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Nguyen JC, Davis KW, Arkader A, Guariento A, Sze A, Hong S, Jaramillo D. Pre-treatment MRI of leukaemia and lymphoma in children: are there differences in marrow replacement patterns on T1-weighted images? Eur Radiol 2021; 31:7992-8000. [PMID: 33768286 DOI: 10.1007/s00330-021-07814-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/18/2020] [Accepted: 02/18/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate the prevalence and distribution of specific marrow patterns on pre-treatment magnetic resonance imaging (MRI) examinations in children with leukaemia and lymphoma and with respect to the anatomic location. MATERIALS AND METHODS This retrospective IRB-approved and HIPAA-compliant study included children with leukaemia or lymphoma who underwent pre-treatment MRI examinations over 18 years (between 1 January 1995 and 31 August 2013). Two radiologists blinded to the clinical diagnosis reviewed each study to determine the presence or absence of abnormal marrow signal and, when present, sub-categorised the pattern into diffuse, patchy, or focal abnormal marrow. Chi-square and Fisher's exact tests were used to compare marrow patterns between leukaemia and lymphoma. RESULTS The study included 50 children (32 males and 18 females; mean age 9.5 ± 5.3 years) with 54 MRI examinations (27 leukaemia and 27 lymphoma) that included 26 spine and 28 non-spine studies. Marrow replacement was present on 43 (80%) studies, significantly more common with leukaemia than with lymphoma (p = 0.039). The diffuse replacement pattern was significantly more common with leukaemia when compared to lymphoma (p < 0.001) and the focal pattern was only observed with lymphoma. In the spine, the diffuse pattern was observed with lymphoma (3/14, 21%). All patients with leukaemia and MRI outside of the spine showed marrow involvement. CONCLUSION Marrow replacement is common on MRI from children with leukaemia and lymphoma. A diffuse pattern was significantly associated with leukaemia on studies outside of the spine and a focal pattern was only observed with lymphoma, independently of the anatomic location. KEY POINTS • Bone marrow replacement on pre-treatment MRI examinations in children with leukaemia and lymphoma was observed in 93% (25/27) and 67% (18/27), respectively. • Diffuse pattern of marrow replacement was significantly more common in leukaemia even though this pattern was also observed with lymphoma on the spine MRI studies. • Focal pattern of marrow replacement was present only with lymphoma and not with leukaemia regardless of the anatomic location.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA. .,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Kirkland W Davis
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alexandre Arkader
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Divison of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Alyssa Sze
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Shijie Hong
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Diego Jaramillo
- Department of Radiology, Columbia University Medical Center, New York City, NY, USA
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Can diffusion-weighted whole-body MRI replace contrast-enhanced CT for initial staging of Hodgkin lymphoma in children and adolescents? Pediatr Radiol 2018; 48:638-647. [PMID: 29362839 DOI: 10.1007/s00247-018-4071-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/30/2017] [Accepted: 01/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although positron emission tomography with 18F-fluoro-2-deoxyglucose (FDG-PET/CT) has been recommended as the method of choice for lymphoma staging, it has limited availability in several countries, therefore, studies comparing whole-body magnetic resonance imaging (MRI) to conventional staging methods or to FDG-PET/CT are an important tool to establish whole-body MRI as an alternative to these methods. OBJECTIVE To compare whole-body MRI versus conventional imaging methods for staging of Hodgkin lymphoma in children and adolescents. MATERIALS AND METHODS The study included 22 patients ages 5 to 21 years. Staging was performed using conventional imaging methods and whole-body MRI. Conventional imaging methods were defined as computed tomography (CT) of the neck, chest, abdomen and pelvis and ultrasonography of the neck and/or abdomen. We calculated the sensitivity of these methods for Hodgkin lymphoma staging and their sensitivity and specificity for detecting sites of nodal and extranodal involvement. RESULTS The sensitivity of whole-body MRI for Hodgkin lymphoma staging was superior to that of conventional imaging methods (95.5% vs. 86.4%, respectively), but both methods had similar sensitivity and specificity for detecting involvement of nodal sites (99.1% and 100% vs. 97.3% and 100%, respectively) and extranodal sites (90.5% and 98.7% vs. 90.5% and 99.4%, respectively). CONCLUSION Whole-body MRI has excellent sensitivity for staging of Hodgkin lymphoma in children and adolescents. It can thus be considered an alternative for this purpose, particularly because it does not expose patients to ionizing radiation.
