Effect of Granulocyte-Stimulating Factors on Marrow of Adult Patients with Musculoskeletal Malignancies: Incidence and MRI Findings
Robert P. Hartman1,
Murali Sundaram1,2,
Scott H. Okuno3 and
Franklin H. Sim4
1 Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN
55902.
2 Present address: Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH
44195.
3 Department of Oncology, Mayo Clinic, Rochester, MN 55902.
4 Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55902.
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Fig. 1A. —34-year-old man with Ewing's sarcoma in left innominate bone. Axial
T1-weighted images (TR/TE, 350/14) obtained through pelvis show large tumor
(asterisks) arising from left innominate bone with extraskeletal
extension of tumor. Moderately diffuse T1 signal (long arrow) shows
in left acetabulum in area of tumor. Scattered lower T1 signal (short
arrow) appears in right acetabulum. Normal fatty marrow is present in
upper femora.
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Fig. 1B. —34-year-old man with Ewing's sarcoma in left innominate bone. Axial
T1-weighted images (TR/TE, 350/14) obtained through pelvis show large tumor
(asterisks) arising from left innominate bone with extraskeletal
extension of tumor. Moderately diffuse T1 signal (long arrow) shows
in left acetabulum in area of tumor. Scattered lower T1 signal (short
arrow) appears in right acetabulum. Normal fatty marrow is present in
upper femora.
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Fig. 1C. —34-year-old man with Ewing's sarcoma in left innominate bone. Axial
T1-weighted images (400/14) obtained through pelvis show postchemotherapy
decrease in tumor size. Low-signal changes in entire right acetabulum and
femora are consistent with red marrow reconversion.
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Fig. 1D. —34-year-old man with Ewing's sarcoma in left innominate bone. Axial
T1-weighted images (400/14) obtained through pelvis show postchemotherapy
decrease in tumor size. Low-signal changes in entire right acetabulum and
femora are consistent with red marrow reconversion.
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Fig. 2A. —56-year-old man with pleomorphic sarcoma in left thigh. Axial
T1-weighted (A) and T2-weighted (B) fat-saturated images (TR/TE,
416/15; TR/TEeff, 2,500/60, respectively) obtained through upper
thigh show healthy marrow signal intensity on prechemotherapy examination.
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Fig. 2B. —56-year-old man with pleomorphic sarcoma in left thigh. Axial
T1-weighted (A) and T2-weighted (B) fat-saturated images (TR/TE,
416/15; TR/TEeff, 2,500/60, respectively) obtained through upper
thigh show healthy marrow signal intensity on prechemotherapy examination.
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Fig. 2C. —56-year-old man with pleomorphic sarcoma in left thigh. Coronal
T1-weighted images (TR/TE, 300/9) obtained through both thighs on
postchemotherapy examination show diffuse low-signal change throughout femora
consistent with red marrow reconversion. Note sarcoma (arrows) in
vastus lateralis muscle.
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Fig. 2D. —56-year-old man with pleomorphic sarcoma in left thigh. Coronal
T1-weighted images (TR/TE, 300/9) obtained through both thighs on
postchemotherapy examination show diffuse low-signal change throughout femora
consistent with red marrow reconversion. Note sarcoma (arrows) in
vastus lateralis muscle.
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Fig. 2E. —56-year-old man with pleomorphic sarcoma in left thigh. Axial
T1-weighted (E) and T2-weighted (F) images (450/15; 2,500/60,
respectively) obtained through upper thigh on postchemotherapy examination
show no increased T2 signal in area of red marrow reconversion.
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Fig. 2F. —56-year-old man with pleomorphic sarcoma in left thigh. Axial
T1-weighted (E) and T2-weighted (F) images (450/15; 2,500/60,
respectively) obtained through upper thigh on postchemotherapy examination
show no increased T2 signal in area of red marrow reconversion.
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Fig. 3A. —73-year-old man with pleomorphic sarcoma in left thigh. Axial
T1-weighted (A) and T2-weighted (B) fat-saturated images (TR/TE,
516/14; TR/TEeff, 3,000/90, respectively) obtained through upper
thigh show healthy marrow signal intensity on prechemotherapy examination.
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Fig. 3B. —73-year-old man with pleomorphic sarcoma in left thigh. Axial
T1-weighted (A) and T2-weighted (B) fat-saturated images (TR/TE,
516/14; TR/TEeff, 3,000/90, respectively) obtained through upper
thigh show healthy marrow signal intensity on prechemotherapy examination.
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Fig. 3C. —73-year-old man with pleomorphic sarcoma in left thigh. Axial
T1-weighted (C) and T2-weighted (D) fat-saturated images (TR/TE,
400/14; 2,366/60, respectively) obtained through left thigh show focal
low-signal change (arrows) in shaft of femur consistent with red
marrow reconversion mimicking bone metastasis on postchemotherapy examination.
Note slightly increased T2 signal intensity in red marrow reconversion.
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Fig. 3D. —73-year-old man with pleomorphic sarcoma in left thigh. Axial
T1-weighted (C) and T2-weighted (D) fat-saturated images (TR/TE,
400/14; 2,366/60, respectively) obtained through left thigh show focal
low-signal change (arrows) in shaft of femur consistent with red
marrow reconversion mimicking bone metastasis on postchemotherapy examination.
