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Fast STIR Whole-Body MR Imaging in Children¹

¹ From the Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada. Presented as an education exhibit at the 2003 RSNA scientific assembly. Received March 17, 2004; revision requested April 14 and received May 13; accepted May 13. All authors have no financial relationships to disclose. Address correspondence to C.J.K., Department of Radiology and Magnetic Resonance, University Children’s Hospital Zurich, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland (e-mail: c_kellenberger@yahoo.co.uk).

View larger version (151K): [in a new window]   Figure 1a.  Fast SE STIR images of a 1-month-old girl before (a) and after (b) administration of gadolinium. Normally bright renal parenchyma decreases in signal because of the T1-shortening effect of gadolinium (negative enhancement effect). Pathologic lesions that take up gadolinium may similarly decrease in signal and become inconspicuous on contrast material-enhanced fast SE STIR images.

View larger version (140K): [in a new window]   Figure 1b.  Fast SE STIR images of a 1-month-old girl before (a) and after (b) administration of gadolinium. Normally bright renal parenchyma decreases in signal because of the T1-shortening effect of gadolinium (negative enhancement effect). Pathologic lesions that take up gadolinium may similarly decrease in signal and become inconspicuous on contrast material-enhanced fast SE STIR images.

View larger version (45K): [in a new window]   Figure 2a.  Normal fast SE STIR whole-body MR images of a 5-year-old girl. Fluid, such as cerebrospinal fluid or contents of the gallbladder or bladder, has the highest signal intensity on STIR images (a, b). Hematopoietic marrow, seen in the central skeleton and proximal femoral metaphyses, is isointense or slightly hyperintense relative to muscle (b, c). Fatty marrow, seen in epiphyses and diaphyses of the lower extremities, is isointense relative to subcutaneous tissue (d). All lymphatic tissue, including the thymus and spleen, exhibits high signal intensity. Normal adenoids, tonsils, and lymph nodes are readily visible (arrows in a, b).

View larger version (58K): [in a new window]   Figure 2b.  Normal fast SE STIR whole-body MR images of a 5-year-old girl. Fluid, such as cerebrospinal fluid or contents of the gallbladder or bladder, has the highest signal intensity on STIR images (a, b). Hematopoietic marrow, seen in the central skeleton and proximal femoral metaphyses, is isointense or slightly hyperintense relative to muscle (b, c). Fatty marrow, seen in epiphyses and diaphyses of the lower extremities, is isointense relative to subcutaneous tissue (d). All lymphatic tissue, including the thymus and spleen, exhibits high signal intensity. Normal adenoids, tonsils, and lymph nodes are readily visible (arrows in a, b).

View larger version (118K): [in a new window]   Figure 2c.  Normal fast SE STIR whole-body MR images of a 5-year-old girl. Fluid, such as cerebrospinal fluid or contents of the gallbladder or bladder, has the highest signal intensity on STIR images (a, b). Hematopoietic marrow, seen in the central skeleton and proximal femoral metaphyses, is isointense or slightly hyperintense relative to muscle (b, c). Fatty marrow, seen in epiphyses and diaphyses of the lower extremities, is isointense relative to subcutaneous tissue (d). All lymphatic tissue, including the thymus and spleen, exhibits high signal intensity. Normal adenoids, tonsils, and lymph nodes are readily visible (arrows in a, b).

View larger version (117K): [in a new window]   Figure 2d.  Normal fast SE STIR whole-body MR images of a 5-year-old girl. Fluid, such as cerebrospinal fluid or contents of the gallbladder or bladder, has the highest signal intensity on STIR images (a, b). Hematopoietic marrow, seen in the central skeleton and proximal femoral metaphyses, is isointense or slightly hyperintense relative to muscle (b, c). Fatty marrow, seen in epiphyses and diaphyses of the lower extremities, is isointense relative to subcutaneous tissue (d). All lymphatic tissue, including the thymus and spleen, exhibits high signal intensity. Normal adenoids, tonsils, and lymph nodes are readily visible (arrows in a, b).

View larger version (104K): [in a new window]   Figure 3a.  Anaplastic large cell lymphoma in a 9-year-old boy. (a) Fast SE STIR whole-body MR image demonstrates a cortical bone lesion with increased marrow signal intensity in the right tibia (arrow) and two additional small bright subcutaneous lesions (arrowheads). (b) US scan shows that these subcutaneous lesions represent solid hypoechoic nodules, which subsequently were proved to be lymphomatous at biopsy. (c) Lateral radiograph of the right tibia demonstrates cortical destruction (arrow). (d) Anterior view from gallium 67 scintigraphy shows tracer uptake in the tibial lesion (arrow) and in one soft-tissue nodule (arrowhead).