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Bednaruk-Młyński E, Pieńkowska J, Skórzak A, Małkowski B, Kulikowski W, Subocz E, Dzietczenia J, Zalewska M, Leśniewski-Kmak K, Zaucha R, Wróbel T, Zaucha JM. Comparison of positron emission tomography/computed tomography with classical contrast-enhanced computed tomography in the initial staging of Hodgkin lymphoma. Leuk Lymphoma 2014; 56:377-82. [PMID: 24794802 DOI: 10.3109/10428194.2014.919635] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We compared initial computed tomography (CT) and positron emission tomography (PET)/CT in 96 patients with Hodgkin lymphoma (HL), assessing the role of baseline PET/CT in stage migration and treatment selection. The number of patients with stage I, II, III and IV disease based on CT versus PET/CT was: 5 vs. 7, 49 vs. 37, 28 vs. 22 and 14 vs. 30, respectively. In 33 (34%) patients, PET/CT changed HL stage: 27 (28%) were upstaged and six (6.3%) downstaged. Upstaging was caused by detection of new extranodal involvements (47 sites in 26 patients): bone marrow (10 patients), spleen (five patients) and lung (two patients). In nine patients≥2 further coexisting locations were detected. Downstaging resulted from the absence of fluorodeoxyglucose (18F-FDG) uptake in enlarged nodes (>15 mm) in the abdomen and pelvis. PET/CT modified HL stage in 34% of patients leading to treatment modification in the majority. Our results indicate that PET/CT should be mandatory in the initial staging of HL.
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Affiliation(s)
- Ewa Bednaruk-Młyński
- Department of Oncology and Radiotherapy, Medical University of Gdansk , Gdansk , Poland
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Jiang XX, Yan ZX, Song YY, Zhao WL. A pooled analysis of MRI in the detection of bone marrow infiltration in patients with malignant lymphoma. Clin Radiol 2013; 68:e143-53. [DOI: 10.1016/j.crad.2012.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/31/2012] [Accepted: 11/09/2012] [Indexed: 01/11/2023]
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5
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Kwee TC, Nievelstein RAJ. Is MRI less accurate than FDG-PET/CT in diagnosing bone marrow involvement in lymphoma? Eur J Radiol 2011; 80:565-6. [PMID: 21237596 DOI: 10.1016/j.ejrad.2010.12.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Accepted: 12/20/2010] [Indexed: 11/24/2022]
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6
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Wu LM, Chen FY, Jiang XX, Gu HY, Yin Y, Xu JR. 18F-FDG PET, combined FDG-PET/CT and MRI for evaluation of bone marrow infiltration in staging of lymphoma: a systematic review and meta-analysis. Eur J Radiol 2010; 81:303-11. [PMID: 21145680 DOI: 10.1016/j.ejrad.2010.11.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 11/10/2010] [Accepted: 11/12/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE Evaluation of bone marrow infiltration is an essential step in the staging of lymphoma. The accuracy of (18)F-fluorodeoxyglucose-positron emission tomography ((18)F-FDG PET), combined (18)F-fluorodeoxyglucose-positron emission tomography/computed tomography ((18)F-FDG-PET/CT) and magnetic resonance imaging (MRI) in diagnosing bone marrow involvement of lymphoma has never been systematically assessed, and the present systematic review was aimed at this issue. METHODS MEDLINE, EMBASE, Cochrane library and some other databases, from January 1995 to July 2010, were searched for initial studies. All the studies published in English or Chinese relating to the diagnostic value of (18)F-FDG PET, PET/CT and MRI for patients with bone marrow involvement of lymphoma were collected. We extracted data to calculate sensitivity, specificity, SROC curves and AUC and to test for heterogeneity. The statistic software called "Meta-Disc 1.4" was used for data analysis. RESULT In 32 included studies, PET/CT had the highest pooled sensitivity, 91.6% (95%CI: 85.1, 95.9) and highest pooled specificity, 90.3% (95%CI: 85.9, 93.7). PET/CT also had the highest pooled DOR, 68.89 (95%CI: 15.88, 298.92). The AUC of PET, PET/CT, and MRI were 0.9430, 0.9505 and 0.8764. There was heterogeneity among studies and no evidence of publication bias. CONCLUSION PET/CT was a highly sensitive and specific modality in diagnosing patients with bone marrow involvement in lymphoma. Compared with MRI and PET alone, PET/CT can play important roles in the staging of lymphoma.
