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Jamet B, Necib H, Carlier T, Frampas E, Bazin J, Desfontis PH, Monnet A, Bodet-Milin C, Moreau P, Touzeau C, Kraeber-Bodere F. DCE-MRI to distinguish all monoclonal plasma cell disease stages and correlation with diffusion-weighted MRI/PET-based biomarkers in a hybrid simultaneous whole body-2-[18F]FDG-PET/MRI imaging approach. Cancer Imaging 2024; 24:93. [PMID: 38992707 PMCID: PMC11241781 DOI: 10.1186/s40644-024-00740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 07/08/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Dynamic contrast-enhanced-MRI (DCE-MRI) is able to study bone marrow angiogenesis in patients with multiple myeloma (MM) and asymptomatic precursor diseases but its role in the management of MM has not yet been established. The aims of this prospective study was to compare DCE-MRI-based parameters between all monoclonal plasma cell disease stages in order to find out discriminatory parameters and to seek correlations with other diffusion-weighted MRI and positron emission tomography (PET)-based biomarkers in a hybrid simultaneous whole-body-2-[18F]fluorodeoxyglucose (FDG)-PET/MRI (WB-2-[18F]FDG-PET/MRI) imaging approach. METHODS Patients with newly diagnosed Monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM) or symptomatic MM according to international myeloma working group and underwent WB-2-[18F]FDG-PET/MRI imaging including bone marrow DCE sequences at the Nantes University Hospital were prospectively enrolled in this study before receiving treatment. RESULTS One hundred and sixty-seven patients (N = 167, mean age: 64 years ± 11 [Standard deviation], 66 males) were considered for the analysis. DCE-MRI-based Peak Enhancement Intensity (PEI), Time to PEI (TPEI) and their maximum intensity time ratio (MITR: PEI/TPEI) values were significantly different between the different monoclonal plasma cell disease stages, PEI values increasing and TPEI values decreasing progressively along the spectrum of plasma cell disorders, from MGUS stage to symptomatic multiple myeloma. PEI values were significantly higher in patients with diffuse bone marrow involvement (either in PET or in MRI images) than in those without diffuse bone marrow involvement, unlike TPEI values. PEI and TPEI values were not significantly different between patients with or without focal bone lesions. CONCLUSION Different DCE-MRI-based parameters (PEI, TPEI, MITR) could significantly differentiate all monoclonal plasma cell disease stages and complemented conventional MRI and PET-based biomarkers.
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Affiliation(s)
- Bastien Jamet
- Nantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Médecine Nucléaire, F-44000, Nantes, France.
- Nuclear Medicine Department, University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes, France.
| | - Hatem Necib
- Nantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Médecine Nucléaire, F-44000, Nantes, France
| | - Thomas Carlier
- Nantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Médecine Nucléaire, F-44000, Nantes, France
| | - Eric Frampas
- Nantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Radiologie, F-44000, Nantes, France
| | - Juliette Bazin
- Nantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Radiologie, F-44000, Nantes, France
| | - Paul-Henri Desfontis
- Nantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Radiologie, F-44000, Nantes, France
| | | | - Caroline Bodet-Milin
- Nantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Médecine Nucléaire, F-44000, Nantes, France
| | - Philippe Moreau
- Nantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Hématologie, F-44000, Nantes, France
| | - Cyrille Touzeau
- Nantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Hématologie, F-44000, Nantes, France
| | - Francoise Kraeber-Bodere
- Nantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Médecine Nucléaire, F-44000, Nantes, France
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Bone marrow MR perfusion imaging and potential for tumor evaluation. Skeletal Radiol 2023; 52:477-491. [PMID: 36271181 DOI: 10.1007/s00256-022-04202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/19/2022] [Accepted: 10/04/2022] [Indexed: 02/02/2023]
Abstract
The physiology of bone perfusion is reviewed outlining how it can be measured with dynamic contrast-enhanced MRI as well as intravoxel incoherent imaging. Evaluation of bone perfusion provides a potential means of assessing tumor activity and treatment response beyond that possible with standard MR imaging.
