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Bone Marrow with Diffuse Tumor Infiltration in Patients with Lymphoproliferative Diseases: Dynamic Gadolinium-enhanced MR Imaging¹

¹ From the Departments of Radiology (A.R., J.L.M., M.B., M.G., H.K.), Hematology (M.D., K.B.), Biostatistics (E.L.), and Pathology (P.G.), Centre Hospitalo-Universitaire Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France. Supported by the Association pour la Recherche contre le Cancer. Received June 18, 2002; revision requested August 20; final revision received March 13, 2003; accepted May 20. Address correspondence to A.R. (e-mail: alain.rahmouni@hmn.ap-hop-paris.fr).

View larger version (69K): [in a new window]   Figure 1a. Sagittal MR images obtained before treatment in 39-year-old man with large cell NHL and 18% of tumor cells in bone marrow (grade 1). (a) Precontrast T1-weighted spin-echo image (500/15) shows heterogeneous signal intensity with mixed areas of low and high signal intensity (group 2). Note the enlarged retroperitoneal lymph node (arrow). (b) T1-weighted spin-echo image (500/15) obtained 4 minutes after bolus injection of gadoterate meglumine shows subtle bone marrow enhancement. (c) T2-weighted spin-echo image (2,000/90) shows homogeneous normal bone marrow signal intensity. (d) Precontrast turbo FLASH image (7/3, 10° flip angle) and (e) turbo FLASH image obtained 38 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show bone marrow enhancement reached 350%.

View larger version (69K): [in a new window]   Figure 1b. Sagittal MR images obtained before treatment in 39-year-old man with large cell NHL and 18% of tumor cells in bone marrow (grade 1). (a) Precontrast T1-weighted spin-echo image (500/15) shows heterogeneous signal intensity with mixed areas of low and high signal intensity (group 2). Note the enlarged retroperitoneal lymph node (arrow). (b) T1-weighted spin-echo image (500/15) obtained 4 minutes after bolus injection of gadoterate meglumine shows subtle bone marrow enhancement. (c) T2-weighted spin-echo image (2,000/90) shows homogeneous normal bone marrow signal intensity. (d) Precontrast turbo FLASH image (7/3, 10° flip angle) and (e) turbo FLASH image obtained 38 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show bone marrow enhancement reached 350%.

View larger version (68K): [in a new window]   Figure 1c. Sagittal MR images obtained before treatment in 39-year-old man with large cell NHL and 18% of tumor cells in bone marrow (grade 1). (a) Precontrast T1-weighted spin-echo image (500/15) shows heterogeneous signal intensity with mixed areas of low and high signal intensity (group 2). Note the enlarged retroperitoneal lymph node (arrow). (b) T1-weighted spin-echo image (500/15) obtained 4 minutes after bolus injection of gadoterate meglumine shows subtle bone marrow enhancement. (c) T2-weighted spin-echo image (2,000/90) shows homogeneous normal bone marrow signal intensity. (d) Precontrast turbo FLASH image (7/3, 10° flip angle) and (e) turbo FLASH image obtained 38 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show bone marrow enhancement reached 350%.

View larger version (65K): [in a new window]   Figure 1d. Sagittal MR images obtained before treatment in 39-year-old man with large cell NHL and 18% of tumor cells in bone marrow (grade 1). (a) Precontrast T1-weighted spin-echo image (500/15) shows heterogeneous signal intensity with mixed areas of low and high signal intensity (group 2). Note the enlarged retroperitoneal lymph node (arrow). (b) T1-weighted spin-echo image (500/15) obtained 4 minutes after bolus injection of gadoterate meglumine shows subtle bone marrow enhancement. (c) T2-weighted spin-echo image (2,000/90) shows homogeneous normal bone marrow signal intensity. (d) Precontrast turbo FLASH image (7/3, 10° flip angle) and (e) turbo FLASH image obtained 38 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show bone marrow enhancement reached 350%.

View larger version (66K): [in a new window]   Figure 1e. Sagittal MR images obtained before treatment in 39-year-old man with large cell NHL and 18% of tumor cells in bone marrow (grade 1). (a) Precontrast T1-weighted spin-echo image (500/15) shows heterogeneous signal intensity with mixed areas of low and high signal intensity (group 2). Note the enlarged retroperitoneal lymph node (arrow). (b) T1-weighted spin-echo image (500/15) obtained 4 minutes after bolus injection of gadoterate meglumine shows subtle bone marrow enhancement. (c) T2-weighted spin-echo image (2,000/90) shows homogeneous normal bone marrow signal intensity. (d) Precontrast turbo FLASH image (7/3, 10° flip angle) and (e) turbo FLASH image obtained 38 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show bone marrow enhancement reached 350%.

