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Abstract
SUMMARY
This study aims to evaluate the role of magnetic resonance imaging in detection of bone marrow infilteration in cases of newly diagnosed untreated lymphoma as bone marrow involvement is considered stage IV and the treatment will be altered. Bone marrow biopsy from posterior iliac crest was routinely performed for staging.
This study included 60 patients (29 males and 31 females), bone marrow biopsy from posterior iliac crest and MRI study were done for all cases.
The MRI of both femurs was performed on 42 cases, lumbosacral spines in 12 cases, pelvic bones in 4 cases and humerus in 2 cases. We used different pulse sequences T1W spin echo sequence, T2W spine echo sequence and STIR sequence.
Our results showed that 32 patients out of 60 imaged patients had positive bone marrow infilteration, while 17 patients out of the 60 biopsed patients had positive bone marrow infilteration 15 of them showed positive MRI study and the remaining 2 patients showed normal MRI study and both were low grade NHL.
Our results showed that used pulse sequence were informative T1W pulse sequence show the infilterating marrow lesion displaying low signal with superior contrast between fat and cellular marrow because lymphoma cause increased cell population contains more water (longer T1) than marrow fat.
T2W pulse sequence show the infilterating marrow lesion displaying variable signals but high signal in most of cases, it emphasize contrast between normal and abnormal marrow.
STIR sequence show the infilterating marrow lesion displaying high signal infilterative lesion and improve the detection of infilteration.
Also, three patterns of infilteration were recognized scattered, diffuse and nodular patterns and also our results showed that the frequency of bone marrow involvement detected by biopsy were more in diffuse than scattered pattern and nil in nodular infilteration.
CONCLUSION
from our study of this highly selected group of patients and although number of patients still small we concluded that:
* MRI is a sensitive non invasive method for detecting areas of lymphomatous marrow infilteration hence can provide the clinician with important informations for the diagnosis and staging before starting treatment.
* MRI can detect marrow involvement that is not detected by blind BM biopsy.
* MRI can’t replace blind bone marrow biopsy, it seems to be helpful to judge the necessity of repeated biopsy in the event of insufficient sampling before treatment so combination of MRI and bone marrow biopsy could be beneficial. And thus we recommend that MRI may be done prior to bone marrow biopsy as a normal MRI will exclude a marrow abnormality and thus obviate the need for biopsy while on the other hand a positive MRI (showing marrow abnormality) can be helpful in determining the best site for biopsy.
* Imaging the proximal femurs and pelvic bones is informative about bone marrow unless there is indication to examine certain bone.
* Among different used sequences T1W pulse sequence and STIR sequence in the best informative sequences.