Primary Lymphoma of Bone: MRI and CT Characteristics During and After Successful Treatment
Bernard Mengiardi1,
Hanspeter Honegger2,
Juerg Hodler1,
Ulrich G. Exner1,
Miklos D. Csherhati3 and
Werner Brühlmann2
1 Departments of Radiology and Orthopedic Surgery, Orthopedic University
Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland.
2 Departments of Radiology and Oncology, City Hospital Triemli,
Birmensdorferstrasse 497, CH-8063 Zurich, Switzerland.
3 Private practice, orthopedic surgery, Zurich, Switzerland.
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Fig. 1. —Time course of tumor volume after treatment. Graph shows
tumor volumes for each patient after beginning of treatment expressed in
percentage of original tumor size before treatment. Duration of chemotherapy
and radiation therapy is indicated with dotted lines (exact duration,
Table 1). RaTh = local
radiation therapy.
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Fig. 2A. —20-year-old woman with primary lymphoma of bone in proximal
metaepiphysis of tibia and development of infarctionlike pattern after therapy
(patient 5). Anteroposterior radiograph obtained before treatment shows
predominantly permeative osteolysis. Despite slight fuzziness
(arrowheads), cortical layer is intact.
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Fig. 2B. —20-year-old woman with primary lymphoma of bone in proximal
metaepiphysis of tibia and development of infarctionlike pattern after therapy
(patient 5). Coronal T1-weighted image (TR/TE, 640/13) obtained at same time
as A reveals hypointense homogeneous tumor mass (white
arrowheads) with focal destruction of medial cortical bone and small
soft-tissue component (black arrowheads).
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Fig. 2C. —20-year-old woman with primary lymphoma of bone in proximal
metaepiphysis of tibia and development of infarctionlike pattern after therapy
(patient 5). Coronal T1-weighted (520/11) (C) and coronal proton
density-weighed fat-saturated (4,870/42) (D) images obtained 10 months
after start of therapy show pattern similar to that found in bone infarction
with linear peripheral hypointense rim (arrows, C) on
T1-weighted images and partial hyperintensity (arrows, D) on
proton density-weighted image.
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Fig. 2D. —20-year-old woman with primary lymphoma of bone in proximal
metaepiphysis of tibia and development of infarctionlike pattern after therapy
(patient 5). Coronal T1-weighted (520/11) (C) and coronal proton
density-weighed fat-saturated (4,870/42) (D) images obtained 10 months
after start of therapy show pattern similar to that found in bone infarction
with linear peripheral hypointense rim (arrows, C) on
T1-weighted images and partial hyperintensity (arrows, D) on
proton density-weighted image.
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Fig. 3A. —24-year-old man with primary lymphoma of bone of distal
metaepiphysis of femur and histologically proven, probably radiation-induced,
necrosis adjacent to primary tumor site (patient 2). Coronal T1-weighted
(TR/TE, 755/20) (A) and axial fat-saturated T2-weighted (4,500/96)
(B) images reveal primary lymphoma of bone (arrowheads) 2
months before start of chemotherapy.
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Fig. 3B. —24-year-old man with primary lymphoma of bone of distal
metaepiphysis of femur and histologically proven, probably radiation-induced,
necrosis adjacent to primary tumor site (patient 2). Coronal T1-weighted
(TR/TE, 755/20) (A) and axial fat-saturated T2-weighted (4,500/96)
(B) images reveal primary lymphoma of bone (arrowheads) 2
months before start of chemotherapy.
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Fig. 3C. —24-year-old man with primary lymphoma of bone of distal
metaepiphysis of femur and histologically proven, probably radiation-induced,
necrosis adjacent to primary tumor site (patient 2). Coronal proton
density-weighted fat-saturated image (3,900/40) obtained 5 months after start
of therapy shows only small residual signal abnormalities
(arrowheads).
