Bone marrow magnetic resonance imaging of the clivus in pediatric leukemia patients and normal controls

An MRI-based pre-test to determine the probability of pediatric leukemia prior to bone marrow aspiration would be useful to prevent unnecessary exposure to this invasive test. We aimed to evaluate the clivus-to-pons signal intensity ratio (CPR) and visual scoring (VS) on T1-weighted images (T1WI) and diffusion-weighted images (DWI) to distinguish pediatric leukemia patients from normal controls.

We retrospectively reviewed 1.5-T brain MR images of 13 consecutive leukemia patients (3 girls, 10 boys; mean age, 8.23 years; range, 1-17 years) and 40 age- and gender-matched normal controls. We evaluated differences between leukemia patients and normal controls using Wilcoxon rank-sum and Mann-Whitney U tests with respect to the following parameters: (1) CPR on T1WI (CPRT1WI); (2) CPR on DWI (CPRDWI); (3) VS on T1WI (VST1WI); and (4) VS on DWI (VSDWI).

The CPRT1WI values for leukemia patients and normal controls were 0.77 ± 0.12 and 1.39 ± 0.47, respectively (P < 0.001). The corresponding CPRDWI values were 1.03 ± 0.38 and 0.50 ± 0.17, respectively (P < 0.001). VST1WI and VSDWI were significantly different between the groups (P < 0.001 for both).

MRI-based quantitative and qualitative analyses of clival bone marrow on T1WI and DWI can distinguish pediatric leukemia patients from normal subjects.