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Ojha VA, Bahl V, Ramachandra SC, Prashant A. Putrescence to Quintessence: An Atypical Presentation of Multiple Osteoporotic Spinal Fractures Masquerading as Multiple Myeloma. Cureus 2021; 13:e20788. [PMID: 35141056 PMCID: PMC8796275 DOI: 10.7759/cureus.20788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 11/30/2022] Open
Abstract
A 64-year-old male patient presented with multiple osteoporotic spinal fractures of unknown origin. He was provisionally diagnosed with multiple myeloma based on biochemical and radiological findings. The patient presented in a very frail condition with a questionable outcome but showed a remarkable recovery from being frail to relatively fit. His baseline characteristics including magnetic resonance imaging of the dorsolumbar spine, beta 2 microglobulins, and C-reactive protein improved. The diagnosis was later changed to multiple spinal osteoporotic fractures. In this case report, we highlight that, although it is a good practice to have a single working diagnosis, when the diagnosis is challenging, a holistic approach should be followed to prevent medical and diagnostic miscalculations.
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Oprea-Lager DE, Cysouw MC, Boellaard R, Deroose CM, de Geus-Oei LF, Lopci E, Bidaut L, Herrmann K, Fournier LS, Bäuerle T, deSouza NM, Lecouvet FE. Bone Metastases Are Measurable: The Role of Whole-Body MRI and Positron Emission Tomography. Front Oncol 2021; 11:772530. [PMID: 34869009 PMCID: PMC8640187 DOI: 10.3389/fonc.2021.772530] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/04/2021] [Indexed: 12/14/2022] Open
Abstract
Metastatic tumor deposits in bone marrow elicit differential bone responses that vary with the type of malignancy. This results in either sclerotic, lytic, or mixed bone lesions, which can change in morphology due to treatment effects and/or secondary bone remodeling. Hence, morphological imaging is regarded unsuitable for response assessment of bone metastases and in the current Response Evaluation Criteria In Solid Tumors 1.1 (RECIST1.1) guideline bone metastases are deemed unmeasurable. Nevertheless, the advent of functional and molecular imaging modalities such as whole-body magnetic resonance imaging (WB-MRI) and positron emission tomography (PET) has improved the ability for follow-up of bone metastases, regardless of their morphology. Both these modalities not only have improved sensitivity for visual detection of bone lesions, but also allow for objective measurements of bone lesion characteristics. WB-MRI provides a global assessment of skeletal metastases and for a one-step "all-organ" approach of metastatic disease. Novel MRI techniques include diffusion-weighted imaging (DWI) targeting highly cellular lesions, dynamic contrast-enhanced MRI (DCE-MRI) for quantitative assessment of bone lesion vascularization, and multiparametric MRI (mpMRI) combining anatomical and functional sequences. Recommendations for a homogenization of MRI image acquisitions and generalizable response criteria have been developed. For PET, many metabolic and molecular radiotracers are available, some targeting tumor characteristics not confined to cancer type (e.g. 18F-FDG) while other targeted radiotracers target specific molecular characteristics, such as prostate specific membrane antigen (PSMA) ligands for prostate cancer. Supporting data on quantitative PET analysis regarding repeatability, reproducibility, and harmonization of PET/CT system performance is available. Bone metastases detected on PET and MRI can be quantitatively assessed using validated methodologies, both on a whole-body and individual lesion basis. Both have the advantage of covering not only bone lesions but visceral and nodal lesions as well. Hybrid imaging, combining PET with MRI, may provide complementary parameters on the morphologic, functional, metabolic and molecular level of bone metastases in one examination. For clinical implementation of measuring bone metastases in response assessment using WB-MRI and PET, current RECIST1.1 guidelines need to be adapted. This review summarizes available data and insights into imaging of bone metastases using MRI and PET.
