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Staging and Monitoring of Malignant Lymphoma of the Bone: Comparison of ⁶⁷Ga Scintigraphy and MRI

The Strahlenklinik und Poliklinik, Medizinische Fakultät Charité der Humboldt Universität zu Berlin, Virchow-Klinikum, Berlin
Department of Hematology, Oncology and Tumor Immunology, Robert-Roessle-Klinik, Virchow-Klinikum, Humboldt Universität zu Berlin, Germany

Correspondence: For correspondence or reprints contact: Christian Stroszczynski, MD, Strahlenklinik und Poliklinik, Medizinische Fakultät Charité der Humboldt Universität zu Berlin, Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.

ABSTRACT

The aim of this study was two-fold: to compare ⁶⁷Ga scintigraphy with MRI (a) for the staging of malignant lymphoma of the bone and (b) with regard to accuracy in detecting residual disease after first-line chemotherapy for restaging. Methods: Twenty-one patients with 36 malignant osseous lesions were examined, including 7 patients with primary or multifocal osseous lymphoma and 14 patients with malignant lymphoma and simultaneous or secondary involvement of the bone. After first-line therapy, MRI and ⁶⁷Ga scintigraphy were performed on 13 patients. The remission status based on all clinical and radiological findings during the follow-up was used as the gold standard. Results: The osseous lesions were located on the axial skeleton in 64% of patients and on the appendicular skeleton in 36%. ⁶⁷Gascintigraphy detected 77% of the osseous lesions examined by MRI for restaging after first-line therapy, MRI had a sensitivity of 90% and a specificity of 80% when dynamic MRI information was included. There were several false-positive results as a result of the pathologic increase in signal intensity ratios of reactive hematopoietic regions after chemotherapy. For ⁶⁷Ga scintigraphy, a sensitivity of 70% and a specificity of 93% were calculated. Conclusion: These data show that monitoring malignant lymphoma of the bone still presents diagnostic problems. Given the high sensitivity of MRI and the high specificity of ⁶⁷Ga scintigraphy but the limited specificity of MRI and sensitivity of ⁶⁷Ga scintigraphy, both methods are valuable but should be used as complementary diagnostic tools.

Key Words: bone neoplasms • lymphoma • radionuclide studies • MRI

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