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Affiliation(s)
- Lian-Ming Wu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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7
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Verstraete KL, Huysse WCJ. Health technology assessment of magnetic resonance imaging of the spine and bone marrow. Eur J Radiol 2008; 65:201-10. [PMID: 18093775 DOI: 10.1016/j.ejrad.2007.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 11/07/2007] [Indexed: 11/26/2022]
Abstract
The high spatial resolution and the lack of ionizing radiation, makes magnetic resonance imaging the method of choice for imaging most spinal pathology, especially if associated with neurological symptoms. However, due to the high sensitivity of MR imaging, careful correlation between imaging findings and clinical findings is important to ensure appropriate treatment. Substituting radiographic evaluations for rapid MRI in the primary care setting may offer little additional benefit to patients. It may even increase the costs of care but the decisions about the use of imaging depend on judgments concerning whether the small observed improvement in outcome justifies additional cost. Because the presence of an abscess is a major factor in deciding between conservative and surgical treatment, MRI plays an essential role in the decision-making process concerning the treatment of spondylodiscitis. MR is also the method of choice for quantitative evaluation of bone marrow in lymphoma patients when a crucial therapeutic decision has to be made or for the qualitative evaluation of the spinal cord if compression is suspected in primary spinal malignancy or metastatic disease.
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Affiliation(s)
- K L Verstraete
- Department of Radiology, Ghent University, De Pintelaan 185, B-9000 Gent, Belgium.
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8
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Kwee TC, Kwee RM, Verdonck LF, Bierings MB, Nievelstein RAJ. Magnetic resonance imaging for the detection of bone marrow involvement in malignant lymphoma. Br J Haematol 2008; 141:60-8. [DOI: 10.1111/j.1365-2141.2008.07020.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Ribrag V, Vanel D, Leboulleux S, Lumbroso J, Couanet D, Bonniaud G, Aupérin A, Masson F, Bosq J, Edeline V, Fermé C, Pigneur F, Schlumberger M. Prospective study of bone marrow infiltration in aggressive lymphoma by three independent methods: whole-body MRI, PET/CT and bone marrow biopsy. Eur J Radiol 2007; 66:325-31. [PMID: 17651934 DOI: 10.1016/j.ejrad.2007.06.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 04/02/2007] [Accepted: 06/15/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE Initial lymphoma staging requires bone marrow assessment in aggressive lymphomas. Bone marrow lymphoma infiltration is routinely assessed by bone marrow biopsy (BMB), considered as the "gold standard". The aim of this study was to compare the performance of BMB, whole-body MRI and PET/CT for evaluation of BM infiltration. METHODS Patients with newly diagnosed aggressive lymphoma were evaluated by BMB, MRI and PET/CT. Two radiologists, two nuclear medicine physicians and one pathologist independently assessed the results of the three modalities. Bone was considered as involved if BM was positive or if PET/CT or MRI was positive and if there was a resolution of the abnormal image shown on PET/CT or MRI halfway or at the end of therapy. RESULTS Both MRI and PET/CT detected bone marrow lesions in the 9/43 patients, but two patients with multiple lesions had more lesions detected by PET/CT compared to MRI. Among these nine patients, two with an iliac crest lesion detected by both MRI and PET/CT had bone marrow involvement with large-cell lymphoma on histological examination. The other seven patients had focal MRI and PET/CT lesions in areas other than the iliac crest, where the blind BMB was done. The other patients had bone marrow without large-cell lymphoma involvement. In all cases, after lymphoma therapy bone marrow involvement regressed on histological examination, PET and MRI. CONCLUSION These preliminary results suggest that non-invasive morphological procedures could be superior to BMB for bone marrow assessment in aggressive lymphomas. Ongoing study is underway to validate these results.