View larger version (83K): [in a new window]   Figure 2a. (a-e) Sagittal MR images obtained before treatment in 45-year-old woman with myeloma and 60% plasmacytes in bone marrow (grade 3). (a) Precontrast T1-weighted spin-echo image (500/15) shows diffuse low signal intensity consistent with bone marrow involvement. (b) T1-weighted spin-echo image (500/15) obtained 4 minutes after bolus injection of gadoterate meglumine shows bone marrow enhancement. (c) Precontrast turbo FLASH image (7/3, 10° flip angle) and (d) turbo FLASH image obtained 34 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show bone marrow enhancement reached 1,233%. (e) Turbo FLASH image (7/3, 10° flip angle) obtained 80 seconds after enhancement of the aorta shows washout effect: Enhancement decreased to 763%. (f-i) Sagittal MR images obtained in the same patient 4 months after three courses of chemotherapy. This patient was considered to be a good responder to treatment. (f) Precontrast T1-weighted spin-echo image (500/15) shows increase in signal intensity, relative to the signal intensity seen on the pretreatment images, consistent with an increase in fat content. (g) Postcontrast T1-weighted spin-echo image (500/15) shows no enhancement. (h) Precontrast turbo FLASH image (7/3, 10° flip angle) and (i) turbo FLASH image obtained 42 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show minimal (25%) enhancement.

View larger version (83K): [in a new window]   Figure 2b. (a-e) Sagittal MR images obtained before treatment in 45-year-old woman with myeloma and 60% plasmacytes in bone marrow (grade 3). (a) Precontrast T1-weighted spin-echo image (500/15) shows diffuse low signal intensity consistent with bone marrow involvement. (b) T1-weighted spin-echo image (500/15) obtained 4 minutes after bolus injection of gadoterate meglumine shows bone marrow enhancement. (c) Precontrast turbo FLASH image (7/3, 10° flip angle) and (d) turbo FLASH image obtained 34 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show bone marrow enhancement reached 1,233%. (e) Turbo FLASH image (7/3, 10° flip angle) obtained 80 seconds after enhancement of the aorta shows washout effect: Enhancement decreased to 763%. (f-i) Sagittal MR images obtained in the same patient 4 months after three courses of chemotherapy. This patient was considered to be a good responder to treatment. (f) Precontrast T1-weighted spin-echo image (500/15) shows increase in signal intensity, relative to the signal intensity seen on the pretreatment images, consistent with an increase in fat content. (g) Postcontrast T1-weighted spin-echo image (500/15) shows no enhancement. (h) Precontrast turbo FLASH image (7/3, 10° flip angle) and (i) turbo FLASH image obtained 42 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show minimal (25%) enhancement.

View larger version (78K): [in a new window]   Figure 2c. (a-e) Sagittal MR images obtained before treatment in 45-year-old woman with myeloma and 60% plasmacytes in bone marrow (grade 3). (a) Precontrast T1-weighted spin-echo image (500/15) shows diffuse low signal intensity consistent with bone marrow involvement. (b) T1-weighted spin-echo image (500/15) obtained 4 minutes after bolus injection of gadoterate meglumine shows bone marrow enhancement. (c) Precontrast turbo FLASH image (7/3, 10° flip angle) and (d) turbo FLASH image obtained 34 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show bone marrow enhancement reached 1,233%. (e) Turbo FLASH image (7/3, 10° flip angle) obtained 80 seconds after enhancement of the aorta shows washout effect: Enhancement decreased to 763%. (f-i) Sagittal MR images obtained in the same patient 4 months after three courses of chemotherapy. This patient was considered to be a good responder to treatment. (f) Precontrast T1-weighted spin-echo image (500/15) shows increase in signal intensity, relative to the signal intensity seen on the pretreatment images, consistent with an increase in fat content. (g) Postcontrast T1-weighted spin-echo image (500/15) shows no enhancement. (h) Precontrast turbo FLASH image (7/3, 10° flip angle) and (i) turbo FLASH image obtained 42 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show minimal (25%) enhancement.