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Affiliation(s)
- Daniela E. Oprea-Lager
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Matthijs C.F. Cysouw
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Christophe M. Deroose
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
- Nuclear Medicine & Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, Netherlands
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS – Humanitas Research Hospital, Milan, Italy
| | - Luc Bidaut
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- College of Science, University of Lincoln, Lincoln, United Kingdom
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Laure S. Fournier
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale (INSERM), Radiology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Hopital europeen Georges Pompidou, Université de Paris, Paris, France
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
| | - Tobias Bäuerle
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Nandita M. deSouza
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Frederic E. Lecouvet
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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Spinnato P, Filonzi G, Conficoni A, Facchini G, Ponti F, Sambri A, De Paolis M, Cavo M, Salizzoni E, Nanni C. Skeletal Survey in Multiple Myeloma: Role of Imaging. Curr Med Imaging 2021; 17:956-965. [PMID: 33573573 DOI: 10.2174/1573405617666210126155129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/23/2020] [Accepted: 12/18/2020] [Indexed: 11/22/2022]
Abstract
Bone disease is the hallmark of multiple myeloma. Skeletal lesions are evaluated to establish the diagnosis, to choose the therapies and also to assess the response to treatments. Due to this, imaging procedures play a key role in the management of multiple myeloma. For decades, conventional radiography has been the standard imaging modality. Subsequently, advances in the treatment of multiple myeloma have increased the need for an accurate evaluation of skeletal disease. The introduction of new high performant imaging tools, such as whole-body lowdose computed tomography, different types of magnetic resonance imaging studies, and 18F-fluorodeoxyglucose positron emission tomography, replaced the conventional radiography. In this review, we analyze the diagnostic potentials, indications of use, and applications of the imaging tools nowadays available. Whole-body low-dose CT should be considered as the imaging modality of choice for the initial assessment of multiple myeloma lytic bone lesions. MRI is the gold-standard for the detection of bone marrow involvement, while PET/CT is the preferred technique in the assessment of response to therapy. Both MRI and PET/CT are able to provide prognostic information.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alberto Conficoni
- Neuroradiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Sambri
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Michele Cavo
- "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Eugenio Salizzoni
- Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, MNM AOU S.Orsola-Malpighi, Bologna, Italy
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Bäuerle T, Roemer FW. Dynamic contrast-enhanced MRI for assessment of subchondral bone marrow vascularization in an experimental osteoarthritis model: a major step towards clinical translation? Osteoarthritis Cartilage 2021; 29:603-606. [PMID: 33716099 DOI: 10.1016/j.joca.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 02/02/2023]
Affiliation(s)
- T Bäuerle
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany.
| | - F W Roemer
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 3(rd) Floor, 820 Harrison Ave, Boston, MA, 02118, USA
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7
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Geng C, Yang G, Wang H, Wu Y, Leng Y, Zhou H, Zhang Z, Jian Y, Chen W. Deep and partial immunoparesis is a poor prognostic factor for newly diagnosed multiple myeloma patients. Leuk Lymphoma 2020; 62:883-890. [PMID: 33275060 DOI: 10.1080/10428194.2020.1855345] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We retrospectively analyzed immunosuppression status in 287 newly diagnosed multiple myeloma (MM) patients and assessed the prognostic value of immunoparesis on survival. Deep immunoparesis was defined that one of uninvolved immunoglobulins was below 50% the lower limit of normal ranges, partial immunoparesis was defined at least two suppressed uninvolved immunoglobulins. We found that patients with deep and partial immunoparesis had a significantly shorter median overall survival (OS) and progression-free survival (PFS). Moreover, deep and partial immunoparesis was a poor prognostic factor for OS and PFS in univariate and multivariable analyses. To reduce the bias between the groups, we performed a 1:1 propensity score matching technique for analysis and found that patients with deep and partial immunoparesis also had shorter OS and PFS. Our study showed that deep and partial immunoparesis can be defined an independent poor prognostic factor for patients with newly diagnosed MM.