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Affiliation(s)
- Vincent Ribrag
- Department of Medicine, Institut Gustave Roussy, Villejuif, France.
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Alyas F, Saifuddin A, Connell D. MR Imaging Evaluation of the Bone Marrow and Marrow Infiltrative Disorders of the Lumbar Spine. Magn Reson Imaging Clin N Am 2007; 15:199-219, vi. [PMID: 17599640 DOI: 10.1016/j.mric.2007.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of MR imaging in assessing lumbar bone marrow first requires an understanding of the bone marrow's normal composition and the various imaging sequences available for use. One of the most useful sequences is the T1-weighted spin-echo sequence. This sequence may be combined with other sequences such as T2-weighted or diffusion-weighted sequences; techniques such as fat suppression, chemical shift imaging, and contrast-enhanced imaging are discussed. The varying features of normal lumbar marrow related to the normal physiologic changes that occur with aging and with changes in hematopoietic demand are important to understand and are described. The appearances of infiltrative marrow disease are explained on the basis of marrow composition and whether disease causes proliferation, replacement, or depletion of normal marrow components.
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Affiliation(s)
- Faisal Alyas
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London, UK, HA7 4LP
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11
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Nöbauer I, Uffmann M. Differential diagnosis of focal and diffuse neoplastic diseases of bone marrow in MRI. Eur J Radiol 2005; 55:2-32. [PMID: 15950098 DOI: 10.1016/j.ejrad.2005.01.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Revised: 01/20/2005] [Accepted: 01/26/2005] [Indexed: 11/18/2022]
Abstract
Magnetic resonance imaging (MRI) has become the preferred imaging modality for the evaluation of malignant disease in the bone marrow. Compared to bone marrow aspiration and biopsy, MRI is noninvasive and provides information by sampling a large volume of bone marrow. Due to disease-related alterations in the composition of bone marrow, MRI provides a very high sensitivity, but lacks specificity for most bone marrow disorders. However, MRI can be a very valuable diagnostic tool properly placed within the clinical context.
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Affiliation(s)
- Iris Nöbauer
- Allgemeines Krankenhaus Wien, Medizinuniversität Wien, Universitätsklinik für Radiodiagnostik, Währinger Gürtel 18-20, A-1090 Wien, Austria.