View larger version (80K): [in a new window]   Figure 2d. (a-e) Sagittal MR images obtained before treatment in 45-year-old woman with myeloma and 60% plasmacytes in bone marrow (grade 3). (a) Precontrast T1-weighted spin-echo image (500/15) shows diffuse low signal intensity consistent with bone marrow involvement. (b) T1-weighted spin-echo image (500/15) obtained 4 minutes after bolus injection of gadoterate meglumine shows bone marrow enhancement. (c) Precontrast turbo FLASH image (7/3, 10° flip angle) and (d) turbo FLASH image obtained 34 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show bone marrow enhancement reached 1,233%. (e) Turbo FLASH image (7/3, 10° flip angle) obtained 80 seconds after enhancement of the aorta shows washout effect: Enhancement decreased to 763%. (f-i) Sagittal MR images obtained in the same patient 4 months after three courses of chemotherapy. This patient was considered to be a good responder to treatment. (f) Precontrast T1-weighted spin-echo image (500/15) shows increase in signal intensity, relative to the signal intensity seen on the pretreatment images, consistent with an increase in fat content. (g) Postcontrast T1-weighted spin-echo image (500/15) shows no enhancement. (h) Precontrast turbo FLASH image (7/3, 10° flip angle) and (i) turbo FLASH image obtained 42 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show minimal (25%) enhancement.

View larger version (77K): [in a new window]   Figure 2e. (a-e) Sagittal MR images obtained before treatment in 45-year-old woman with myeloma and 60% plasmacytes in bone marrow (grade 3). (a) Precontrast T1-weighted spin-echo image (500/15) shows diffuse low signal intensity consistent with bone marrow involvement. (b) T1-weighted spin-echo image (500/15) obtained 4 minutes after bolus injection of gadoterate meglumine shows bone marrow enhancement. (c) Precontrast turbo FLASH image (7/3, 10° flip angle) and (d) turbo FLASH image obtained 34 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show bone marrow enhancement reached 1,233%. (e) Turbo FLASH image (7/3, 10° flip angle) obtained 80 seconds after enhancement of the aorta shows washout effect: Enhancement decreased to 763%. (f-i) Sagittal MR images obtained in the same patient 4 months after three courses of chemotherapy. This patient was considered to be a good responder to treatment. (f) Precontrast T1-weighted spin-echo image (500/15) shows increase in signal intensity, relative to the signal intensity seen on the pretreatment images, consistent with an increase in fat content. (g) Postcontrast T1-weighted spin-echo image (500/15) shows no enhancement. (h) Precontrast turbo FLASH image (7/3, 10° flip angle) and (i) turbo FLASH image obtained 42 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show minimal (25%) enhancement.

View larger version (81K): [in a new window]   Figure 2f. (a-e) Sagittal MR images obtained before treatment in 45-year-old woman with myeloma and 60% plasmacytes in bone marrow (grade 3). (a) Precontrast T1-weighted spin-echo image (500/15) shows diffuse low signal intensity consistent with bone marrow involvement. (b) T1-weighted spin-echo image (500/15) obtained 4 minutes after bolus injection of gadoterate meglumine shows bone marrow enhancement. (c) Precontrast turbo FLASH image (7/3, 10° flip angle) and (d) turbo FLASH image obtained 34 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show bone marrow enhancement reached 1,233%. (e) Turbo FLASH image (7/3, 10° flip angle) obtained 80 seconds after enhancement of the aorta shows washout effect: Enhancement decreased to 763%. (f-i) Sagittal MR images obtained in the same patient 4 months after three courses of chemotherapy. This patient was considered to be a good responder to treatment. (f) Precontrast T1-weighted spin-echo image (500/15) shows increase in signal intensity, relative to the signal intensity seen on the pretreatment images, consistent with an increase in fat content. (g) Postcontrast T1-weighted spin-echo image (500/15) shows no enhancement. (h) Precontrast turbo FLASH image (7/3, 10° flip angle) and (i) turbo FLASH image obtained 42 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show minimal (25%) enhancement.