View larger version (127K): [in a new window]   Figure 3b.  Anaplastic large cell lymphoma in a 9-year-old boy. (a) Fast SE STIR whole-body MR image demonstrates a cortical bone lesion with increased marrow signal intensity in the right tibia (arrow) and two additional small bright subcutaneous lesions (arrowheads). (b) US scan shows that these subcutaneous lesions represent solid hypoechoic nodules, which subsequently were proved to be lymphomatous at biopsy. (c) Lateral radiograph of the right tibia demonstrates cortical destruction (arrow). (d) Anterior view from gallium 67 scintigraphy shows tracer uptake in the tibial lesion (arrow) and in one soft-tissue nodule (arrowhead).

View larger version (79K): [in a new window]   Figure 3c.  Anaplastic large cell lymphoma in a 9-year-old boy. (a) Fast SE STIR whole-body MR image demonstrates a cortical bone lesion with increased marrow signal intensity in the right tibia (arrow) and two additional small bright subcutaneous lesions (arrowheads). (b) US scan shows that these subcutaneous lesions represent solid hypoechoic nodules, which subsequently were proved to be lymphomatous at biopsy. (c) Lateral radiograph of the right tibia demonstrates cortical destruction (arrow). (d) Anterior view from gallium 67 scintigraphy shows tracer uptake in the tibial lesion (arrow) and in one soft-tissue nodule (arrowhead).

View larger version (102K): [in a new window]   Figure 3d.  Anaplastic large cell lymphoma in a 9-year-old boy. (a) Fast SE STIR whole-body MR image demonstrates a cortical bone lesion with increased marrow signal intensity in the right tibia (arrow) and two additional small bright subcutaneous lesions (arrowheads). (b) US scan shows that these subcutaneous lesions represent solid hypoechoic nodules, which subsequently were proved to be lymphomatous at biopsy. (c) Lateral radiograph of the right tibia demonstrates cortical destruction (arrow). (d) Anterior view from gallium 67 scintigraphy shows tracer uptake in the tibial lesion (arrow) and in one soft-tissue nodule (arrowhead).

View larger version (60K): [in a new window]   Figure 4a.  Initial staging in a 13-year-old girl with stage IV Hodgkin disease. (a, b) Fast SE STIR whole-body MR images demonstrate lymphomatous involvement as evidenced by enlarged hilar, mediastinal, and axillary lymph nodes (arrowheads in a), nodular thymus (arrowhead in b), and a hypointense focal splenic lesion (large arrow in b). Multifocal bone marrow lesions are seen in the spine, pelvis, and right femur (small arrows). (c, d) Contrast-enhanced CT images show enlarged lymph nodes, a nodular thymus, and a focal lesion in the spleen (arrow in d). (e) Anterior view from 67Ga scintigraphy helps confirm nodal involvement, seen as increased tracer uptake in left axillary and mediastinal lymph nodes (arrowheads). Skeletal involvement is visible only in the sacrum (arrows); the other bone marrow lesions seen on MR images are not evident. Results from a previous blind bone marrow biopsy had been negative.

View larger version (109K): [in a new window]   Figure 4b.  Initial staging in a 13-year-old girl with stage IV Hodgkin disease. (a, b) Fast SE STIR whole-body MR images demonstrate lymphomatous involvement as evidenced by enlarged hilar, mediastinal, and axillary lymph nodes (arrowheads in a), nodular thymus (arrowhead in b), and a hypointense focal splenic lesion (large arrow in b). Multifocal bone marrow lesions are seen in the spine, pelvis, and right femur (small arrows). (c, d) Contrast-enhanced CT images show enlarged lymph nodes, a nodular thymus, and a focal lesion in the spleen (arrow in d). (e) Anterior view from 67Ga scintigraphy helps confirm nodal involvement, seen as increased tracer uptake in left axillary and mediastinal lymph nodes (arrowheads). Skeletal involvement is visible only in the sacrum (arrows); the other bone marrow lesions seen on MR images are not evident. Results from a previous blind bone marrow biopsy had been negative.