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12
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DeNardo G, Yuan A, Goldstein D, Richman C, O'Donnell R, Shen S, Hartmann Siantar C, DeNardo S. Impact of interpatient pharmacokinetic variability on design considerations for therapy with radiolabeled MAbs. Cancer Biother Radiopharm 2003; 18:231-7. [PMID: 12804049 DOI: 10.1089/108497803765036409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Radionuclides provide biologically-distributed vehicles for radiotherapy of multifocal cancer. Two algorithms, fixed vs individualized, have been used to prescribe the therapeutic dose of radionuclide (GBq) for the patient. The individualized method for prescribing radionuclide dose takes variations in drug pharmacokinetics into consideration, whereas the fixed method depends, in part, on documentation that there is little interpatient pharmacokinetic variability for the radiolabeled drug. Two data bases, selected to compare iodine-131((131)I) and indium-111((111)In) labeled MAbs, were used to assess interpatient pharmacokinetic variability and its impact on radionuclide dose prescription. Pharmacokinetic data obtained over 7 days for non-Hodgkins lymphoma (NHL) patients given (131)I-Lym-1 (n = 46) or (111)In-Lym-1 (n = 13) were used to obtain cumulated activities. Although (131)I-Lym-1 often showed greater interpatient variability, (111)In-Lym-1 showed several-fold variability for many tissues. Both (131)I- and (111)In-Lym-1 had sufficient interpatient variability to be significant for radionuclide dose prescription, depending on the dose-limiting critical tissue. Interpatient variability exceeded intra- and interoperator variability and intrapatient variability over time for a single institution. In summary, the magnitude of interpatient pharmacokinetic variability for (131)I- and (111)In-Lym-1 suggested that an optimally safe and effective therapy can be best achieved when radionuclide dose is influenced by estimated radiation dose, if the latter is reproducible from institution to institution.
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Affiliation(s)
- Gerald DeNardo
- Department of Internal Medicine, University of California Davis Medical Center, Sacramento 95816, USA.
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DeNardo GL, Siantar CLH, DeNardo SJ. Radiation dosimetry for radionuclide therapy in a nonmyeloablative strategy. Cancer Biother Radiopharm 2002; 17:107-18. [PMID: 11915167 DOI: 10.1089/10849780252824127] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Radionuclide therapy extends the usefulness of radiation from localized disease of multifocal disease by combining radionuclides with disease-seeking drugs, such as antibodies or custom-designed synthetic agents. Like conventional radiotherapy, the effectiveness of targeted radionuclides is ultimately limited by the amount of undesired radiation given to a critical, dose-limiting normal tissue, most often the bone marrow. Because radionuclide therapy relies on biological delivery of radiation, its optimization and characterization are necessarily different than for conventional radiation therapy. However, the principals of radiobiology and of absorbed radiation dose remain important for predicting radiation effects. Fortunately, most radionuclides emit gamma rays that allow the measurement of isotope concentrations in both tumor and normal tissues in the body. By administering a small "test dose" of the intended therapeutic drug, the clinician can predict the radiation dose distribution in the patient. This can serve as a basis to predict therapy effectiveness, optimize drug selection, and select the appropriate drug dose, in order to provide the safest, most effective treatment for each patient. Although treatment planning for individual patients based upon tracer radiation dosimetry is an attractive concept and opportunity, practical considerations may dictate simpler solutions under some circumstances. There is agreement that radiation dosimetry (radiation absorbed dose distribution, cGy) should be utilized to establish the safety of a specific radionuclide drug during drug development, but it is less generally accepted that absorbed radiation dose should be used to determine the dose of radionuclide (radioactivity, GBq) to be administered to a specific patient (i.e., radiation dose-based therapy). However, radiation dosimetry can always be utilized as a tool for developing drugs, assessing clinical results, and establishing the safety of a specific radionuclide drug. Bone marrow dosimetry continues to be a "work in progress." Blood-derived and/or body-derived marrow dosimetry may be acceptable under specific conditions but clearly do not account for marrow and skeletal targeting of radionuclide. Marrow dosimetry can be expected to improve significantly but no method for marrow dosimetry seems likely to account for decreased bone marrow reserve.
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Affiliation(s)
- Gerald L DeNardo
- Division of Hematology/Oncology, University of California Davis Medical Center, Sacramento, California, USA.