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Affiliation(s)
- Chuanying Geng
- Department of Hematology, Beijing Chaoyang Hospital, Capital medical University, Beijing, China
| | - Guangzhong Yang
- Department of Hematology, Beijing Chaoyang Hospital, Capital medical University, Beijing, China
| | - Huijuan Wang
- Department of Hematology, Beijing Chaoyang Hospital, Capital medical University, Beijing, China
| | - Yin Wu
- Department of Hematology, Beijing Chaoyang Hospital, Capital medical University, Beijing, China
| | - Yun Leng
- Department of Hematology, Beijing Chaoyang Hospital, Capital medical University, Beijing, China
| | - Huixing Zhou
- Department of Hematology, Beijing Chaoyang Hospital, Capital medical University, Beijing, China
| | - Zhiyao Zhang
- Department of Hematology, Beijing Chaoyang Hospital, Capital medical University, Beijing, China
| | - Yuan Jian
- Department of Hematology, Beijing Chaoyang Hospital, Capital medical University, Beijing, China
| | - Wenming Chen
- Department of Hematology, Beijing Chaoyang Hospital, Capital medical University, Beijing, China
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8
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Pan P, Su L, Liu D, Wang X. Microcirculation-guided protection strategy in hemodynamic therapy. Clin Hemorheol Microcirc 2020; 75:243-253. [PMID: 31903987 DOI: 10.3233/ch-190784] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Microcirculatory shock is a condition defined by the presence of tissue hypoperfusion despite the normalization of systemic and regional blood flow. Currently, more evidence shows that intrinsic septic shock is microcirculatory shock, which results in septic shock that is difficult to resuscitate. At present, treatments are aimed at recovering macro-circulation functions and include fluid resuscitation, vasoactive drugs, positive inotropic drugs, de-obstruction, and even mechanical assistance to improve oxygen delivery. However, the application of these treatments to more accurately improve microcirculation or avoid further microcirculatory damage is more important in clinics. In this article, we discuss the need for microcirculation protection and microcirculation-guided protection strategies in hemodynamic therapies.
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Affiliation(s)
- Pan Pan
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.,Center of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Longxiang Su
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
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Zamagni E, Cavo M, Fakhri B, Vij R, Roodman D. Bones in Multiple Myeloma: Imaging and Therapy. Am Soc Clin Oncol Educ Book 2018; 38:638-646. [PMID: 30231385 DOI: 10.1200/edbk_205583] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
F-fluorodeoxyglucose (FDG)-PET/CT, MRI, and other novel imaging modalities in the management of disease in patients with plasma cell dyscrasias. We also review the state of the art in treatment of MM bone disease (MMBD) and the role of bisphosphonates and denosumab, a monoclonal antibody that binds and blocks the activity of receptor activator of nuclear factor-kappa B ligand (RANKL), which was recently approved by the U.S. Food and Drug Administration for MMBD.
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Affiliation(s)
- Elena Zamagni
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - Michele Cavo
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - Bita Fakhri
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - Ravi Vij
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - David Roodman
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
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Koutoulidis V, Papanikolaou N, Moulopoulos LA. Functional and molecular MRI of the bone marrow in multiple myeloma. Br J Radiol 2018; 91:20170389. [PMID: 29393672 PMCID: PMC6209491 DOI: 10.1259/bjr.20170389] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 01/13/2018] [Accepted: 01/30/2018] [Indexed: 12/22/2022] Open
Abstract
MRI plays an important role in the management of patients with plasma cell neoplasms and has been recognized as a biomarker of malignancy in the novel criteria for the diagnosis of multiple myeloma. Functional and molecular MRI techniques such as diffusion-weighted imaging (spinal or whole body), intravoxel incoherent motion, and dynamic contrast enhanced MRI, provide additional information related to tumor cellularity and angiogenesis, which may have prognostic implications for patients with smoldering and symptomatic myeloma. These non-invasive functional techniques are also being evaluated as imaging biomarkers for response assessment in myeloma patients. The purpose of this article is to provide a comprehensive critical review on the current use and potential future applications of these advanced MRI techniques in multiple myeloma. In addition, we will address the technologies involved and describe the qualitative and quantitative characteristics of normal bone marrow with these techniques.
