Prospective evaluation of bone marrow signal changes on magnetic resonance tomography during high-dose chemotherapy and peripheral blood stem cell transplantation in patients with breast cancer.
OBJECTIVE
The authors evaluate bone marrow signal changes on magnetic resonance (MR) imaging during high-dose chemotherapy and peripheral blood stem cell transplantation (PBSCT).


METHODS
Fourteen patients with breast cancer without bone metastases underwent four sagittal MR imaging studies with T1-weighted, T2-weighted turbo spin-echo and inversion recovery sequences with short inversion time (STIR) of the lumbar spine: (1) during initial staging, (2) prior to high-dose chemotherapy after two cycles of induction chemotherapy, (3) early after PBSCT with a leukocyte exceeding 2000/microL, and (4) 6 to 8 weeks after PBSCT. Signal intensity ratios of averaged lumbar bone marrow to nucleus pulposus were measured and homogeneity was evaluated visually using a semiquantitative score.


RESULTS
Compared with the initial finding (1): Signal intensity ratios were altered significantly at (2): T1-weighted: -22% +/- 14, P < 0.001; T2-weighted: -11% +/- 11, P < 0.01; STIR: +33% +/- 31, P < 0.01; Signal intensity ratios were altered significantly at (3): T2-weighted: -23% +/- 12, P < 0.001, STIR: -22% +/- 23, P < 0.01; and Signal intensity ratios were altered significantly at (4): only STIR: -16% +/- 19, P < 0.01. Homogeneity scores decreased at (3) for T1-weighted and STIR sequences (-1.6 +/- 0.5 to -2.0 +/- 0.7, P < 0.01 and -1.0 +/- 0.5 to -1.4 +/- 0.5, P < 0.01, respectively) and at (4) for the latter sequence (-1.0 +/- 0.5 versus -1.4 +/- 0.5, P < 0.01). At (4), T1-weighted images were less homogenous than initially in 3 of 14 (21%) patients.


CONCLUSIONS
Magnetic resonance imaging demonstrates significant alterations of bone marrow composition during PBSCT but allows differentiation of benign therapy-related changes from those known in metastatic disease after completion of PBSCT.
Altehoefer
C
C
Department of Diagnostic Radiology, University Hospital Freiburg, Germany. alca@mrs1.ukl.uni-freiburg.de
Laubenberger
J
J
Lange
W
W
Kraus
A
A
Allmann
K H
KH
Uhrmeister
P
P
Langer
M
M
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001853:Bone Marrow / Q000473:pathology*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008279:Magnetic Resonance Imaging; D011446:Prospective Studies
D000970:Antineoplastic Agents