Magnetic resonance imaging of femoral marrow in patients with myelodysplastic syndromes or leukemia

We evaluated magnetic resonance imaging (MRI) of femoral marrow in 85 untreated adult patients with myelodysplastic syndromes (MDS) (N = 27), aplastic anemia (N = 9), and leukemia (N = 49). Images of femoral marrow were obtained using a T1-weighted spin-echo (SE) method and a short T1 inversion recovery (STIR) technique. In patients with MDS, the change in MRI pattern from a fatty or nodular pattern to a uniform pattern correlated with disease progression. Evolution to acute leukemia in MDS patients was associated with a higher signal intensity on STIR images (lower signal intensity on T1-weighted SE images) and an extended area of involvement. The femoral marrow in patients with de novo acute myeloid leukemia (AML) showed increased signal and varied patterns (scattered to uniform) on STIR images. However, the faint pattern (grade 4a) was characteristic of M2 AML. In patients with chronic myelogenous leukemia (CML) in the chronic phase, increased leukemic mass was represented by replacement of the femoral marrow with a region of abnormal signal intensity. The extent of involved areas in these CML patients correlated with the spleen size. This study indicates that MRI of femoral marrow is an important tool for the accurate diagnosis and management of patients with MDS and leukemia that may function as an adjunct to bone marrow aspiration and biopsy.