title: Dynamic contrast enhanced magnetic resonance imaging of diffuse spinal bone marrow infiltration in patients with hematological malignancies.
abstract: OBJECTIVE
  To investigate the significance of the dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) parameters of diffuse spinal bone marrow infiltration in patients with hematological malignancies.
  
  
  METHODS
  Dynamic gadolinium-enhanced MR imaging of the lumbar spine was performed in 26 patients with histologically proven diffuse bone marrow infiltration, including multiple myeloma (n = 6), acute lymphoblastic leukemia (n = 6), acute myeloid leukemia (n = 5), chronic myeloid leukemia (n = 7), and non-Hodgkin lymphoma (n = 2). Twenty subjects whose spinal MRI was normal, made up the control group. Peak enhancement percentage (E(max)), enhancement slope (ES), and time to peak (TTP) were determined from a time-intensity curve (TIC) of lumbar vertebral bone marrow. A comparison between baseline and follow-up MR images and its histological correlation were evaluated in 10 patients. The infiltration grade of hematopoietic marrow with plasma cells was evaluated by a histological assessment of bone marrow.
  
  
  RESULTS
  Differences in E(max), ES, and TTP values between the control group and the patients with diffuse bone marrow infiltration were significant (t = -11.51, -9.81 and 3.91, respectively, p < 0.01). E(max), ES, and TTP values were significantly different between bone marrow infiltration groups Grade 1 and Grade 2 (Z = -2.72, -2.24 and -2.89 respectively, p < 0.05). E(max), ES and TTP values were not significantly different between bone marrow infiltration groups Grade 2 and Grade 3 (Z = -1.57, -1.82 and -1.58 respectively, p > 0.05). A positive correlation was found between E(max), ES values and the histological grade of bone marrow infiltration (r = 0.86 and 0.84 respectively, p < 0.01). A negative correlation was found between the TTP values and bone marrow infiltration histological grade (r = -0.54, p < 0.01). A decrease in the E(max) and ES values was observed with increased TTP values after treatment in all of the 10 patients who responded to treatment (t = -7.92, -4.55, and 5.12, respectively, p < 0.01).
  
  
  CONCLUSIONS
  DCE-MRI of spine can be a useful tool in detecting diffuse marrow infiltration of hematological malignancies, while its parameters including E(max), ES, and TTP can reflect the malignancies' histological grade.
authors.affiliation: Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China. zhayunfei@hotmail.com
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Zha
authors.forename: Maojin
authors.initials: M
authors.lastname: Li
authors.forename: Jianyong
authors.initials: J
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019046:Bone Marrow Neoplasms / Q000473:pathology; D002648:Child; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D019337:Hematologic Neoplasms / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007938:Leukemia / Q000473:pathology*; D008232:Lymphoproliferative Disorders / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D013125:Spinal Neoplasms / Q000473:pathology*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA