This study included 30 patients with bone marrow infiltrative
lesions; they were 14 males and 16 females.
According to the pathological and radiological results, The lesions
in our study are classified into:
Metastasis (12 cases)
Plasma cell dyscrasias (8 cases), including:
- Multiple myloma (6 cases)
- Plasmacytoma (2 cases)
Lymphoma (7 cases), including:
- Non Hodgkin's lymphoma (5 cases)
- Hodgkin's lymphoma (2 cases)
Ewing's sarcoma (2 cases)
Leukemia (Chronic lymphatic leukemia) (1 case)
The age of the patients ranged from 8 to 75 years, (mean
41.5 years). The age distribution varies from one pathological entity to
another. In metastatic disease, the peak incidence of age in our study
ranges from 36 to 70 years with most of cases above 40 years (11/12
cases). In lymphoma, the commonest age incidence in the studied cases
of non-Hodgkin's lymphoma is 61-70 years (4/5 cases). As regard the two
cases of Hodgkin's lymphoma, the 1st case was in the 4th decade while the
other one was in the 8th decade of life. In multiple myeloma, the 6 cases
of multiple myeloma are older than 40 years, 3 cases are between 51-60
years of age (50 %) and 1 cases for each of the following age groups (41-
50, 61-70 and 71-80). The 2 cases of solitary plasmacytoma was in the 4th
and 6th decades (aged 37 and 60 years). In 2 cases of Ewing's sarcoma,
the 1st case aged 8 years (First decade of life) while the 2nd case aged 12
years (Second decade of life). In one case of leukemia was in the 4th
decade of life.
The patients showed variable clinical presentations and most of
cases showed more than one presenting sign or symptom. Pain was the
commonest symptom in the studied cases followed by swelling.
Patients in this study were examined by plain radiography (15
cases), computed tomography (5 cases), isotopic bone scan in (1 case)
and magnetic resonance imaging (all cases).
The information provided by MRI is valuable for staging purposes,
as a means for identification of potential biopsy sites, and for assessment
of response to therapy or disease progression. This information can also
identify patients at increased risk for recurrence and thus direct the type
and frequency of follow-up studies. All these factors become critical
when different therapeutic regimens are evaluated in the rapidly changing
fields of hematology and oncology.
Using different imaging techniques, MRI can depict a wide range of
focal or diffuse signal alterations in the bone marrow. In the past, bone
marrow imaging was based on conventional radiology, nuclear medicine
and computed tomography, which have some limitations on detection of
bone marrow lesions. Unlike these modalities, MR imaging is the only
imaging technique that allows direct visualization of the bone marrow.
In this study, MRI is a sensitive method for detection of areas of
marrow infiltration. The value of MRI lies in its ability to document the
presence and extent of disease and determining an appropriate radiation
field. MRI of the bone marrow could be used as a non invasive imaging
method to indicate prognosis. Most of our results are in agreement with
different authors.
MRI can detect intramedullary infiltration in a manner that has
never seen before. It is also useful in detection of tumor extension,
associated soft tissue masses and neurological compromise. MRI can
increase the rate of successful bone marrow biopsies as it can assess a
Summary And Conclusion
﴾189﴿
large volume of bone marrow non-invasively and relatively quickly and
so, can detect foci of marrow involvement in diseases with focal pattern
of marrow infiltration.
From this study, it is concluded that:
(1) MR imaging has become an important noninvasive tool that can
provide the clinician with important information for the diagnosis,
staging, and monitoring of therapy in patients with bone marrow
infiltrative lesions.
(2) By assessing a large volume of bone marrow noninvasively and
relatively quickly, MR imaging studies can designate foci of marrow
involvement in diseases with focal patterns of marrow infiltration and,
thus, can increase the rate of successful bone marrow biopsies.
(3) Serial MR imaging studies after initiation of therapy may obviate
the need for bone marrow biopsies.
(4) MR imaging can help determine the etiology of spinal
compression fractures in patients with bone marrow malignancies.
(5) MR can accurately depict the level and extent of extraosseous
mass and identify sites of impending cord compression. |
