Musculoskeletal Imaging Findings of Hematologic Malignancies

Abstract

Hematologic malignancies comprise a set of prevalent yet clinically diverse diseases that can affect every organ system. Because blood components originate in bone marrow, it is no surprise that bone marrow is a common location for both primary and metastatic hematologic neoplasms. Findings of hematologic malignancy can be seen with most imaging modalities including radiography, computed tomography (CT), technetium 99m (Tc) methylene diphosphonate (MDP) bone scanning, fluorine 18 (F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT, and magnetic resonance (MR) imaging. Because of the diversity of imaging appearances and clinical behavior of this spectrum of disease, diagnosis can be challenging, and profound understanding of the underlying pathophysiologic changes and current treatment modalities can be daunting. The appearance of normal bone marrow at MR imaging and FDG PET/CT is also varied due to dynamic compositional changes with normal aging and in response to hematologic demand or treatment, which can lead to false-positive interpretation of imaging studies. In this article, the authors review the normal maturation and imaging appearance of bone marrow. Focusing on lymphoma, leukemia, and multiple myeloma, they present the spectrum of imaging findings of hematologic malignancy affecting the musculoskeletal system and the current imaging tools available to the radiologist. They discuss the imaging findings of posttreatment bone marrow and review commonly used staging systems and consensus recommendations for appropriate imaging for staging, management, and assessment of clinical remission. RSNA, 2017.

Ewing's Sarcoma and Primary Osseous Lymphoma: Spectrum of Imaging Appearances

“…29 Secondary lymphomas also favor the spine and should be distinguished from primary multifocal lymphoma. 30…”

“…33,34 The mixed sclerotic-lytic type is more common in secondary lymphomas and after treatment. 30 However, radiographic findings may be very subtle even in the presence of aggressive appearance on other imaging modalities (►Fig. 12).…”

T2-weighted Hypointense Tumors and Tumor-like Lesions

“…Sclerotic lymphoma is more common both in secondary (metastatic) lymphoma and lymphoma arising in the axial skeleton. 16 Magnetic resonance imaging (MRI) demonstrates mixed signal intensity on T2WI that can be either predominantly hypointense or hyperintense. The very aggressive nature of lymphoma with permeative growth is typically reflected by a soft tissue mass that is usually disproportionally large compared with cortical destruction; the cortex may even appear preserved.…”

En kvinne i 40-årene med bekkensmerter og uklare MR-funn

“…Pasienten hadde hvilesmerter, opplevde at smertene hadde en annen karakter enn tidligere, og MR-undersøkelse viste patologisk signal i relasjon til beinmarg i affisert område. Myelomatose debuterer ofte med ryggsmerter, og andre hematologiske sykdommer kan også gi smerter og signalavvik ved MR-undersøkelse (3,4). Det var ikke sett monoklonalt bånd ved proteinelektroforese, noe som gjorde myelomatose lite sannsynlig.…”

“…MR avbilder beinmargens bløtdelskomponent direkte og er sensitiv for påvisning av patologiske prosesser i skjelettet (5). Infiltrasjon i beinmarg ved MR er et lite spesifikt funn som ses ved flere tilstander i skjelettet (4). Et histologisk bilde med ikke-nekrotiserende granulomer, som hos vår pasient, kan forekomme ved sarkoidose, malignitet og infeksjoner (10).…”