View larger version (80K): [in a new window]   Figure 2g. (a-e) Sagittal MR images obtained before treatment in 45-year-old woman with myeloma and 60% plasmacytes in bone marrow (grade 3). (a) Precontrast T1-weighted spin-echo image (500/15) shows diffuse low signal intensity consistent with bone marrow involvement. (b) T1-weighted spin-echo image (500/15) obtained 4 minutes after bolus injection of gadoterate meglumine shows bone marrow enhancement. (c) Precontrast turbo FLASH image (7/3, 10° flip angle) and (d) turbo FLASH image obtained 34 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show bone marrow enhancement reached 1,233%. (e) Turbo FLASH image (7/3, 10° flip angle) obtained 80 seconds after enhancement of the aorta shows washout effect: Enhancement decreased to 763%. (f-i) Sagittal MR images obtained in the same patient 4 months after three courses of chemotherapy. This patient was considered to be a good responder to treatment. (f) Precontrast T1-weighted spin-echo image (500/15) shows increase in signal intensity, relative to the signal intensity seen on the pretreatment images, consistent with an increase in fat content. (g) Postcontrast T1-weighted spin-echo image (500/15) shows no enhancement. (h) Precontrast turbo FLASH image (7/3, 10° flip angle) and (i) turbo FLASH image obtained 42 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show minimal (25%) enhancement.

View larger version (83K): [in a new window]   Figure 2h. (a-e) Sagittal MR images obtained before treatment in 45-year-old woman with myeloma and 60% plasmacytes in bone marrow (grade 3). (a) Precontrast T1-weighted spin-echo image (500/15) shows diffuse low signal intensity consistent with bone marrow involvement. (b) T1-weighted spin-echo image (500/15) obtained 4 minutes after bolus injection of gadoterate meglumine shows bone marrow enhancement. (c) Precontrast turbo FLASH image (7/3, 10° flip angle) and (d) turbo FLASH image obtained 34 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show bone marrow enhancement reached 1,233%. (e) Turbo FLASH image (7/3, 10° flip angle) obtained 80 seconds after enhancement of the aorta shows washout effect: Enhancement decreased to 763%. (f-i) Sagittal MR images obtained in the same patient 4 months after three courses of chemotherapy. This patient was considered to be a good responder to treatment. (f) Precontrast T1-weighted spin-echo image (500/15) shows increase in signal intensity, relative to the signal intensity seen on the pretreatment images, consistent with an increase in fat content. (g) Postcontrast T1-weighted spin-echo image (500/15) shows no enhancement. (h) Precontrast turbo FLASH image (7/3, 10° flip angle) and (i) turbo FLASH image obtained 42 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show minimal (25%) enhancement.

View larger version (83K): [in a new window]   Figure 2i. (a-e) Sagittal MR images obtained before treatment in 45-year-old woman with myeloma and 60% plasmacytes in bone marrow (grade 3). (a) Precontrast T1-weighted spin-echo image (500/15) shows diffuse low signal intensity consistent with bone marrow involvement. (b) T1-weighted spin-echo image (500/15) obtained 4 minutes after bolus injection of gadoterate meglumine shows bone marrow enhancement. (c) Precontrast turbo FLASH image (7/3, 10° flip angle) and (d) turbo FLASH image obtained 34 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show bone marrow enhancement reached 1,233%. (e) Turbo FLASH image (7/3, 10° flip angle) obtained 80 seconds after enhancement of the aorta shows washout effect: Enhancement decreased to 763%. (f-i) Sagittal MR images obtained in the same patient 4 months after three courses of chemotherapy. This patient was considered to be a good responder to treatment. (f) Precontrast T1-weighted spin-echo image (500/15) shows increase in signal intensity, relative to the signal intensity seen on the pretreatment images, consistent with an increase in fat content. (g) Postcontrast T1-weighted spin-echo image (500/15) shows no enhancement. (h) Precontrast turbo FLASH image (7/3, 10° flip angle) and (i) turbo FLASH image obtained 42 seconds after enhancement of the aorta with bolus injection of gadoterate meglumine show minimal (25%) enhancement.

View larger version (17K): [in a new window]   Figure 3. Receiver operating characteristic curve constructed from quantitative data depicts sensitivity versus 1 - specificity of Emax for the diagnosis of bone marrow involvement. This analysis was conducted by comparing Emax values between the 42 patients with bone marrow involvement and the 71 control patients (22). Receiver operating characteristic analysis results indicated excellent accuracy of Emax values in the diagnosis of bone marrow involvement.