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

The aim of this study was two-fold: to compare 67 Ga 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 67 Ga 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%. 67 Ga scintigraphy 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 67 Ga 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 67 Ga scintigraphy but the limited specificity of MRI and sensitivity of 67 Ga scintigraphy, both methods are valuable but should be used as complementary diagnostic tools.