To evaluate the role of in vivo 1H MR spectroscopic determination of relaxation times and of fat and water content to differentiate between infiltration of multiple myeloma or osteoporosis in patients with roentgenologic unclear demineralization of the lumbar spine. Ten patients each with osteoporotic reduction of bone mineral density (BMD), histologically proven multiple myeloma who showed only diffuse tumor manifestations without tumor compression fractures in the spine, and volunteers were investigated. Osteoporosis was confirmed by dual-energy X-ray absorptiometry (DXA) (Hologic QDR 2000 device, Siemens Medical Systems). The MR investigations were performed with a 1.5 T whole body system (Gyroscan S15/ACS II, Philips Medical Systems). Localized MR spectra from a cubic volume of about 8 cm3 were acquired by the PRESS technique. Chemical shift selective T1 relaxation times were obtained from an IR series, T2 was measured by variation of the interval between the first and the second echo in the volume selection scheme. Statistical analysis was done using the Kruskal-Wallis test and the Mann-Whitney test with the software SPSS. There were highly significant differences in T2 values and fat content between patients with osteoporosis and multiple myeloma. T2 values were decreased in osteoporosis (37 ms and 59 ms vs. 44 ms and 70 ms in plasmocytoma) and fat content was decreased in multiple myeloma (20% vs 31% and 34% in volunteers and osteoporosis). Between volunteers and patients with osteoporosis the differences in the T2 of the fat component was significantly different. In our preliminary experience MRS is helpful in the differential diagnosis of bony demineralization. It enables a differentiation between osteoporosis and diffuse multiple myeloma. T2 value measurements may be helpful in the diagnostic trial of osteoporosis.
Read full abstract