Bone marrow MR imaging in the initial staging of small-cell lung cancer

This paper evaluates prospectively the staging implications of bone marrow MR imaging in the initial staging of small-cell lung cancer (SCLC). Fifty patients with histologically verified SCLC were examined for possible bone marrow infiltration using a 1.5-T whole-body system (Magnetom SP, Siemens). The MR imaging protocol included contiguous coronal 5-mm sections, including the region from the lumbar spine down to the proximal femora (FOV, 50 cm) using a T1-weighted sequence (SE, 600/15). In doubtful cases, T2-weighted, contrast-enhanced, and chemical shift images were obtained. All patients simultaneously underwent routine clinical staging procedures, including radionuclide bone scan and unilateral crest biopsy. All bone or bone marrow lesions detected with iliac crest biopsy (n = 6) and radionuclide bone scan (n = 8) were also depicted by MR imaging. In addition, MR imaging revealed 14 hypointense bone marrow foci not found in the conventional staging. In 10 patients this meant a conversion from limited to extensive stage of disease. The MR imaging diagnosis was confirmed in all cases that came to autopsy