Note slightly increased T2 signal intensity in red marrow reconversion.
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Fig. 4A. —29-year-old man with Ewing's sarcoma in left humerus. Axial
T1-weighted (A) and T2-weighted (B) fat-saturated images (TR/TE,
400/14; TR/TEeff, 3,200/33.3, respectively) obtained through upper
left humerus show circumscribed lesion (arrows) in healthy marrow on
prechemotherapy examination. Lesion was biopsied shortly after MRI and was
found to be Ewing's sarcoma.
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Fig. 4B. —29-year-old man with Ewing's sarcoma in left humerus. Axial
T1-weighted (A) and T2-weighted (B) fat-saturated images (TR/TE,
400/14; TR/TEeff, 3,200/33.3, respectively) obtained through upper
left humerus show circumscribed lesion (arrows) in healthy marrow on
prechemotherapy examination. Lesion was biopsied shortly after MRI and was
found to be Ewing's sarcoma.
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Fig. 4C. —29-year-old man with Ewing's sarcoma in left humerus. Axial
T1-weighted (C) and T2-weighted (D) fat-saturated images (TR/TE,
566/14; 3,000/86.5, respectively) obtained at same level as A and
B on postchemotherapy examination show intensely increased T2 signal in
lesion, probably caused by necrosis from treatment.
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Fig. 4D. —29-year-old man with Ewing's sarcoma in left humerus. Axial
T1-weighted (C) and T2-weighted (D) fat-saturated images (TR/TE,
566/14; 3,000/86.5, respectively) obtained at same level as A and
B on postchemotherapy examination show intensely increased T2 signal in
lesion, probably caused by necrosis from treatment.
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Fig. 4E. —29-year-old man with Ewing's sarcoma in left humerus.
18F-FDG PET scan shows no metabolic activity in region of known
tumor in left humerus. Diffuse increased activity present in marrow of
remaining visualized skeleton is consistent with red marrow reconversion.
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Fig. 5A. —21-year-old man with Ewing's sarcoma in left femur. Axial
T1-weighted (A and B) and T2-weighted (C and D)
postchemotherapy images (TR/TE, 650/14; 2,000/60, respectively) obtained
through femur above level of bone tumor show diffuse low TI signal, consistent
with red marrow reconversion. Note similar changes in right femur and both
ischia. These areas exhibit slightly increased T2 signal.
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Fig. 5B. —21-year-old man with Ewing's sarcoma in left femur. Axial
T1-weighted (A and B) and T2-weighted (C and D)
postchemotherapy images (TR/TE, 650/14; 2,000/60, respectively) obtained
through femur above level of bone tumor show diffuse low TI signal, consistent
with red marrow reconversion. Note similar changes in right femur and both
ischia. These areas exhibit slightly increased T2 signal.
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Fig. 5C. —21-year-old man with Ewing's sarcoma in left femur. Axial
T1-weighted (A and B) and T2-weighted (C and D)
postchemotherapy images (TR/TE, 650/14; 2,000/60, respectively) obtained
through femur above level of bone tumor show diffuse low TI signal, consistent
with red marrow reconversion. Note similar changes in right femur and both
ischia. These areas exhibit slightly increased T2 signal.
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Fig. 5D. —21-year-old man with Ewing's sarcoma in left femur. Axial
T1-weighted (A and B) and T2-weighted (C and D)
postchemotherapy images (TR/TE, 650/14; 2,000/60, respectively) obtained
through femur above level of bone tumor show diffuse low TI signal, consistent
with red marrow reconversion. Note similar changes in right femur and both
ischia. These areas exhibit slightly increased T2 signal.
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Fig. 5E. —21-year-old man with Ewing's sarcoma in left femur. T1-weighted
(E) and T2-weighted (F) images (650/14; 2,000/60, respectively)
were obtained through sarcoma in shaft of left femur. Tumor shows markedly
increased T2 signal in medullary canal. Increased T2 signal in adjacent
musculature suggests tumor extension.
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Fig. 5F. —21-year-old man with Ewing's sarcoma in left femur. T1-weighted
(E) and T2-weighted (F) images (650/14; 2,000/60, respectively)
were obtained through sarcoma in shaft of left femur. Tumor shows markedly
increased T2 signal in medullary canal. Increased T2 signal in adjacent
musculature suggests tumor extension.
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Fig. 5G. —21-year-old man with Ewing's sarcoma in left femur. 21-year-old man
with Ewing's sarcoma in left femur. T1-weighted (G) and T2-weighted
(H) images obtained below tumor again show mild bilaterally symmetric
T2 signal prolongation, consistent with red marrow reconversion.
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Fig. 5H. —21-year-old man with Ewing's sarcoma in left femur. 21-year-old man
with Ewing's sarcoma in left femur. T1-weighted (G) and T2-weighted
(H) images obtained below tumor again show mild bilaterally symmetric
T2 signal prolongation, consistent with red marrow reconversion.
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Fig. 5I. —21-year-old man with Ewing's sarcoma in left femur. Photograph of
cross-section of surgical specimen shows tumor (long arrow)
juxtaposed to red marrow reconversion (short arrow) in shaft of
femur.
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Copyright © 2004 by the American Roentgen Ray Society.
