the Netherlands). Marrow involvement was characterized as normal, focal, diffuse or variegated. Microvessel density (MVD) was evaluated in marrow trephine biopsies at the time of diagnosis. The following serum indices of bone metabolism and angiogenesis were measured on the day of MRI: i) osteoclast stimulators [sRANKL, osteoprotegerin (OPG), osteopontin (OPN) and macrophage inflammatory protein-1alpha (MIP-1alpha)], ii) dickkopf-1 (Dkk-1), iii) bone resorption markers [C- and N-terminal cross-linking telopeptide of collagen type-I (CTX and NTX, respectively) and TRACP-5b], iv) bone formation markers [bone alkaline phosphatase (bALP) and osteocalcin (OC)], and v) angiogenic cytokines [VEGF, VEGF-A, angiogenin (ANG), angiopoietin-1 (ANGP-1), angiopoietin-2 (ANGP-2) and bFGF]. MRI evaluation of the spine revealed that 34 (41.5%) patients had focal, 26 (31.7%) diffuse, 18 (22%) normal, and 4 (4.9%) had a variegated pattern of marrow involvement. Low-grade angiogenesis, as assessed by MVD, was present in 32 (39%) patients, while 33 (40%) had intermediate-grade and 17 (20%) patients had high-grade angiogenesis. Twenty-one of 26 (80%) patients with a diffuse MR pattern had intermediate or high-grade angiogenesis in contrast to 14/34 (41%) patients with focal involvement (p=0.01) and 12/18 (66%) with normal MR pattern (p=0.037). Patients had increased values of VEGF (p<0.001), VEGF-A (p<0.001), ANGP-2 (p<0.001) and bFGF (p=0.001), and reduced values of ANGP1/ANGP2 ratio (p<0.01) compared to healthy controls (n=36). Patients with a diffuse pattern were the only patients who had increased ANG compared to controls (p=0.004). Patients with diffuse pattern had higher levels of serum VEGF and VEGF-A compared to patients with normal (p=0.028 and p=0.006, respectively) and focal pattern (p=0.009 and p<0.01, respectively) and borderline elevated ANG compared to normal pattern (p=0.06). Myeloma patients had increased values of sRANKL (p<0.001), sRANKL/OPG ratio (p=0.004), NTX (p<0.001), CTX (p<0.001), TRACP-5b (p<0.001), Dkk-1 (p=0.01), and OPN (p<0.001) and borderline reduced values of bALP (p=0.09) compared to controls. Patients with normal MRI pattern showed no difference in terms of Dkk-1 and bone formation markers compared to controls. Patients with diffuse pattern of marrow involvement had reduced values of bone formation markers (p=0.01), while patients with focal pattern had only a borderline reduction of OC (p=0.09). Both diffuse and focal MRI patterns had increased Dkk-1 levels. All abnormal MRI patterns had increased levels of NTX, CTX and TRACP-5b and increased levels of osteoclast stimulators sRANKL/OPG, MIP-1alpha and OPN. Diffuse and variegated patterns of infiltration correlated with greater bone marrow plasma cell infiltration (p=0.043) and advanced ISS stage (p=0.018). All patients received a combination regimen that contained at least one novel anti-myeloma agent (IMiD and/or bortezomib) at some point during the course of their disease. The median follow-up of the patients was 25 months. Patients with diffuse or variegated pattern had a median survival of 29 months, patients with focal pattern had a median survival of 62 months, while the median survival of patients with normal MRI pattern has not been reached at the time of the analysis (p=0.009). Multivariate analysis showed that only MRI pattern and ISS stage were independent prognostic factors for survival. In conclusion, our analysis provides strong evidence that diffuse MRI pattern of marrow involvement correlates with increased angiogenesis, adverse disease features and inferior survival in MM patients who were treated with novel agents. Such patients may be considered for upfront treatment with combinations of novel agents. Our results highlight the important prognostic value of MRI in MM and support its routine use in MM patients. Disclosures:No relevant conflicts of interest to declare.

