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Characteristic MRI Appearances of Diffuse Bone Marrow Replacement in ALL

January 2, 2008
Written by: , Filed in: Nuclear Medicine, Pediatric Radiology
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A recent retrospective study was conducted to describe MRI observations in 8 children with biopsy-proven acute lymphocytic leukemic (ALL) relapse, and to compare these findings with those of other symptomatic leukemic survivors without relapse. The study has shown that well-defined nodular lesions in the marrow as demonstrated on MRI are characteristic of ALL relapse.

Methodology
Over a 7-year period, at 2 separate institutions, 1026 patients with myeloproliferative disease were identified. Of those, 58 were identified to have had musculoskeletal MRI examinations. Of these patients, 14 were newly diagnosed, 10 showed relapse, and 34 were in remission.

Only those with relapse and an MRI performed recently after relapse diagnosis were included. One patient who underwent treatment before MRI examination was excluded. The total number of patients with ALL from both institutions with relapse was 8.

The mean age of these patients was 10.6 years, and 16 were males. MRI was performed an average of 11.4 days before pathological diagnosis of relapse. The MRI examinations varied from examinations of the pelvis, knee, or ankle.

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Results
All 8 children with biopsy-proven leukemic relapse had abnormal marrow changes. Multiple, well-defined nodules were present in 7 children, and a single heterogeneous nodule with a corrugated but still well-defined margin was present in 1 patient. No extramedullary soft-tissue masses were seen. Biopsy proof of relapse was made by directed bone biopsy of marrow signal alterations.

Of those in remission, 17% had normal marrow pattern, 31% had a nodular pattern with poorly defined margins, and the rest had non-specific findings, some of which related to stress fractures or osteonecrosis.

Conclusions
All patients with ALL relapse demonstrated on MRI showed well-defined nodular lesions in the marrow that could be differentiated from marrow alterations in patients in remission.

Reviewer’s Comments
This is a simple and elegant way to differentiate patients in relapse versus patients in remission using MRI examination of bone marrow. The limitations of the study include a small sample size. Practically speaking, the study would be helpful in suggesting a relapse in patients of concern.

Author:
Basil Hubbi, MD

Reference:
Kan JH, Hernanz-Schulman M, et al. MRI Diagnosis of Bone Marrow Relapse in Children With ALL. Pediatr Radiol; 2008; 38 (January): 76-81

CME Courses Available:

 

PET/CT and SPECT/CT To Plan and Monitor the Treatment of Cancer The precise tailoring of treatment for patients with cancer is an unmet challenge. The goal is to only administer treatments that have a high probability of being effective. Imaging with PET/CT and SPECT/CT provides methods that will help achieve this goal. The program covers the current clinical challenges, the new emerging answers from imaging, and how these methods can be applied to patient care. Read more: Nuclear Medicine: PET/CT and SPECT/CT

 

-- Diagnostic Imaging Review: For Residents, Fellows and Radiologists UCSF’s Department of Radiology and Biomedical Imaging recently conducted its annual radiology review course. It will soon be available in two video formats to meet your needs— DVD and MP4. Order now to get your special pre-publication discount. Read more or order: Diagnostic Imaging Review
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