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Affiliation(s)
- Vassilis Koutoulidis
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nickolas Papanikolaou
- Computational Clinical Imaging Group, Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal
| | - Lia A Moulopoulos
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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11
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Latifoltojar A, Hall-Craggs M, Bainbridge A, Rabin N, Popat R, Rismani A, D'Sa S, Dikaios N, Sokolska M, Antonelli M, Ourselin S, Yong K, Taylor SA, Halligan S, Punwani S. Whole-body MRI quantitative biomarkers are associated significantly with treatment response in patients with newly diagnosed symptomatic multiple myeloma following bortezomib induction. Eur Radiol 2017; 27:5325-5336. [PMID: 28656463 PMCID: PMC5674123 DOI: 10.1007/s00330-017-4907-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/13/2017] [Accepted: 05/23/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate whole-body MRI (WB-MRI) parameters significantly associated with treatment response in multiple myeloma (MM). METHODS Twenty-one MM patients underwent WB-MRI at diagnosis and after two cycles of chemotherapy. Scans acquired at 3.0 T included T2, diffusion-weighted-imaging (DWI) and mDixon pre- and post-contrast. Twenty focal lesions (FLs) matched on DWI and post-contrast mDixon were selected for each time point. Estimated tumour volume (eTV), apparent diffusion coefficient (ADC), enhancement ratio (ER) and signal fat fraction (sFF) were derived. Clinical treatment response to chemotherapy was assessed using conventional criteria. Significance of temporal parameter change was assessed by the paired t test and receiver operating characteristics/area under the curve (AUC) analysis was performed. Parameter repeatability was assessed by interclass correlation (ICC) and Bland-Altman analysis of 10 healthy volunteers scanned at two time points. RESULTS Fifteen of 21 patients responded to treatment. Of 254 FLs analysed, sFF (p < 0.0001) and ADC (p = 0.001) significantly increased in responders but not non-responders. eTV significantly decreased in 19/21 cases. Focal lesion sFF was the best discriminator of treatment response (AUC 1.0). Bone sFF repeatability was excellent (ICC 0.98) and better than bone ADC (ICC 0.47). CONCLUSION WB-MRI derived focal lesion sFF shows promise as an imaging biomarker of treatment response in newly diagnosed MM. KEY POINTS • Bone signal fat fraction using mDixon is a robust quantifiable parameter • Fat fraction and ADC significantly increase in myeloma lesions responding to treatment • Bone lesion fat fraction is the best discriminator of myeloma treatment response.
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Affiliation(s)
- Arash Latifoltojar
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
| | - Margaret Hall-Craggs
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Alan Bainbridge
- Department of Medical Physics and Bioengineering, University College London Hospital, London, UK
| | - Neil Rabin
- Department of Haematology, University College London Hospital, London, UK
| | - Rakesh Popat
- Department of Haematology, University College London Hospital, London, UK
| | - Ali Rismani
- Department of Haematology, University College London Hospital, London, UK
| | - Shirley D'Sa
- Department of Haematology, University College London Hospital, London, UK
| | - Nikolaos Dikaios
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
| | - Magdalena Sokolska
- Department of Medical Physics and Bioengineering, University College London Hospital, London, UK
| | - Michela Antonelli
- Translational Imaging Group, Centre for Medical Imaging Computing, University College London, London, UK
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Imaging Computing, University College London, London, UK
| | - Kwee Yong
- Department of Haematology, University College London Hospital, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE.
- Department of Radiology, University College London Hospital, London, UK.
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12
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Mayerhoefer ME, Haug A. [Hemato-oncological imaging : Importance of hybrid procedures]. Radiologe 2017; 56:597-604. [PMID: 27335021 DOI: 10.1007/s00117-016-0126-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CLINICAL/METHODICAL ISSUE Biomedical imaging procedures play a major role in hemato-oncological diseases with respect to pre-therapeutic staging and assessment of treatment response. STANDARD RADIOLOGICAL METHODS Originally, the therapeutic management was the domain of computed tomography (CT) and whole-body magnetic resonance imaging (MRI). METHODICAL INNOVATIONS Over the last decade these purely morphological techniques have gradually been replaced by hybrid imaging techniques, such as positron emission tomography-CT (PET/CT) and PET/MRI, which also provide metabolic and functional information. PERFORMANCE For lymphomas, the PET tracer 18F-fluorodeoxyglucose (18 F-FDG) is meanwhile so well-established that its use is a cornerstone of the Lugano classification; however, for multiple myeloma the search for an optimal PET tracer that can also detect early disease stages is still ongoing. Functional MRI techniques, such as diffusion-weighted imaging (DWI), perfusion-weighted imaging and dynamic contrast-enhanced imaging have shown promising results for both lymphomas and multiple myelomas. ACHIEVEMENTS The PET/MRI technique can combine the different types of information due to its truly multiparametric approach. PRACTICAL RECOMMENDATIONS In the future PET/MRI could possibly become the hybrid imaging technique of choice for hemato-oncological diseases.
