Dynamic Contrast Enhanced Magnetic Resonance Imaging of Diffuse Spinal Bone Marrow Infiltration in Patients with Hematological Malignancies

Abstract

ObjectiveTo 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.Materials and MethodsDynamic 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 (Emax), 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.ResultsDifferences in Emax, 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). Emax, 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). Emax, 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 Emax, 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 Emax 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).ConclusionDCE-MRI of spine can be a useful tool in detecting diffuse marrow infiltration of hematological malignancies, while its parameters including Emax, ES, and TTP can reflect the malignancies' histological grade.

Diagnosis of Spinal Lesions Using Heuristic and Pharmacokinetic Parameters Measured by Dynamic Contrast-Enhanced MRI

“…Regardless of the analysis methods, most studies found DCE parameters showing significant differences between diseased and normal bone marrow, or between different lesions(8–15). Khadem et al used heuristic DCE analysis to discriminate hypervascular from hypovascular spinal metastases (12), and later Saha et al from the same research group showed that pharmacokinetic parameters analyzed by using a commercial software (NordicNeuroLab) could distinguish hypervascular renal cell carcinoma from hypovascular prostate carcinoma (13).…”

“…Khadem et al used heuristic DCE analysis to discriminate hypervascular from hypovascular spinal metastases (12), and later Saha et al from the same research group showed that pharmacokinetic parameters analyzed by using a commercial software (NordicNeuroLab) could distinguish hypervascular renal cell carcinoma from hypovascular prostate carcinoma (13). DCEMRI using heuristic analysis and model fitting has been applied to characterize vascular properties of different hematologic malignancies (eg, myeloma and lymphoma) with different grades of bone marrow involvement (8,9,15). We have shown that DCE parameters of metastatic cancers were significantly different from those of myeloma (10) and inflammatory TB (11).…”

Current Concepts in MRI of Focal and Diffuse Malignancy of Bone Marrow

“…[14][15][16][17][18] Alterations of dynamic contrast enhancement with diffuse malignant bone marrow infiltration have been described. [19][20][21] Numerous studies have focused on the use of DCE-MRI as a tool for evaluating bone marrow in hematologic malignancies. 19,20,[22][23][24] Chen et al evaluated the use of DCE-MRI of bone marrow as a predictor of survival for patients with acute myeloid leukemia who were clinically in complete remission and found that the perfusion kinetics of the bone marrow were an indicator of survival.…”

“…[19][20][21] Numerous studies have focused on the use of DCE-MRI as a tool for evaluating bone marrow in hematologic malignancies. 19,20,[22][23][24] Chen et al evaluated the use of DCE-MRI of bone marrow as a predictor of survival for patients with acute myeloid leukemia who were clinically in complete remission and found that the perfusion kinetics of the bone marrow were an indicator of survival. 24 More recently, DCE-MRI has been suggested as a tool to help differentiate acute, subacute, and chronic metastatic lesions.…”

Quality of life in patients with multiple myeloma treated with percutaneous vertebroplasty

“…1,2 The role of imaging studies in the treatment of MM includes assessment of the extent of the severity of the disease at presentation, and identification and characterization of complications, as well as the subsequent stage of the disease. [3][4][5][6][7] Compression fractures increase morbidity and mortality, causing spinal deformity and intractable pain. Clinical studies of vertebroplasty (VP) have reported a 90% reduction of pain, with minimal complications, which is relatively high.…”