Comparative diagnostic accuracy of magnetic resonance imaging and immunoscintigraphy for detection of bone marrow involvement in patients with malignant lymphoma.
OBJECTIVE
To compare the diagnostic accuracy of magnetic resonance imaging (MRI) and immunoscintigraphy (IS) for detection of bone marrow infiltration in malignant lymphoma.


METHODS
In 32 patients with Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL), MRI of the axial skeleton and whole-body IS using technetium-99m (99mTc)-labeled monoclonal antibodies were reviewed and compared with iliac crest biopsies. Criterion for marrow infiltration was a positive biopsy or concordant positive results of MRI and IS.


RESULTS
In 16 patients (50%), MRI, IS, and iliac crest biopsies were negative for marrow infiltration. Iliac crest biopsy showed infiltration in only four patients (13%). Infiltration was missed in two of 32 patients with IS and in one patient with MRI. In one additional patient, MRI was false-positive because of pelvic hematopoietic hyperplasia. A subset of nine patients (28%) with negative biopsies had bone marrow involvement according to MRI and IS with identical location and pattern of infiltration. In eight of these nine patients, diagnostic imaging indicated marrow involvement only in noncrest marrow. Subsequent biopsy confirmed infiltration in five patients. The clinical course suggested true-positive imaging results in the remaining four patients. Two patients (6%) remained equivocal. Overall concordance of MRI and IS for marrow infiltration was 88% (28 of 32 patients).


CONCLUSIONS
Diagnostic imaging is essential for optimal staging in malignant lymphoma, as blind biopsies appear to have low sensitivity for bone marrow infiltration because of frequent involvement in noncrest marrow. both imaging modalities show a high rate of detection of bone marrow infiltration.
Altehoefer
C
C
Department of Diagnostic Radiology, University Hospital Freiburg, Germany. alca@mrsl.ukl.uni-freiburg.de
Blum
U
U
Bathmann
J
J
Wüstenberg
C
C
Uhrmeister
P
P
Laubenberger
J
J
Lange
W
W
Schwarzkopf
J
J
Moser
E
E
Langer
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D001853:Bone Marrow / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging / Q000473:pathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000000981:diagnostic imaging* / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016719:Radioimmunodetection; D012447:Sacrum / Q000000981:diagnostic imaging / Q000473:pathology; D012680:Sensitivity and Specificity