New Perspectives on Bone Marrow Contrast Agents and Molecular Imaging

Magnetic resonance (MR) imaging of bone marrow provides a noninvasive diagnosis of the vascularity, cell quantity, and composition of the normal and pathological bone marrow. This article reviews new and evolving techniques for bone marrow MR imaging with a special focus on translational and clinical applications. Evaluations of bone marrow perfusion with standard small molecular contrast agents and, more recently, with macromolecular contrast agents are currently being applied for therapy monitoring. Cell-specific contrast agents are expected to improve the sensitivity and specificity of bone marrow MR imaging. Novel cellular and molecular imaging techniques for the depiction of cell metabolism and specific biochemical pathways are discussed. Cell tracking techniques may allow specific diagnoses of inflammatory processes as well as monitoring of novel therapies based on stem cells. Future developments of fusion imaging techniques and bifunctional contrast agents are directed to combine comprehensive information about bone marrow structure and function with targeted and image-guided therapies.

Improved Sensitivity of Bone Marrow Magnetic Resonance Imaging (BM-MRI) in Quantifying the Extent of Bone Marrow Involvement in Patients with Multiple Myeloma (MM).

Background: Traditionally, bone marrow aspirate/biopsy (BM-Bx) has been used for diagnosis and quantification of the extent of disease as well as response to therapy in MM patients. This information is used to make decision for treatment initiation. Since MM is not a contiguous disease, marrow involvement can be patchy and BM-Bx may be misleading in assessing the true extent of the disease. BM-MRI is a non-invasive technique that can evaluate a large amount of marrow for tumor infiltration. We prospectively investigated the sensitivity of BM-MRI and compared its results with those obtained by BM-Bx as well as with the clinical stage of disease.Methods: All patients with the diagnosis of MM who had BM-MRI at our center were evaluable. Patients must have received a BM-Bx within 4 weeks of the BM-MRI. In these patients sagittal T1 and fast spin echo inversion recovery sequences of the cervical, thoracic and lumbosacral spine and coronal T1 and fast spin echo inversion recovery sequences of the sacrum and pelvic bones were reviewed on the MRI. Durie-Salmon (DS) staging criteria were used for correlation. To study the statistical relationship between pairs of ordinal variables the test corresponding to the Spearman correlation was used. To study the statistical relationship between nominal and ordinal variables, the Wilcoxon or Kruskal-Wallis test was used. A 0.05 nominal significance level was used in all testing. Following staging system was defined for evaluation of the involvement of the marrow by BM-MRI: A (0%), B (< 10%), C (10%–25%), D (26%–50%), E (> 50%). Results of this were then compared with the extent of involvement reported on histological evaluation of the BM-Bx.Results: A total of 50 patients (23 females and 27 males) were identified. Median age was 61.5 years (range 35–82 years) with 23 (46%) having stage IIIA disease. As per the staging system defined above, 6%, 10%, 10%, 22% and 52% of the patients had categories A, B, C, D and E involvement as per BM-MRI, respectively. Similarly, involvement observed on the BM-Bx was 8%, 24%, 22%, 16% and 30%, respectively. Categories of marrow involvement on BM-Bx and BM-MRI were concordant in 23 (46%) and discordant in 27 (54%) patients. Of the patients that showed discordance, 89% had a more extensive BM involvement detected by the BM-MRI and 11% had a higher reading on BM-Bx. The estimated Spearman correlation coefficient between MRI involvement and MM stage was 0.4849 (95% CI; 0.2494, 0.7205), showing a significant association between BM-MRI involvement and MM stage (p =0.0002). The estimated Spearman correlation coefficient between BM-Bx involvement and MM stage was 0.1775 (95% CI; −0.1406, 0.4956), showing no significant association between BM-Bx involvement and MM stage (p = 0.2764).Conclusions: We demonstrate for the first time that BM-MRI is a more sensitive technique to assess the true disease burden in MM and is significantly better than BM-Bx. We also observe that the extent of marrow infiltration noted on the BM-MRI correlates significantly with other prognostic characteristics like DS stage. Based on this observation we recommend that BM-MRI should be considered as part of the pre-treatment evaluation of patients with multiple myeloma.