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Affiliation(s)
- M E Mayerhoefer
- Abteilung für Allgemeine und Kinderradiologie, Medizinische Universität Wien, Univ.-Klinik für Radiologie und Nuklearmedizin, Waehringer Guertel 18-20, 1090, Wien, Österreich.
| | - A Haug
- Abteilung für Nuklearmedizin, Medizinische Universität Wien, Univ.-Klinik für Radiologie und Nuklearmedizin, Wien, Österreich
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Lavini C, Kramer G, Pieters-den Bos I, Hoekstra O, Marcus JT. MRI protocol optimization for quantitative DCE-MRI of the spine. Magn Reson Imaging 2017; 44:96-103. [PMID: 28867668 DOI: 10.1016/j.mri.2017.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 08/14/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE In this study we systematically investigated different Dynamic Contrast Enhancement (DCE)-MRI protocols in the spine, with the goal of finding an optimal protocol that provides data suitable for quantitative pharmacokinetic modelling (PKM). MATERIALS AND METHODS In 13 patients referred for MRI of the spine, DCE-MRI of the spine was performed with 2D and 3D MRI protocols on a 3T Philips Ingenuity MR system. A standard bolus of contrast agent (Dotarem - 0.2ml/kg body weight) was injected intravenously at a speed of 3ml/s. Different techniques for acceleration and motion compensation were tested: parallel imaging, partial-Fourier imaging and flow compensation. The quality of the DCE MRI images was scored on the basis of SNR, motion artefacts due to flow and respiration, signal enhancement, quality of the T1 map and of the arterial input function, and quality of pharmacokinetic model fitting to the extended Tofts model. RESULTS Sagittal 3D sequences are to be preferred for PKM of the spine. Acceleration techniques were unsuccessful due to increased flow or motion artefacts. Motion compensating gradients failed to improve the DCE scans due to the longer echo time and the T2* decay which becomes more dominant and leads to signal loss, especially in the aorta. The quality scoring revealed that the best method was a conventional 3D gradient-echo acquisition without any acceleration or motion compensation technique. The priority in the choice of sequence parameters should be given to reducing echo time and keeping the dynamic temporal resolution below 5s. Increasing the number of acquisition, when possible, helps towards reducing flow artefacts. In our setting we achieved this with a sagittal 3D slab with 5 slices with a thickness of 4.5mm and two acquisitions. CONCLUSION The proposed DCE protocol, encompassing the spine and the descending aorta, produces a realistic arterial input function and dynamic data suitable for PKM.