View larger version (66K): [in a new window]   Figure 4c.  Initial staging in a 13-year-old girl with stage IV Hodgkin disease. (a, b) Fast SE STIR whole-body MR images demonstrate lymphomatous involvement as evidenced by enlarged hilar, mediastinal, and axillary lymph nodes (arrowheads in a), nodular thymus (arrowhead in b), and a hypointense focal splenic lesion (large arrow in b). Multifocal bone marrow lesions are seen in the spine, pelvis, and right femur (small arrows). (c, d) Contrast-enhanced CT images show enlarged lymph nodes, a nodular thymus, and a focal lesion in the spleen (arrow in d). (e) Anterior view from 67Ga scintigraphy helps confirm nodal involvement, seen as increased tracer uptake in left axillary and mediastinal lymph nodes (arrowheads). Skeletal involvement is visible only in the sacrum (arrows); the other bone marrow lesions seen on MR images are not evident. Results from a previous blind bone marrow biopsy had been negative.

View larger version (95K): [in a new window]   Figure 4d.  Initial staging in a 13-year-old girl with stage IV Hodgkin disease. (a, b) Fast SE STIR whole-body MR images demonstrate lymphomatous involvement as evidenced by enlarged hilar, mediastinal, and axillary lymph nodes (arrowheads in a), nodular thymus (arrowhead in b), and a hypointense focal splenic lesion (large arrow in b). Multifocal bone marrow lesions are seen in the spine, pelvis, and right femur (small arrows). (c, d) Contrast-enhanced CT images show enlarged lymph nodes, a nodular thymus, and a focal lesion in the spleen (arrow in d). (e) Anterior view from 67Ga scintigraphy helps confirm nodal involvement, seen as increased tracer uptake in left axillary and mediastinal lymph nodes (arrowheads). Skeletal involvement is visible only in the sacrum (arrows); the other bone marrow lesions seen on MR images are not evident. Results from a previous blind bone marrow biopsy had been negative.

View larger version (59K): [in a new window]   Figure 4e.  Initial staging in a 13-year-old girl with stage IV Hodgkin disease. (a, b) Fast SE STIR whole-body MR images demonstrate lymphomatous involvement as evidenced by enlarged hilar, mediastinal, and axillary lymph nodes (arrowheads in a), nodular thymus (arrowhead in b), and a hypointense focal splenic lesion (large arrow in b). Multifocal bone marrow lesions are seen in the spine, pelvis, and right femur (small arrows). (c, d) Contrast-enhanced CT images show enlarged lymph nodes, a nodular thymus, and a focal lesion in the spleen (arrow in d). (e) Anterior view from 67Ga scintigraphy helps confirm nodal involvement, seen as increased tracer uptake in left axillary and mediastinal lymph nodes (arrowheads). Skeletal involvement is visible only in the sacrum (arrows); the other bone marrow lesions seen on MR images are not evident. Results from a previous blind bone marrow biopsy had been negative.

View larger version (161K): [in a new window]   Figure 5a.  Stage IV thoracic neuroblastoma in a 4-year-old boy. (a) Chest radiograph shows a posterior mediastinal mass (arrowheads). (b) Axial contrast-enhanced T1-weighted fat-saturated image demonstrates involvement of the spinal canal and vertebral body. (c, d) Fast SE STIR whole-body MR images demonstrate a paraspinal mass (arrowheads) and multiple focal bone marrow lesions (arrows) that were not present on bone (e) or metaiodobenzylguanidine (MIBG) (f) scintigrams.

View larger version (123K): [in a new window]   Figure 5b.  Stage IV thoracic neuroblastoma in a 4-year-old boy. (a) Chest radiograph shows a posterior mediastinal mass (arrowheads). (b) Axial contrast-enhanced T1-weighted fat-saturated image demonstrates involvement of the spinal canal and vertebral body. (c, d) Fast SE STIR whole-body MR images demonstrate a paraspinal mass (arrowheads) and multiple focal bone marrow lesions (arrows) that were not present on bone (e) or metaiodobenzylguanidine (MIBG) (f) scintigrams.

View larger version (76K): [in a new window]   Figure 5c.  Stage IV thoracic neuroblastoma in a 4-year-old boy. (a) Chest radiograph shows a posterior mediastinal mass (arrowheads). (b) Axial contrast-enhanced T1-weighted fat-saturated image demonstrates involvement of the spinal canal and vertebral body. (c, d) Fast SE STIR whole-body MR images demonstrate a paraspinal mass (arrowheads) and multiple focal bone marrow lesions (arrows) that were not present on bone (e) or metaiodobenzylguanidine (MIBG) (f) scintigrams.