Bone marrow edema syndromes of the hip: MRI features in different hip disorders

The objectives of this study were to describe the essential magnetic resonance imaging (MRI) features of bone marrow edema syndromes affecting the hip joint. In addition, to evaluate the role of MRI in the assessment of hip joint involvement in different clinical settings that may share similar clinical findings. Thirty-four patients who complained of hip pain were studied consecutively. Of these, 21 were men (61.8%) and 13 were women (38.2%). After clinical assessment of possible hip disease, plain radiograph and MRI study of both hips were performed. The literature was searched using keywords: bone marrow edema, hip, and MRI. All patients had antalgic gait and limping. Initial clinical examination revealed painful limited internal and external rotation of the affected hip/hips suspect for hip disease. Unilateral hip involvement was identified in 31 patients (91.2%), and bilateral hip involvement was found in three patients (8.8%), with a total of 37 hips evaluated by MRI. The final diagnoses in our patients were: reactive arthritis (1), transient osteoporosis (7), avascular necrosis (10), osteoarthritis (2), tuberculous arthritis (4), septic arthritis (2), osteomyelitis (2), sickle cell anemia (2), lymphocytic leukemia (1), and femoral stress fracture (3). Bone marrow edema affecting the hip is neither a specific MR imaging finding nor a specific diagnosis and may be encountered in a variety of hip disorders due to different etiologies. MR imaging is the modality of choice when clinical examination is suspect for hip disease and plain radiographs are normal or equivocal. Early diagnosis and treatment is important in many of the disorders. The literature is reviewed regarding bone marrow edema of the hip.

Regression of Myelofibrosis and Osteosclerosis following Hematopoietic Cell Transplantation Assessed by Magnetic Resonance Imaging and Histologic Grading

Myelofibrosis is a reactive, often inhomogeneous process in the marrow cavity, and sampling errors on biopsies obtained to diagnose and monitor the course of myelofibrosis have been a constant problem in hematopathology. We investigated the potential utility of magnetic resonance imaging (MRI) of the lumbar spine, pelvis, and femora as a diagnostic and monitoring technique for assessment of myelofibrosis. Findings on serial marrow biopsies were correlated with T1-weighted spin-echo and short inversion time inversion recovery (STIR) images in patients with chronic idiopathic myelofibrosis or myelofibrosis developing from polycythemia vera or essential thrombocythemia who underwent hematopoietic cell transplantation (HCT). Thirty-five patients were studied before HCT; 11 were followed for 3 months and 10 patients for ≥1 year after HCT with sequential marrow biopsies and MRI studies. MRI allowed direct visualization of the biopsy sites and correlation of histologic and MRI findings. MRI also provided assessment of the extent and degree of myelofibrosis in a large volume of the skeletal marrow. There was good correlation between biopsy results and MRI findings at specific biopsy sites and between successful HCT and resolution of fibrosis and osteosclerosis as determined by MRI. We conclude that in patients with myelofibrosis, MRI of the skeleton provides a comprehensive assessment of the pattern and extent of fibrosis and allows for correlation with biopsy findings. In patients undergoing HCT, MRI accurately reflects response or progression of marrow disease.

Aplasia medular tratada exitosamente con ciclosporina en un paciente en hemodiálisis crónica

A 28 years old male on chronic hemodialysis for 40 months due to a IgA crescentic glomerulonephritis developed pancytopenia (hematocrit 16%, white blood cell count 3,800 mm3 and platelets 11,000 mm3. The bone marrow aspirate showed erythropoietic hyperplasia. Hemolytic anemia, folate or vitamin B12 deficiency and paroxysmal nocturnal hemoglobinuria were ruled out. Steroids were given with a transient elevation of red cells and platelets, which lasted only for some weeks. Afterwards, intravenous immunoglobulin was given without benefit. Two months after, a bone marrow biopsy and a bone marrow magnetic resonance imaging showed severe aplasia. Cyclosporine was started with a rapid increase in blood cells count. Eight months later, he received a renal transplant from a cadaveric donor. Immunosupression was achieved with cyclosporine, prednisone and mycofenolate mofetil. The patient required hemodialysis for the first three weeks and a mild acute cellular rejection was treated with methylprednisolone. At discharge, 6 weeks later, serum creatinine was 2.4 mg/dl and creatinine clearance 37.6 ml/min. During the first months after transplant, platelet count and hemoglobin decreased and a bone marrow biopsy showed only mild hypoplasia. Four months after renal transplant the hematocrit was 43%, white blood cell count 6,600 mm3 and platelets, 150,000 mm3 and did not change during the first year of follow up.

608 Bone marrow magnetic resonance imaging allows objective assessment of prostate cancer (PCA) bone metastases

608 Bone marrow magnetic resonance imaging allows objective assessment of prostate cancer (PCA) bone metastases