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Navarro SM, Matcuk GR, Patel DB, Skalski M, White EA, Tomasian A, Schein AJ. Musculoskeletal Imaging Findings of Hematologic Malignancies. Radiographics 2017; 37:881-900. [PMID: 28388273 DOI: 10.1148/rg.2017160133] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hematologic malignancies comprise a set of prevalent yet clinically diverse diseases that can affect every organ system. Because blood components originate in bone marrow, it is no surprise that bone marrow is a common location for both primary and metastatic hematologic neoplasms. Findings of hematologic malignancy can be seen with most imaging modalities including radiography, computed tomography (CT), technetium 99m (99mTc) methylene diphosphonate (MDP) bone scanning, fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT, and magnetic resonance (MR) imaging. Because of the diversity of imaging appearances and clinical behavior of this spectrum of disease, diagnosis can be challenging, and profound understanding of the underlying pathophysiologic changes and current treatment modalities can be daunting. The appearance of normal bone marrow at MR imaging and FDG PET/CT is also varied due to dynamic compositional changes with normal aging and in response to hematologic demand or treatment, which can lead to false-positive interpretation of imaging studies. In this article, the authors review the normal maturation and imaging appearance of bone marrow. Focusing on lymphoma, leukemia, and multiple myeloma, they present the spectrum of imaging findings of hematologic malignancy affecting the musculoskeletal system and the current imaging tools available to the radiologist. They discuss the imaging findings of posttreatment bone marrow and review commonly used staging systems and consensus recommendations for appropriate imaging for staging, management, and assessment of clinical remission. ©RSNA, 2017.
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Affiliation(s)
- Shannon M Navarro
- From the Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.M.N., G.R.M., D.B.P., M.S., E.A.W., A.T.); and Los Robles Radiology Associates, 227 Janss Rd, Ste 150, Thousand Oaks, CA 91360 (A.J.S.)
| | - George R Matcuk
- From the Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.M.N., G.R.M., D.B.P., M.S., E.A.W., A.T.); and Los Robles Radiology Associates, 227 Janss Rd, Ste 150, Thousand Oaks, CA 91360 (A.J.S.)
| | - Dakshesh B Patel
- From the Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.M.N., G.R.M., D.B.P., M.S., E.A.W., A.T.); and Los Robles Radiology Associates, 227 Janss Rd, Ste 150, Thousand Oaks, CA 91360 (A.J.S.)
| | - Matthew Skalski
- From the Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.M.N., G.R.M., D.B.P., M.S., E.A.W., A.T.); and Los Robles Radiology Associates, 227 Janss Rd, Ste 150, Thousand Oaks, CA 91360 (A.J.S.)
| | - Eric A White
- From the Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.M.N., G.R.M., D.B.P., M.S., E.A.W., A.T.); and Los Robles Radiology Associates, 227 Janss Rd, Ste 150, Thousand Oaks, CA 91360 (A.J.S.)
| | - Anderanik Tomasian
- From the Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.M.N., G.R.M., D.B.P., M.S., E.A.W., A.T.); and Los Robles Radiology Associates, 227 Janss Rd, Ste 150, Thousand Oaks, CA 91360 (A.J.S.)
| | - Aaron J Schein
- From the Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.M.N., G.R.M., D.B.P., M.S., E.A.W., A.T.); and Los Robles Radiology Associates, 227 Janss Rd, Ste 150, Thousand Oaks, CA 91360 (A.J.S.)
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The imaging prevalence of osteolytic metastasis or multiple myeloma presenting as a periprosthetic lucency in the hip. AJR Am J Roentgenol 2014; 202:811-8. [PMID: 24660711 DOI: 10.2214/ajr.12.10510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to determine how often a malignant process presents as a lucency near a hip prosthesis, and to classify the frequency and distribution of differential diagnoses of these lytic lesions, and to determine their disposition. MATERIALS AND METHODS Hip and pelvis imaging examinations obtained from January 1998 to June 2008 were text searched (1,164,560 reports) to identify patients with hip prostheses (3508 patients); the records were then searched and individually reviewed to identify periprosthetic lucency (2036 reports; 176 patients). The most likely cause for the lucency, as determined by the interpreting radiologist, was recorded. Malignancy was confirmed in all cases. Malignancy was excluded by biopsy for some patients but by clinical follow-up or at the time of revision, if performed, for most patients. Prevalence rates and 95% CIs were calculated. RESULTS The overall prevalence of periprosthetic lucency was 5.02%. The prospective diagnoses suggested included loosening or infection (37.5%), degenerative cysts (19.3%), metastases (23.3%), multiple myeloma (14.8%), and metastasis of previously unknown malignancy (3.4%). The prevalence of metastases or multiple myeloma near a hip prosthesis was 1.54%; however, each of these patients had a known prior diagnosis of bone metastases, multiple myeloma, or primary bone malignancy. CONCLUSION Among the 2036 examinations with periprosthetic lucency, there were no instances of new malignancy, metastasis, or myeloma. These results suggest that it is statistically unlikely that a lucency near a hip prosthesis represents the first presentation of malignancy or metastases, regardless of how large or aggressive it may appear on imaging.
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