View larger version (82K): [in a new window]   Figure 5d.  Stage IV thoracic neuroblastoma in a 4-year-old boy. (a) Chest radiograph shows a posterior mediastinal mass (arrowheads). (b) Axial contrast-enhanced T1-weighted fat-saturated image demonstrates involvement of the spinal canal and vertebral body. (c, d) Fast SE STIR whole-body MR images demonstrate a paraspinal mass (arrowheads) and multiple focal bone marrow lesions (arrows) that were not present on bone (e) or metaiodobenzylguanidine (MIBG) (f) scintigrams.

View larger version (61K): [in a new window]   Figure 5e.  Stage IV thoracic neuroblastoma in a 4-year-old boy. (a) Chest radiograph shows a posterior mediastinal mass (arrowheads). (b) Axial contrast-enhanced T1-weighted fat-saturated image demonstrates involvement of the spinal canal and vertebral body. (c, d) Fast SE STIR whole-body MR images demonstrate a paraspinal mass (arrowheads) and multiple focal bone marrow lesions (arrows) that were not present on bone (e) or metaiodobenzylguanidine (MIBG) (f) scintigrams.

View larger version (59K): [in a new window]   Figure 5f.  Stage IV thoracic neuroblastoma in a 4-year-old boy. (a) Chest radiograph shows a posterior mediastinal mass (arrowheads). (b) Axial contrast-enhanced T1-weighted fat-saturated image demonstrates involvement of the spinal canal and vertebral body. (c, d) Fast SE STIR whole-body MR images demonstrate a paraspinal mass (arrowheads) and multiple focal bone marrow lesions (arrows) that were not present on bone (e) or metaiodobenzylguanidine (MIBG) (f) scintigrams.

View larger version (108K): [in a new window]   Figure 6a.  Renal cell carcinoma in a 7-year-old boy. (a, b) Fast SE STIR whole-body MR images obtained at initial staging demonstrate a left renal mass and retroperitoneal lymph node metastases. A subtle hyperintense marrow lesion is seen in the L2 vertebral body (arrow in b). (c, d) Corresponding reformatted coronal (c) and axial (d) contrast-enhanced CT images show the renal tumor with retroperitoneal metastases and a small lytic lesion involving the L2 vertebral body (arrow in d). (e) Posterior view from bone scintigraphy does not reveal the vertebral lesion. (f, g) Follow-up fast SE STIR whole-body MR images, obtained after left nephrectomy and chemotherapy, demonstrate disease progression with new liver metastases (arrowheads in g) and help confirm the previously suggested bone metastasis. The L2 and L3 vertebral bodies show pathologic fractures and increased marrow signal intensity (arrows in f). (h) Only at follow-up did the bone scintigraphic findings become abnormal, with a posterior view showing increased tracer uptake at L2 (arrow).

View larger version (128K): [in a new window]   Figure 6b.  Renal cell carcinoma in a 7-year-old boy. (a, b) Fast SE STIR whole-body MR images obtained at initial staging demonstrate a left renal mass and retroperitoneal lymph node metastases. A subtle hyperintense marrow lesion is seen in the L2 vertebral body (arrow in b). (c, d) Corresponding reformatted coronal (c) and axial (d) contrast-enhanced CT images show the renal tumor with retroperitoneal metastases and a small lytic lesion involving the L2 vertebral body (arrow in d). (e) Posterior view from bone scintigraphy does not reveal the vertebral lesion. (f, g) Follow-up fast SE STIR whole-body MR images, obtained after left nephrectomy and chemotherapy, demonstrate disease progression with new liver metastases (arrowheads in g) and help confirm the previously suggested bone metastasis. The L2 and L3 vertebral bodies show pathologic fractures and increased marrow signal intensity (arrows in f). (h) Only at follow-up did the bone scintigraphic findings become abnormal, with a posterior view showing increased tracer uptake at L2 (arrow).

View larger version (101K): [in a new window]   Figure 6c.  Renal cell carcinoma in a 7-year-old boy. (a, b) Fast SE STIR whole-body MR images obtained at initial staging demonstrate a left renal mass and retroperitoneal lymph node metastases. A subtle hyperintense marrow lesion is seen in the L2 vertebral body (arrow in b). (c, d) Corresponding reformatted coronal (c) and axial (d) contrast-enhanced CT images show the renal tumor with retroperitoneal metastases and a small lytic lesion involving the L2 vertebral body (arrow in d). (e) Posterior view from bone scintigraphy does not reveal the vertebral lesion. (f, g) Follow-up fast SE STIR whole-body MR images, obtained after left nephrectomy and chemotherapy, demonstrate disease progression with new liver metastases (arrowheads in g) and help confirm the previously suggested bone metastasis. The L2 and L3 vertebral bodies show pathologic fractures and increased marrow signal intensity (arrows in f). (h) Only at follow-up did the bone scintigraphic findings become abnormal, with a posterior view showing increased tracer uptake at L2 (arrow).

