Journal of Clinical Oncology, Vol 15, 1754-1760, Copyright © 1997 by American Society of Clinical Oncology
Comparative diagnostic accuracy of magnetic resonance imaging and immunoscintigraphy for detection of bone marrow involvement in patients with malignant lymphoma
C Altehoefer, U Blum, J Bathmann, C Wustenberg, P Uhrmeister, J Laubenberger, W Lange, J Schwarzkopf, E Moser and M Langer
Department of Diagnostic Radiology, University Hospital Freiburg, Germany. alca@mrsl.ukl.uni-freiburg.de
PURPOSE: To compare the diagnostic accuracy of magnetic resonance imaging
(MRI) and immunoscintigraphy (IS) for detection of bone marrow infiltration
in malignant lymphoma. PATIENTS AND METHODS: In 32 patients with Hodgkin's
disease (HD) or non-Hodgkin's lymphoma (NHL), MRI of the axial skeleton and
whole-body IS using technetium-99m (99mTc)-labeled monoclonal antibodies
were reviewed and compared with iliac crest biopsies. Criterion for marrow
infiltration was a positive biopsy or concordant positive results of MRI
and IS. RESULTS: In 16 patients (50%), MRI, IS, and iliac crest biopsies
were negative for marrow infiltration. Iliac crest biopsy showed
infiltration in only four patients (13%). Infiltration was missed in two of
32 patients with IS and in one patient with MRI. In one additional patient,
MRI was false-positive because of pelvic hematopoietic hyperplasia. A
subset of nine patients (28%) with negative biopsies had bone marrow
involvement according to MRI and IS with identical location and pattern of
infiltration. In eight of these nine patients, diagnostic imaging indicated
marrow involvement only in noncrest marrow. Subsequent biopsy confirmed
infiltration in five patients. The clinical course suggested true-positive
imaging results in the remaining four patients. Two patients (6%) remained
equivocal. Overall concordance of MRI and IS for marrow infiltration was
88% (28 of 32 patients). CONCLUSION: Diagnostic imaging is essential for
optimal staging in malignant lymphoma, as blind biopsies appear to have low
sensitivity for bone marrow infiltration because of frequent involvement in
noncrest marrow. both imaging modalities show a high rate of detection of
bone marrow infiltration.
