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Magnetic resonance imaging for evaluation of childhood aplastic anemia
V S Kanwar1, W C Wang, H T Winer-Muram
1Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38101-0318, USA.
Insights
Magnetic resonance imaging (MRI) of the thoraco-lumbar spine can assess bone marrow activity in children with aplastic anemia. Short T1 inversion recovery (STIR) MRI effectively reflects marrow cellularity and peripheral blood counts.
Area of Science:
- Pediatric Hematology
- Radiology
- Medical Imaging
Background:
- Aplastic anemia is a rare but serious condition characterized by bone marrow failure.
- Accurate assessment of bone marrow cellularity and hematopoietic status is crucial for managing pediatric aplastic anemia.
- Noninvasive imaging techniques are desirable for monitoring disease progression and treatment response.
Purpose of the Study:
- To evaluate the utility of thoraco-lumbar spine magnetic resonance imaging (MRI) in quantifying red and fatty marrow in children with aplastic anemia.
- To correlate MRI findings with bone marrow biopsy cellularity and peripheral blood counts.
Main Methods:
- Prospective evaluation of 20 pediatric patients (ages 1-19) with aplastic anemia.
- T1-weighted (T1W) and short T1 inversion recovery (STIR) MRI of the thoraco-lumbar spine were performed.
- Comparison of MRI grading with bone marrow (BM) biopsy cellularity and peripheral blood counts (absolute neutrophil count [ANC], absolute reticulocyte count [ARC], platelet count).
Main Results:
- STIR MRI grading showed significant association with BM biopsy cellularity (p = 0.032), ANC (p = 0.044), ARC (p = 0.007), and platelet count (p = 0.003).
- T1W MRI grade was significantly associated with ANC (p = 0.011) but not ARC or platelet count.
- BM biopsy cellularity correlated with ANC (p = 0.032) and ARC (p = 0.036).
Conclusions:
- STIR MRI of the thoraco-lumbar spine is a valuable noninvasive tool for assessing bone marrow activity in pediatric aplastic anemia.
- MRI findings correlate with both bone marrow biopsy cellularity and peripheral blood counts, offering a comprehensive measure of hematopoietic status.
- T1W MRI also shows potential, though STIR appears more robust for this patient cohort.
Purpose:
We prospectively evaluated the ability of magnetic resonance imaging (MRI) of the thoraco-lumbar vertebrae to determine the relative amount of red and fatty marrow in children with aplastic anemia.
Patients And Methods:
Twenty pediatric patients (ages 1-19 years) with aplastic anemia underwent T1-weighted (T1W, n = 31) and short T1 inversion recovery (STIR, n = 30) MRI of the midline sagittal thoraco-lumbar spine. Bone marrow (BM) biopsies from the posterior iliac crest (n = 29) were also performed. All studies were evaluated by blinded observers; MR grading was based on visual inspection of signal intensity. Biopsy-estimated cellularity was compared with T1W and STIR grading when these were performed within 14 days of each other (n = 16). All studies were compared to a simultaneous absolute neutrophil count (ANC), absolute reticulocyte count (ARC), and platelet count.
Results:
BM cellularity estimated by BM biopsy was significantly associated with STIR grading (p = 0.032, Jonckheere-Terpstra test), as were peripheral ANC (p = 0.044), ARC (p = 0.007), and platelet count (p = 0.003). T1W grade was significantly associated with ANC (P = 0.011) but not ARC (p = 0.053) or platelet count (p = 0.377). Biopsy-estimated cellularity was associated with ANC (p = 0.032) and ARC (p = 0.036), but not platelet count (p = 0.282).
Conclusion:
In childhood aplastic anemia patients, STIR (and, to a lesser extent, T1W) MRI of the thoraco-lumbar spine reflects BM activity, as measured by peripheral blood ANC, ARC, and platelet count, and BM cellularity, as measured by BM biopsy. MRI may thus provide a noninvasive measure of hematopoietic status.