View larger version (105K): [in a new window]   Figure 6d.  Renal cell carcinoma in a 7-year-old boy. (a, b) Fast SE STIR whole-body MR images obtained at initial staging demonstrate a left renal mass and retroperitoneal lymph node metastases. A subtle hyperintense marrow lesion is seen in the L2 vertebral body (arrow in b). (c, d) Corresponding reformatted coronal (c) and axial (d) contrast-enhanced CT images show the renal tumor with retroperitoneal metastases and a small lytic lesion involving the L2 vertebral body (arrow in d). (e) Posterior view from bone scintigraphy does not reveal the vertebral lesion. (f, g) Follow-up fast SE STIR whole-body MR images, obtained after left nephrectomy and chemotherapy, demonstrate disease progression with new liver metastases (arrowheads in g) and help confirm the previously suggested bone metastasis. The L2 and L3 vertebral bodies show pathologic fractures and increased marrow signal intensity (arrows in f). (h) Only at follow-up did the bone scintigraphic findings become abnormal, with a posterior view showing increased tracer uptake at L2 (arrow).

View larger version (67K): [in a new window]   Figure 6e.  Renal cell carcinoma in a 7-year-old boy. (a, b) Fast SE STIR whole-body MR images obtained at initial staging demonstrate a left renal mass and retroperitoneal lymph node metastases. A subtle hyperintense marrow lesion is seen in the L2 vertebral body (arrow in b). (c, d) Corresponding reformatted coronal (c) and axial (d) contrast-enhanced CT images show the renal tumor with retroperitoneal metastases and a small lytic lesion involving the L2 vertebral body (arrow in d). (e) Posterior view from bone scintigraphy does not reveal the vertebral lesion. (f, g) Follow-up fast SE STIR whole-body MR images, obtained after left nephrectomy and chemotherapy, demonstrate disease progression with new liver metastases (arrowheads in g) and help confirm the previously suggested bone metastasis. The L2 and L3 vertebral bodies show pathologic fractures and increased marrow signal intensity (arrows in f). (h) Only at follow-up did the bone scintigraphic findings become abnormal, with a posterior view showing increased tracer uptake at L2 (arrow).

View larger version (114K): [in a new window]   Figure 6f.  Renal cell carcinoma in a 7-year-old boy. (a, b) Fast SE STIR whole-body MR images obtained at initial staging demonstrate a left renal mass and retroperitoneal lymph node metastases. A subtle hyperintense marrow lesion is seen in the L2 vertebral body (arrow in b). (c, d) Corresponding reformatted coronal (c) and axial (d) contrast-enhanced CT images show the renal tumor with retroperitoneal metastases and a small lytic lesion involving the L2 vertebral body (arrow in d). (e) Posterior view from bone scintigraphy does not reveal the vertebral lesion. (f, g) Follow-up fast SE STIR whole-body MR images, obtained after left nephrectomy and chemotherapy, demonstrate disease progression with new liver metastases (arrowheads in g) and help confirm the previously suggested bone metastasis. The L2 and L3 vertebral bodies show pathologic fractures and increased marrow signal intensity (arrows in f). (h) Only at follow-up did the bone scintigraphic findings become abnormal, with a posterior view showing increased tracer uptake at L2 (arrow).

View larger version (126K): [in a new window]   Figure 6g.  Renal cell carcinoma in a 7-year-old boy. (a, b) Fast SE STIR whole-body MR images obtained at initial staging demonstrate a left renal mass and retroperitoneal lymph node metastases. A subtle hyperintense marrow lesion is seen in the L2 vertebral body (arrow in b). (c, d) Corresponding reformatted coronal (c) and axial (d) contrast-enhanced CT images show the renal tumor with retroperitoneal metastases and a small lytic lesion involving the L2 vertebral body (arrow in d). (e) Posterior view from bone scintigraphy does not reveal the vertebral lesion. (f, g) Follow-up fast SE STIR whole-body MR images, obtained after left nephrectomy and chemotherapy, demonstrate disease progression with new liver metastases (arrowheads in g) and help confirm the previously suggested bone metastasis. The L2 and L3 vertebral bodies show pathologic fractures and increased marrow signal intensity (arrows in f). (h) Only at follow-up did the bone scintigraphic findings become abnormal, with a posterior view showing increased tracer uptake at L2 (arrow).

