AML and Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging (MRI) involves application of the magnetic field to generate detailed images of targeted part of the body. A radiotracer is administered to a patient that helps in creating contrast images for detection of cancer.
Can you tell if a tumor is cancerous from an MRI?
The images produced by MRI scan contain soft tissue pictures, which are not possible by other imaging procedures. Thus, MRI is a good technique to detect some cancer types but only an expert radiologist or oncologist can tell about cancerous tumor after reading the scan report.
MRI blood cancer detection
MRI images can reveal signs of cancer cells or tumors. MRI scan can also identify changes in bone structure, which are very common in some types of cancer for instance myeloma.
How accurate is MRI in detecting AML cancer?
MRI scans are effective in detecting some cancer types. It depends on the infected part and skills of radiographer and expertise of a doctor to make accurate inference from the reports.
Can MRI scan be wrong about blood cancer?
When compared to a CT scan or ultrasound, MRI scan provides improved result but it still lacks the accuracy and details received by PET/CT scan. MRI gives an insight to cell density variations, shadows, and changing shapes leaving it up to discretion and analysis of technologists about a cancerous cell, which could also go wrong sometime.
AML & Positron Emission Tomography (PET) Scan
PET scan for acute myeloid (AML)
A PET scan creates pictures of organs and tissues inside the body. To begin with, a small amount of radioactive sugar is injected into the patient’s body which is taken up by cells. And because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this radioactive substance to produce images of the inside of the body.
A PET scan also helps to find out how well the treatment is working against the sarcoma.
PET scan for blood cancer
PET scan is used for diagnosis or staging of blood cancer as well as to check the effectiveness of the treatment. Before scan, the patient is injected with a radiotracer that is absorbed in higher quantities by the cancerous blood cells and infected organs than the normal ones, which makes a basis for detection of cancer.
PET scan for cancer
PET scans are able to explain benign or malignant tumor conditions, sometimes on the disease onset, making its management quite easy.
PET scan disadvantages
Normally, PET scan is a painless procedure and poses fewer risks, as the scanner does not emit any radiation itself because radiotracer is given intravenously or ingested directly by the patient.
The injection may cause some temporary swelling or localized pain, with some allergic reaction in particular cases.
PET scan cancer accuracy
Besides mapping the spread of the disease, PET scan can detect the effectiveness of therapy. In around 30-40% cases, PET scans are capable of changing the course of treatment.
How does cancer show up on a PET scan?
The radioactive tracers or radiopharmaceuticals are the molecules that are labeled with a minute quantity of radioactive substance which can be detected by a PET scanner. These radiotracers accumulate in the infected region of the organ and bind to particular proteins molecules.
AML & Lumbar puncture
Lumbar puncture refers to the examining of the CSF (cerebral spinal fluid) for presence of leukemia cells. CSF is the fluid that surrounds your spinal cord and the brain. During the test, CSF is extracted from lower back by using a needle that’s inserted between two lumber bones. The procedure takes around 40 minutes to complete under local or general anesthesia.
Lumbar puncture technique for diagnosis of AML cancer
Prior to the fluid extraction, patient is given general or local anesthesia. CSF sample is examined under the microscope for AML cells. Generally, the lumbar puncture is not recommended to all patients.
Lumbar puncture side effects
Some patients may experience the temporary headache after the lumbar puncture test, caused by leakage of CSF to surrounding cells. Sometimes, the lumbar puncture may lead to back pain or discomfort.
Lumbar puncture risks
In some rare cases, patients may develop headaches, feel radiating pain down the back of your legs or experience brainstem herniation which is increased pressure within the skull. This could be due to a brain tumor or other lesion.
Lumbar puncture results
- WBC count: Typically, CSF may contain 5 WBCs per micro liter. An enhanced value of WBCs may indicate blood cancer infection. However, laboratory value may vary from one facility to another.
- Presence of cancer cells: The CSF examination can also detect the presence of immature blood cells or tumor, to confirm AML or blood cancer.
Karyotyping Techniques
Cytogenetic testing for diagnosis of blood cancer
The molecular genetics of leukemia cells can also be used to help find if a person needs more or less chemotherapy and/or bone marrow/stem cell transplantation.
The test is performed to look for small genetic mutations, called sub-microscopic mutations.
Genetic testing for AML disease
Immunohistochemical and Cytochemical tests are done in the laboratory to identify the precise subtype of AML.
Immunohistochemical tests along with the Flow Cytometry are done to detect markers present on the leukemia cells. Each subtype of leukemia has unique combinations of these markers.
Cytogenetics is a microscopic technique to examine cell’s chromosomes to analyze the count, shape, size and the gene pattern to cite any changes in the leukemia cells.
The molecular genetics of leukemia cells can play a crucial role in deciding the modality for treatment of AML such as chemotherapy dosage and/or stem cell/bone marrow transplantation. The objective of molecular testing is to examine sub-microscopic genetic mutations.