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Fig. 3D. —24-year-old man with primary lymphoma of bone of distal
metaepiphysis of femur and histologically proven, probably radiation-induced,
necrosis adjacent to primary tumor site (patient 2). Coronal proton
density-weighted fat-saturated image (3,950/45) obtained 16 months after start
of radiation therapy shows new signal abnormalities in field of therapy
adjacent to primary tumor site (straight arrows). Susceptibility
artifacts (curved arrow) are due to surgical biopsy. Pathologic
examination after biopsy revealed necrosis and scar tissue without any tumor
cells.
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Fig. 4A. —57-year-old woman with primary lymphoma of bone of proximal
femur with large soft-tissue component and fast dissolution during therapy
(patient 3). Transverse T1-weighted fat-saturated images (TR/TE, 600/15) on
level of lesser trochanter (arrow) obtained after gadopentetate
administration show large circumferential soft-tissue component
(arrowheads, A) before treatment with complete infiltration of
bone marrow and complete disappearance of soft-tissue mass (B) after
only 2 months of chemotherapy.
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Fig. 4B. —57-year-old woman with primary lymphoma of bone of proximal
femur with large soft-tissue component and fast dissolution during therapy
(patient 3). Transverse T1-weighted fat-saturated images (TR/TE, 600/15) on
level of lesser trochanter (arrow) obtained after gadopentetate
administration show large circumferential soft-tissue component
(arrowheads, A) before treatment with complete infiltration of
bone marrow and complete disappearance of soft-tissue mass (B) after
only 2 months of chemotherapy.
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Fig. 5A. —17-year-old boy with remodeling of scapular osteolysis
(patient 1). Helical CT scan of shoulder (3-mm slice thickness with arm
positioned at patient's side) obtained 1 month before chemotherapy shows
extensive osteolysis with destruction of cortical bone
(arrowheads).
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Fig. 5B. —17-year-old boy with remodeling of scapular osteolysis
(patient 1). Helical CT scan of chest (5-mm slice thickness with arms
positioned above patient's head) obtained 2 months after start of chemotherapy
shows that initially present osteolysis is nearly completely filled with new
unstructured bone (arrowheads). Scapula is slightly enlarged but has
expected shape.
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Fig. 5C. —17-year-old boy with remodeling of scapular osteolysis
(patient 1). Helical CT scan of chest (5-mm slice thickness with arms
positioned over patient's head) obtained 6 months after start of therapy shows
architecture similar to that of Paget's disease of remodeled bone, with new
cortical layer (arrows) and coarse trabecular bone.
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Fig. 6A. —52-year-old man with remodeling of extensive osteolysis of
third right rib and third vertebra (patient 6). Helical CT scan of chest (5-mm
slice thickness) obtained 1 month before start of chemotherapy reveals large
mass with extensive destruction of rib (white arrowheads), vertebral
pedicle, and transverse process (black arrowheads).
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Fig. 6B. —52-year-old man with remodeling of extensive osteolysis of
third right rib and third vertebra (patient 6). MDCT scans of chest (4 x
2.5 mm collimation with 5-mm reconstructed slice thickness) were obtained 4
(B) and 14 (C) months after start of therapy. After 4 months,
mass has disappeared. New unstructured bone formation of rib (straight
arrows), vertebral pedicle (curved arrow), and transverse
process can be seen. After 14 months, bones were remodeled with slightly
enlarged volume and architecture similar to that of Paget's disease.
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Fig. 6C. —52-year-old man with remodeling of extensive osteolysis of
third right rib and third vertebra (patient 6). MDCT scans of chest (4 x
2.5 mm collimation with 5-mm reconstructed slice thickness) were obtained 4
(B) and 14 (C) months after start of therapy. After 4 months,
mass has disappeared. New unstructured bone formation of rib (straight
arrows), vertebral pedicle (curved arrow), and transverse
process can be seen. After 14 months, bones were remodeled with slightly
enlarged volume and architecture similar to that of Paget's disease.
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Copyright © 2005 by the American Roentgen Ray Society.