View larger version (58K): [in a new window]   Figure 6h.  Renal cell carcinoma in a 7-year-old boy. (a, b) Fast SE STIR whole-body MR images obtained at initial staging demonstrate a left renal mass and retroperitoneal lymph node metastases. A subtle hyperintense marrow lesion is seen in the L2 vertebral body (arrow in b). (c, d) Corresponding reformatted coronal (c) and axial (d) contrast-enhanced CT images show the renal tumor with retroperitoneal metastases and a small lytic lesion involving the L2 vertebral body (arrow in d). (e) Posterior view from bone scintigraphy does not reveal the vertebral lesion. (f, g) Follow-up fast SE STIR whole-body MR images, obtained after left nephrectomy and chemotherapy, demonstrate disease progression with new liver metastases (arrowheads in g) and help confirm the previously suggested bone metastasis. The L2 and L3 vertebral bodies show pathologic fractures and increased marrow signal intensity (arrows in f). (h) Only at follow-up did the bone scintigraphic findings become abnormal, with a posterior view showing increased tracer uptake at L2 (arrow).

View larger version (162K): [in a new window]   Figure 7a.  Rhabdomyosarcoma in a 17-year-old girl. Fast SE STIR whole-body MR images obtained at initial staging demonstrate diffusely increased marrow signal intensity in the central skeleton (marrow infiltration proved with biopsy) and additional focal lesions in the distal femora (arrows in b). The paraspinal soft-tissue mass seen at the thoracoabdominal junction (arrowheads in c) was thought to represent the primary tumor. Enlarged lymph nodes are shown in the retroperitoneum and mediastinum (arrows in a, d).

View larger version (139K): [in a new window]   Figure 7b.  Rhabdomyosarcoma in a 17-year-old girl. Fast SE STIR whole-body MR images obtained at initial staging demonstrate diffusely increased marrow signal intensity in the central skeleton (marrow infiltration proved with biopsy) and additional focal lesions in the distal femora (arrows in b). The paraspinal soft-tissue mass seen at the thoracoabdominal junction (arrowheads in c) was thought to represent the primary tumor. Enlarged lymph nodes are shown in the retroperitoneum and mediastinum (arrows in a, d).

View larger version (175K): [in a new window]   Figure 7c.  Rhabdomyosarcoma in a 17-year-old girl. Fast SE STIR whole-body MR images obtained at initial staging demonstrate diffusely increased marrow signal intensity in the central skeleton (marrow infiltration proved with biopsy) and additional focal lesions in the distal femora (arrows in b). The paraspinal soft-tissue mass seen at the thoracoabdominal junction (arrowheads in c) was thought to represent the primary tumor. Enlarged lymph nodes are shown in the retroperitoneum and mediastinum (arrows in a, d).

View larger version (185K): [in a new window]   Figure 7d.  Rhabdomyosarcoma in a 17-year-old girl. Fast SE STIR whole-body MR images obtained at initial staging demonstrate diffusely increased marrow signal intensity in the central skeleton (marrow infiltration proved with biopsy) and additional focal lesions in the distal femora (arrows in b). The paraspinal soft-tissue mass seen at the thoracoabdominal junction (arrowheads in c) was thought to represent the primary tumor. Enlarged lymph nodes are shown in the retroperitoneum and mediastinum (arrows in a, d).

View larger version (130K): [in a new window]   Figure 8a.  Nodular sclerosing Hodgkin disease in a 14-year-old girl. (a) Fast SE STIR whole-body MR image demonstrates hypointense nodules within the thymus (arrows). (b) Axial contrast-enhanced CT scan shows nodular enlargement of the thymus (arrows).

View larger version (101K): [in a new window]   Figure 8b.  Nodular sclerosing Hodgkin disease in a 14-year-old girl. (a) Fast SE STIR whole-body MR image demonstrates hypointense nodules within the thymus (arrows). (b) Axial contrast-enhanced CT scan shows nodular enlargement of the thymus (arrows).

View larger version (135K): [in a new window]   Figure 9a.  Choriocarcinoma in a 16-year-old boy who presented with enlarged inguinal lymph nodes. (a, b) Fast SE STIR whole-body MR images, obtained after inguinal lymph node resection, demonstrate a heterogeneous pelvic mass (arrowheads in a), bright lung nodules (arrows in a), and a seroma in the left inguina (arrow in b). The left testis is enlarged and less intense than the right (arrowheads in b), an appearance suggestive of a testicular mass. (c) Contrast-enhanced CT image shows three lung nodules (arrows). (d) Transverse US image of the pelvis demonstrates a solid mass (arrowheads) behind the bladder. (e) Longitudinal US image demonstrates a mixed solid and cystic mass in the left testis (arrowheads).

