Differential Diagnosis of Myelodysplastic Syndrome and Aplastic Anemia using MRI

PURPOSE: To assess the patterns of myelodysplastic syndrome(MDS) and aplastic anemia(AA) on MRI of the spinal bone marrow and to find the differential points between the two groups. MATERIALS AND METHODS: Fourteen patients with MDS(n=7) and AA(n=7) were studied using magnetic resonance imaging. Sagittal images from the lower thoracic and lumbar vertebral marrow were evaluated on Tl-weighted and STIR images. Five distinct patterns of signal intensity of the Tl-weighted and STIR images were classified. T1 and T2 relaxation times and T1 marrow/fat signal intensity ratio were measured and analyzed (t-test). The cellularity of bone marrow was evaluated on histologic slides. RESULTS: MDS showed homogeneously low signal intensity on T1WI and high signal intensity on STIR image, indicating hypercellular marrow, whereas AA showed relative high signal intensity on T1WI and low signal intensity on STIR image, representing fatty marrow. T1 and T2 relaxation time(T1 for MDS=750.26msec +/- 177.50, T1 for AA= 413.21 msec +/- 167.39 (p<0.000), T2 for MDS=91.86 msec +/- 14.16, T2 for AA=81.44msec +/- 15.31 (p< 0.001) and T1 marrow/fat signal intensity ratio(0.22 +/- 0.048 in MDS, 0.30 +/- 0.083 in AA(p<0.000)) revealed statistically significant difference between the two groups. CONCLUSION: Although the marrow aspiration and needle biopsy are mandatory in hematologic disease for diagnosis, there are limited in assessing the change of total marrow mass. Therefore MRI of bone marrow might be useful in distinguishing MDS from AA because of its ability of representation of total marrow mass.

Differential Diagnosis of Myelodysplastic Syndrome and Aplastic Anemia using MRI

PURPOSE: To assess the patterns of myelodysplastic syndrome(MDS) and aplastic anemia(AA) on MRI of the spinal bone marrow and to find the differential points between the two groups. MATERIALS AND METHODS: Fourteen patients with MDS(n=7) and AA(n=7) were studied using magnetic resonance imaging. Sagittal images from the lower thoracic and lumbar vertebral marrow were evaluated on Tl-weighted and STIR images. Five distinct patterns of signal intensity of the Tl-weighted and STIR images were classified. T1 and T2 relaxation times and T1 marrow/fat signal intensity ratio were measured and analyzed (t-test). The cellularity of bone marrow was evaluated on histologic slides. RESULTS: MDS showed homogeneously low signal intensity on T1WI and high signal intensity on STIR image, indicating hypercellular marrow, whereas AA showed relative high signal intensity on T1WI and low signal intensity on STIR image, representing fatty marrow. T1 and T2 relaxation time(T1 for MDS=750.26msec +/- 177.50, T1 for AA= 413.21 msec +/- 167.39 (p<0.000), T2 for MDS=91.86 msec +/- 14.16, T2 for AA=81.44msec +/- 15.31 (p< 0.001) and T1 marrow/fat signal intensity ratio(0.22 +/- 0.048 in MDS, 0.30 +/- 0.083 in AA(p<0.000)) revealed statistically significant difference between the two groups. CONCLUSION: Although the marrow aspiration and needle biopsy are mandatory in hematologic disease for diagnosis, there are limited in assessing the change of total marrow mass. Therefore MRI of bone marrow might be useful in distinguishing MDS from AA because of its ability of representation of total marrow mass.

Small atypically redistributed pleural effusion in upper lobe collapse: An auxiliary differential feature of bronchogenic carcinoma and pulmonary tuberculosis

We reviewed the computed tomography (CT) of 32 patients with upper lobe collapse to assess the significance of small atypically redistributed pleural effusion (ARPE) in distinguishing the bronchogenic carcinoma (BC) form tuberculosis (TB). Upper lobe collapse was caused by BC in 21 and by TB in 11 of the 32 patients. Small ARPE was Present in 14 of 21 patients with BC and two of the 11 patients with TB, Among 16 patients with small ARPE, CT showd mediastinal invasion in 11 (69%) patients and mediastinal lymphadenopathyn 6 (38%). Our results suggest that small ARPE associated with upper lobe collapse can be used a an auxiliary sign in the differential diagnosis between BC and TB.

Comparison of Tc-99m-HMPAO SPECT and MRI in cerebral infarction

Cerebral infarction is caused by decreased perfusion to the brain. In the evaluation of the infarction, CT has been widely used but MRI ans SPECT recently tend to increase in use. The purpose of this study is to compare the efficacy of MR imaging with that of 99mTc-hexamethylpropylene amine(HMPAO) single photon emission computed tomography(SPECT) in the patients with cerebral infarction in the points of (1) number of detected lesion, (2) size of the lesion, and (3) correlation with clinical neurologic deficits. Sixty-one patients with cerebral infarctions(acute: 23, subacute:30, chronic:8) were reviewed. In all patients, MRI and corresponding 99mTc-HMPAO SPECT examinations were performed within a reasonable time span. We analyzed the fiadings of (1) clinical neurologic examination, (2) MR and, (3) Tc-99m-HMPAO SPECT independently they were compared later on. The lesion of SPECT was larger than the seen on MRI in 9 of 23 acute cases, 13 of 30 subacute cases, and 3 of 8 chronic cases. The lesion on MRI was larger than that on SPECT in seven acute cases, six subacute, and only one case in chronic stage. In the remaining cases, the size of the lesion was similar to that on both SPECT and MRI. For the detection of lesion, MRI was superior to SPECT in 15 acute cases, 13 subacute cases, and four chronic cases, while SPECT was super or to MRI in four of 30 cases at subacute stage, and one of 8 cases at chronic stage. In conclusion, there was a tendency that the detection rate of the lesion was higher on MRI but the lesion was larger on SPECT. The lesions detected on both MRI and SPECT correlated well with clinical symptoms.

Radiation Treatment of Postmastectomy Lymphangiosarcoma / 대한치료방사선과학회지

Since the entity of postmastectomy lymphangiosarcoma was first reported by Stewart and Traves in 1948, postmastectomy lymphangiosarcoma has become a well recognized, uncommon malignant tumor which occurs in the upper extremity following mastectomy for mammary carcinoma. The postmastectomy lymphangiosarcoma occurred at an average age of 63.9 years and at an average of 10 years and 3 months following mastectomy. The lymphangiosarcoma raised from blood and lymphatic vessel. The histologic appearance has been observed edematous dermis and dilated lymphatics lining with malignant cells. Most authors recommend radical amputation for treatment, either shoulder disarticulation or forequarter amputation. Other modalities of treatment including radiotherapy were considered as ineffective. The present report provides a case of the regression of postmastectomy lymphangiosarcoma with chronic lymphedima by external irradiation. Radiation therapy was used as primary therapy. Total tumor dose of 6500 cgy in 9 weeks was delivered using 6 MV x-ray and 8 MeV electron.