MR features of primary bone lymphoma in children

Primary lymphoma of bone is an uncommon non-Hodgkin lymphoma. Magnetic resonance imaging (MRI) features of primary lymphoma of bone in children are not well described.

To identify typical MRI characteristics of pediatric primary lymphoma of bone at diagnosis and following treatment.

Two pediatric radiologists retrospectively reviewed all imaging studies of 10 patients with biopsy-proven primary lymphoma of bone at presentation and after treatment. Anatomic location, number of sites, location within bone (epiphyseal, metaphyseal, diaphyseal), T1-weighted imaging margins, soft tissue mass, T2-weighted imaging appearance and enhancement pattern (homogeneous, heterogeneous, infarct-like), soft tissue edema, cortical disruption, and regional lymph nodes as seen on MRI as well as radiographic and positron emission tomography (PET) findings were recorded. Pathologic results, treatment plans, and outcomes at follow-up as detailed in the medical record were tabulated.

Of 10 patients, age at diagnosis 8-17 years, median 15 years, 4 (40%) had multifocal disease. MRI revealed 20 total lesions in the 10 patients with femoral lesions most common, being present in 7 (70%) of patients. Eight (80%) patients had at least one lesion around the knee. Eight (80%) patients had 1 or more lesions involving an epiphysis and 5 (50%) had at least 1 lesion confined to the epiphysis. Seven (70%) showed infarct-like appearance on T2-weighted imaging; 7 (88%) of the 8 patients with post-contrast imaging had infarct-like enhancement. Six (60%) had sharp T1 margins, 3 (30%) had cortical disruption, 8 (80%) had at least mild soft tissue edema, and 1 (10%) had soft tissue mass. Three (30%) had at least 1 PET-positive regional lymph node. At follow-up (range 1-108 months, median 4.3 months), all had residual osseous abnormality on MRI with 6 (60%) maintaining an infarct-like or combination of infarct-like and T2 hyperintense appearance.

Our results in this series of pediatric primary lymphoma of bone identified several frequent MR imaging features. Multifocality, epiphyseal involvement (especially about the knee), infarct-like enhancement pattern, sharp T1 margins, and surrounding soft tissue edema should raise suspicion for primary lymphoma of bone. Following treatment, residual osseous abnormality is expected on MRI.