Chronic Lymphocytic Leukemia - CLL
Chronic lymphocytic leukemia or CLL is induced by B-cells, a form of white blood cells, which grow at the slower rate and normally affect old age individuals. This disease may progress asymptomatically for decades and may arise with sudden symptoms such as easy bruising, fatigue and lymph nodes. For early stage CLL, chemotherapy is preferred modality while in some rare aggressive disease progression stem cell transplant is used.
Blood tests
The process of diagnosing CLL usually begins with a routine blood test, called Complete Blood Count or CBC. The test measures count of different types of blood cells — RBCs, WBCs and platelets present in the blood. Normally, patients suspected with CLL will have increased number of lymphocytes with lower count of platelets and RBCs.
Flow cytometry and cytochemistry
Cytochemistry tests are done in laboratory to diagnose CLL, through comparing normal cells to cancerous cells using immunophenotyping of lymphocytes. The marked lymphocytes are examined from the perspective of the infected source or normal ones. This test is combined with flow cytometry to detect markers present on the leukemia cells. Each subtype of leukemia has unique combinations of these markers. If results from flow cytometry confirm the presence of 5,000/uL anomalous B-cells, then CLL is diagnosed.
Genomic and molecular testing
Cytogenetics is a microscopic technique to examine leukemia cells for specific chromosomes, genes, proteins to analyze the count, shape, size and the gene pattern to cite any changes in the leukemia cells.
The molecular genetics of leukemia cells can play a crucial role in deciding the modality for treatment of CLL such as chemotherapy dosage and/or stem cell/bone marrow transplantation. The objective of molecular testing is to examine sub-microscopic genetic mutations.
X-ray
X-ray imaging creates a picture of the gland and organs inside the chest to detect leukemia infection in the lungs. X-ray cannot reveal the leukemia cells, though. An experienced doctor can examine the X-ray for enlarged lymph nodes.
Computerized tomography (CT) scan
A three dimensional CT image can detect CLL lymph nodes around the lungs, heart, abdomen, windpipe and pelvis. Sometimes, CT scan is also used to examine size, shape and other details of the lymph node by using a radiotracer element.
Normally, CT scan is not required for asymptomatic patients, however, doctor recommend this test before and after the treatment.
Bone marrow aspiration and biopsy
Normally, a doctor will not recommend the biopsy and bone marrow aspiration for diagnosis of CLL, if the platelet and RBC count is within the limit. But this test can be done prior to the treatment to ensure that there is no other disease present, which will make CLL therapy more effective.
Generally, the biopsy for blood cancer is done along with bone marrow aspiration test. For the biopsy, a tiny part of the bone filled with marrow is collected for examination, while in bone marrow aspiration a liquid marrow sample is taken. The patient is given anesthetic before sample collection.
Chronic Myeloid Leukemia - CML
Blood tests: Complete Blood Count or CBC refers to count of RBCs, WBCs and platelets present in the blood. Normally, patients suspected with CML will have lower count of platelets and RBCs. However, WBC count may be increased due to other conditions. Advanced stage of CML may induce low RBCs and abnormal platelet count.
Molecular testing: Cytogenetics is a microscopic technique to examine chromosomes to analyze the count, shape, size and the gene pattern to cite any changes in the leukemia cells. Often, this may be done on the circulating or peripheral blood after CML is diagnosed by using the immature WBCs only.
The objective of molecular testing is to examine sub-microscopic genetic mutations with Philadelphia chromosome.
In CML diagnosis, Cytogenetic testing is used to examine progress of treatment and reduction pattern for cells linked to Philadelphia chromosome. Cytogenetic testing for CML is also combined with FISH and PCR tests.
Fluorescence in situ hybridization (FISH): FISH or Fluorescence in situ hybridization test is used to identify the BCR-ABL gene and check the progress of CML treatment. FISH test does not need immature WBCs and may be done by using bone marrow cells or a blood sample. This is a sensitive procedure to confirm CML compared to the standard cytogenetic test, which detects the Philadelphia chromosome.
Polymerase chain reaction (PCR): Polymerase chain reaction or PCR refers to a DNA test, which can detect the BCR-ABL fusion gene along with other molecular anomalies. This test can also be used to examine the treatment progress. PCR test is one of the most sensitive, which can detect even single anomalous cell out of one million normal cells, by using some specialized techniques.
Imaging: CT scan and Ultra sound imaging are often used to examine and measure the spleen’s size in CML patients.
Computerized tomography (CT) scan: A three dimensional CT image can detect CML cells inside the body from various angles. Sometimes, CT scan is also used to examine size, shape and other details of the abnormal cells by using a radiotracer element.
Ultrasound: This test involves use of high-frequency sound waves for generating image of inner organs.
Bone marrow aspiration and biopsy
Normally, a doctor will not recommend the biopsy and bone marrow aspiration for diagnosis of CML, if the platelet and RBC count is within the limit. But this test is usually done prior to treatment to ensure that there is no other disease present, which will make CML therapy more effective.
Generally, biopsy for blood cancer is done along with bone marrow aspiration test. For the biopsy a tiny part of the bone filled with marrow is collected for examination, while in bone marrow aspiration a liquid marrow sample is taken. The patient is given anesthetic before sample collection.
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