View larger version (117K): [in a new window]   Figure 9b.  Choriocarcinoma in a 16-year-old boy who presented with enlarged inguinal lymph nodes. (a, b) Fast SE STIR whole-body MR images, obtained after inguinal lymph node resection, demonstrate a heterogeneous pelvic mass (arrowheads in a), bright lung nodules (arrows in a), and a seroma in the left inguina (arrow in b). The left testis is enlarged and less intense than the right (arrowheads in b), an appearance suggestive of a testicular mass. (c) Contrast-enhanced CT image shows three lung nodules (arrows). (d) Transverse US image of the pelvis demonstrates a solid mass (arrowheads) behind the bladder. (e) Longitudinal US image demonstrates a mixed solid and cystic mass in the left testis (arrowheads).

View larger version (122K): [in a new window]   Figure 9c.  Choriocarcinoma in a 16-year-old boy who presented with enlarged inguinal lymph nodes. (a, b) Fast SE STIR whole-body MR images, obtained after inguinal lymph node resection, demonstrate a heterogeneous pelvic mass (arrowheads in a), bright lung nodules (arrows in a), and a seroma in the left inguina (arrow in b). The left testis is enlarged and less intense than the right (arrowheads in b), an appearance suggestive of a testicular mass. (c) Contrast-enhanced CT image shows three lung nodules (arrows). (d) Transverse US image of the pelvis demonstrates a solid mass (arrowheads) behind the bladder. (e) Longitudinal US image demonstrates a mixed solid and cystic mass in the left testis (arrowheads).

View larger version (131K): [in a new window]   Figure 9d.  Choriocarcinoma in a 16-year-old boy who presented with enlarged inguinal lymph nodes. (a, b) Fast SE STIR whole-body MR images, obtained after inguinal lymph node resection, demonstrate a heterogeneous pelvic mass (arrowheads in a), bright lung nodules (arrows in a), and a seroma in the left inguina (arrow in b). The left testis is enlarged and less intense than the right (arrowheads in b), an appearance suggestive of a testicular mass. (c) Contrast-enhanced CT image shows three lung nodules (arrows). (d) Transverse US image of the pelvis demonstrates a solid mass (arrowheads) behind the bladder. (e) Longitudinal US image demonstrates a mixed solid and cystic mass in the left testis (arrowheads).

View larger version (140K): [in a new window]   Figure 9e.  Choriocarcinoma in a 16-year-old boy who presented with enlarged inguinal lymph nodes. (a, b) Fast SE STIR whole-body MR images, obtained after inguinal lymph node resection, demonstrate a heterogeneous pelvic mass (arrowheads in a), bright lung nodules (arrows in a), and a seroma in the left inguina (arrow in b). The left testis is enlarged and less intense than the right (arrowheads in b), an appearance suggestive of a testicular mass. (c) Contrast-enhanced CT image shows three lung nodules (arrows). (d) Transverse US image of the pelvis demonstrates a solid mass (arrowheads) behind the bladder. (e) Longitudinal US image demonstrates a mixed solid and cystic mass in the left testis (arrowheads).

View larger version (134K): [in a new window]   Figure 10a.  Langerhans cell histiocytosis in a 6-year-old boy who presented with lower back pain. (a) Fast SE STIR whole-body MR image demonstrates increased marrow signal intensity in the collapsed vertebral body L5 (vertebra plana) without an associated soft-tissue mass (arrow). No further bone involvement was seen. (b) T2-weighted fat-saturated sagittal image does not show any spinal stenosis. (c) Posterior view from bone scintigraphy demonstrates bilateral increased activity at the level of L5 (arrow), a finding that initially suggested spondylolysis or spondylolisthesis. (d) Three-dimensional surface-shaded CT image shows the degree of collapse of the L5 vertebral body.

View larger version (110K): [in a new window]   Figure 10b.  Langerhans cell histiocytosis in a 6-year-old boy who presented with lower back pain. (a) Fast SE STIR whole-body MR image demonstrates increased marrow signal intensity in the collapsed vertebral body L5 (vertebra plana) without an associated soft-tissue mass (arrow). No further bone involvement was seen. (b) T2-weighted fat-saturated sagittal image does not show any spinal stenosis. (c) Posterior view from bone scintigraphy demonstrates bilateral increased activity at the level of L5 (arrow), a finding that initially suggested spondylolysis or spondylolisthesis. (d) Three-dimensional surface-shaded CT image shows the degree of collapse of the L5 vertebral body.