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DeNardo GL, Juweid ME, White CA, Wiseman GA, DeNardo SJ. Role of radiation dosimetry in radioimmunotherapy planning and treatment dosing. Crit Rev Oncol Hematol 2001; 39:203-18. [PMID: 11418317 DOI: 10.1016/s1040-8428(01)00109-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cancer-seeking antibodies (Abs) carrying radionuclides can be powerful drugs for delivering radiotherapy to cancer. As with all radiotherapy, undesired radiation dose to critical organs is the limiting factor. It has been proposed that optimization of radioimmunotherapy (RIT), that is, maximization of therapeutic efficacy and minimization of normal tissue toxicity, depends on a foreknowledge of the radiation dose distributions to be expected. The necessary data can be acquired by established tracer techniques, in individual patients, using quantitative radionuclide imaging. Object-oriented software systems for estimating internal emitter radiation doses to the tissues of individual patients (patient-specific radiation dosimetry), using computer modules, are available for RIT, as well as for other radionuclide therapies. There is general agreement that radiation dosimetry (radiation absorbed dose distribution, cGy) should be utilized to establish the safety of RIT with a specific radiolabeled Ab in the early stages (i.e. phase I or II) of drug evaluation. However, it is less well established that radiation dose should be used to determine the radionuclide dose (amount of radioactivity, GBq) to be administered to a specific patient (i.e. radiation dose-based therapy). Although treatment planning for individual patients based upon tracer radiation dosimetry is an attractive concept and opportunity, particularly for multimodality RIT with intent to cure, practical considerations may dictate simpler solutions under some circumstances.
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Affiliation(s)
- G L DeNardo
- Room 3100, Hematology/Oncology, University of California, Davis Medical Center, 1508 Alhambra Blvd., Sacramento, CA 95816, USA.
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Takagi S, Tsunoda S, Tanaka O. Bone marrow involvement in lymphoma: the importance of marrow magnetic resonance imaging. Leuk Lymphoma 1998; 29:515-22. [PMID: 9643565 DOI: 10.3109/10428199809050911] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Detection of bone marrow involvement is important for staging and treatment decisions in patients with lymphoma. Although routine bone marrow evaluation is based on aspirates and bone marrow biopsies, new diagnostic tools are required to improve diagnostic accuracy. Visual and quantitative assessment of the bone marrow by magnetic resonance (MR) imaging is useful for the detection of occult lymphomatous marrow involvement. MRI is also suitable for the evaluation of disease extent in the bone marrow. Furthermore, abnormal images on marrow MRI may be associated with a significantly poorer survival in patients with lymphoma, regardless of histologic findings in the marrow. Evaluation of the bone marrow by MRI is essential to assess disease status in patients with lymphoma.
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Affiliation(s)
- S Takagi
- Division of Hematology and Department of Radiology, Omiya Medical Center, Jichi Medical School, Omiya Saitama, Japan
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DeNardo DA, DeNardo GL, O'Donnell RT, Lim SM, Shen S, Yuan A, DeNardo SJ. Imaging for improved prediction of myelotoxicity after radioimmunotherapy. Cancer 1997. [DOI: 10.1002/(sici)1097-0142(19971215)80:12+<2558::aid-cncr31>3.0.co;2-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tardivon AA, Vanel D, Munck JN, Bosq J. Magnetic resonance imaging of the bone marrow in lymphomas and leukemias. Leuk Lymphoma 1997; 25:55-68. [PMID: 9130614 DOI: 10.3109/10428199709042496] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article reviews MRI techniques and results in the assessment of bone marrow in patients with lymphoma. MRI is more sensitive than blind biopsy (BB) in detecting bone marrow invasion. False-negative results have been reported in low-grade non Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia. Bone marrow imaging is particularly indicated in patients with Hodgkin's disease, high grade NHL or myelocytic leukemia, with a negative BB and abnormal clinical (stage B, bone pains) or biochemical data (elevated alkaline phosphatase) and who have relapsed. During treatment. MR imaging is a valuable tool for the evaluation of response and the diagnosis of benign bone marrow complications. Knowledge of post-therapeutic patterns is essential to avoid misinterpretations. The main drawback with this technique is its inability to differentiate residual lesions from fibrosis and needle guided-biopsy is mandatory if treatment decision-making relies on the MR result, alone.
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Affiliation(s)
- A A Tardivon
- Department of Radiology, Institut Gustave Roussy, Villejuif, France
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