Bone marrow with diffuse tumor infiltration in patients with lymphoproliferative diseases: dynamic gadolinium-enhanced MR imaging.
OBJECTIVE
To evaluate gadolinium enhancement of bone marrow in patients with lymphoproliferative diseases and diffuse bone marrow involvement.


METHODS
Dynamic contrast material-enhanced magnetic resonance (MR) imaging of the thoracolumbar spine was performed in 42 patients with histologically proved diffuse bone marrow involvement and newly diagnosed myeloma (n = 31), non-Hodgkin lymphoma (n = 8), or Hodgkin disease (n = 3). The maximum percentage of enhancement (Emax), enhancement slope, and enhancement washout were determined from enhancement time curves (ETCs). A three-grade system for scoring bone marrow involvement was based on the percentage of neoplastic cells in bone marrow samples. Quantitative ETC values for the 42 patients were compared with ETC values for healthy subjects and with grades of bone marrow involvement by using mean t test comparisons. Receiver operating characteristic (ROC) analysis was conducted by comparing Emax values between patients with and those without bone marrow involvement. Baseline and follow-up MR imaging findings were compared in nine patients.


RESULTS
Significant differences in Emax (P <.001), slope (P <.001), and washout (P =.005) were found between subjects with normal bone marrow and patients with diffuse bone marrow involvement. ROC analysis results showed Emax values to have a diagnostic accuracy of 99%. Emax, slope, and washout values increased with increasing bone marrow involvement grade. The mean Emax increased from 339% to 737%. Contrast enhancement decreased after treatment in all six patients who responded to treatment but not in two of three patients who did not respond to treatment.


CONCLUSIONS
Dynamic contrast-enhanced MR images can demonstrate increased bone marrow enhancement in patients with lymphoproliferative diseases and marrow involvement.
Department of Radiology, Centre Hospitalo-Universitaire Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France. alain.rahmouni@hmn.ap-hop-paris.fr
Alain
A
Rahmouni
Jean-Luc
JL
Montazel
Marine
M
Divine
Eric
E
Lepage
Karim
K
Belhadj
Philippe
P
Gaulard
Mohamed
M
Bouanane
Mondher
M
Golli
Hicham
H
Kobeiter
D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000473:pathology*; D005500:Follow-Up Studies; D005682:Gadolinium; D006689:Hodgkin Disease / Q000473:pathology; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013131:Spine
D005682:Gadolinium