View larger version (111K): [in a new window]   Figure 10c.  Langerhans cell histiocytosis in a 6-year-old boy who presented with lower back pain. (a) Fast SE STIR whole-body MR image demonstrates increased marrow signal intensity in the collapsed vertebral body L5 (vertebra plana) without an associated soft-tissue mass (arrow). No further bone involvement was seen. (b) T2-weighted fat-saturated sagittal image does not show any spinal stenosis. (c) Posterior view from bone scintigraphy demonstrates bilateral increased activity at the level of L5 (arrow), a finding that initially suggested spondylolysis or spondylolisthesis. (d) Three-dimensional surface-shaded CT image shows the degree of collapse of the L5 vertebral body.

View larger version (141K): [in a new window]   Figure 10d.  Langerhans cell histiocytosis in a 6-year-old boy who presented with lower back pain. (a) Fast SE STIR whole-body MR image demonstrates increased marrow signal intensity in the collapsed vertebral body L5 (vertebra plana) without an associated soft-tissue mass (arrow). No further bone involvement was seen. (b) T2-weighted fat-saturated sagittal image does not show any spinal stenosis. (c) Posterior view from bone scintigraphy demonstrates bilateral increased activity at the level of L5 (arrow), a finding that initially suggested spondylolysis or spondylolisthesis. (d) Three-dimensional surface-shaded CT image shows the degree of collapse of the L5 vertebral body.

View larger version (185K): [in a new window]   Figure 11a.  Neonatal hemangiomatosis in an 8-month-old girl. Fast SE STIR whole-body MR images demonstrate multiple bright lesions in the subcutaneous tissues (arrows). No visceral involvement is seen. Linear areas of high signal intensity in the right upper lobe (arrowheads in a) likely represent atelectasis caused by sedation.

View larger version (161K): [in a new window]   Figure 11b.  Neonatal hemangiomatosis in an 8-month-old girl. Fast SE STIR whole-body MR images demonstrate multiple bright lesions in the subcutaneous tissues (arrows). No visceral involvement is seen. Linear areas of high signal intensity in the right upper lobe (arrowheads in a) likely represent atelectasis caused by sedation.

View larger version (146K): [in a new window]   Figure 12a.  Stage II Hodgkin disease in a 12-year-old girl. (a, b) Fast SE STIR whole-body MR images demonstrate residual bulky enlargement of the thymus (arrowheads in a) and marrow changes. Bone marrow signal intensity in the central skeleton and metaphyses of the long bones is diffusely increased, likely representing marrow hyperplasia after granulocyte-colony stimulating factor therapy. In addition, several diaphyseal and epiphyseal lesions with the characteristic appearance of osteonecrosis are seen in the femora and tibiae (arrows in b). On MR images, such therapy-induced marrow changes can be impossible to differentiate from lymphomatous involvement. (c) Contrast-enhanced CT image demonstrates residual asymmetric enlargement of the thymus (arrowhead).

View larger version (69K): [in a new window]   Figure 12b.  Stage II Hodgkin disease in a 12-year-old girl. (a, b) Fast SE STIR whole-body MR images demonstrate residual bulky enlargement of the thymus (arrowheads in a) and marrow changes. Bone marrow signal intensity in the central skeleton and metaphyses of the long bones is diffusely increased, likely representing marrow hyperplasia after granulocyte-colony stimulating factor therapy. In addition, several diaphyseal and epiphyseal lesions with the characteristic appearance of osteonecrosis are seen in the femora and tibiae (arrows in b). On MR images, such therapy-induced marrow changes can be impossible to differentiate from lymphomatous involvement. (c) Contrast-enhanced CT image demonstrates residual asymmetric enlargement of the thymus (arrowhead).

View larger version (89K): [in a new window]   Figure 12c.  Stage II Hodgkin disease in a 12-year-old girl. (a, b) Fast SE STIR whole-body MR images demonstrate residual bulky enlargement of the thymus (arrowheads in a) and marrow changes. Bone marrow signal intensity in the central skeleton and metaphyses of the long bones is diffusely increased, likely representing marrow hyperplasia after granulocyte-colony stimulating factor therapy. In addition, several diaphyseal and epiphyseal lesions with the characteristic appearance of osteonecrosis are seen in the femora and tibiae (arrows in b). On MR images, such therapy-induced marrow changes can be impossible to differentiate from lymphomatous involvement. (c) Contrast-enhanced CT image demonstrates residual asymmetric enlargement of the thymus (arrowhead).