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Affiliation(s)
- Cristina Lavini
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Gem Kramer
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Indra Pieters-den Bos
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Otto Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - J T Marcus
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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Terpos E, Matsaridis D, Koutoulidis V, Zagouri F, Christoulas D, Fontara S, Panourgias E, Gavriatopoulou M, Kastritis E, Dimopoulos MA, Moulopoulos LA. Dynamic contrast-enhanced magnetic resonance imaging parameters correlate with advanced revised-ISS and angiopoietin-1/angiopoietin-2 ratio in patients with multiple myeloma. Ann Hematol 2017; 96:1707-1714. [PMID: 28766001 DOI: 10.1007/s00277-017-3078-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/23/2017] [Indexed: 11/28/2022]
Abstract
The aim of the study was to assess the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in patients with newly diagnosed multiple myeloma (MM) who were treated with novel anti-myeloma agents. We studied 60 previously untreated MM patients at diagnosis, 14 with smoldering MM (SMM) and 5 with MGUS. All patients underwent MRI of the thoracolumbar spine and pelvis before the administration of any kind of therapy, and DCE-MRI was performed. The MRI perfusion parameters evaluated were wash-in (WIN), washout (WOUT), time-to-peak (TTPK), time-to-maximum slope (TMSP), and the WIN/TMSP ratio. The following serum levels of angiogenic cytokines were measured on the day of MRI: VEGF, angiogenin (Ang), angiopoietin-1 (Angp-1), and -2 (Angp-2). Symptomatic MM patients had increased WIN compared to SMM (p < 0.05) and MGUS patients (p = 0.001). TTPK was decreased, and WIN/TMSP was increased in both symptomatic and SMM patients compared to MGUS patients (p < 0.05). Symptomatic MM patients had decreased TMSP compared to MGUS patients. The Angp-1/Angp-2 ratio was reduced in symptomatic MM compared to SMM (p = 0.017) and MGUS patients (p < 0.001). TTPK correlated with Angp-1/Angp-2 ratio and importantly with R-ISS. Patients with R-ISS-3 had lower TTPK median value (23 s, range 18-29 s) compared to patients with R-ISS-2 (48 s, range 27-68 s) and patients with R-ISS-1 MM (54 s, range 42-76 s; p ANOVA = 0.01). A subset of patients with low TTPK (lower quartile) had shorter time to progression compared to all other patients. These data suggest that certain DCE-MRI parameters correlate with R-ISS and adverse prognostic features of angiogenesis, such as the ratio of Angp-1/Angp-2.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - Dimitris Matsaridis
- First Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, "Aretaieion" Hospital, Athens, Greece
| | - Vassilis Koutoulidis
- First Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, "Aretaieion" Hospital, Athens, Greece
| | - Flora Zagouri
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Christoulas
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sophia Fontara
- First Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, "Aretaieion" Hospital, Athens, Greece
| | - Evangelia Panourgias
- First Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, "Aretaieion" Hospital, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Lia A Moulopoulos
- First Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, "Aretaieion" Hospital, Athens, Greece
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Whole-body MRI, dynamic contrast-enhanced MRI, and diffusion-weighted imaging for the staging of multiple myeloma. Skeletal Radiol 2017; 46:733-750. [PMID: 28289855 DOI: 10.1007/s00256-017-2609-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 02/02/2023]
Abstract
Magnetic resonance imaging (MRI) is the most sensitive imaging technique for the detection of bone marrow infiltration, and has therefore recently been included in the new diagnostic myeloma criteria, as proposed by the International Myeloma Working Group. Nevertheless, conventional MRI only provides anatomical information and is therefore only of limited use in the response assessment of patients with multiple myeloma. The additional information from functional MRI techniques, such as diffusion-weighted imaging and dynamic contrast-enhanced MRI, can improve the detection rate of bone marrow infiltration and the assessment of response. This can further enhance the sensitivity and specificity of MRI in the staging of multiple myeloma patients. This article provides an overview of the technical aspects of conventional and functional MRI techniques with practical recommendations. It reviews the diagnostic performance, prognostic value, and role in therapy assessment in multiple myeloma and its precursor stages.
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Abstract
PET-magnetic resonance (MR) is a hybrid imaging modality that combines PET and MR. Evidence for this new modality is in the process of being developed, but both component modalities are well tested in the diagnosis and management of multiple myeloma. It allows advanced bimodality imaging of the whole body with an adaptable field of view and it can be used for monitoring plasma cell dyscrasias for progression to multiple myeloma, for assessing disease burden in patients with known multiple myeloma, for assessing response to therapy and relapse after remission, and for radiation therapy treatment planning.
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Affiliation(s)
- Shetal N Shah
- Abdominal Imaging Section and Nuclear Medicine Department, Imaging Institute and Taussig Cancer Institute, Cleveland Clinic Main Campus, Mail Code JB3, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Jorge D Oldan
- Nuclear Medicine, Department of Radiology, 2006 Old Clinic, CB# 7510, Chapel Hill, NC 27599, USA
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Prognostic significance of focal lesions and diffuse infiltration on MRI for multiple myeloma: a meta-analysis. Eur Radiol 2016; 27:2333-2347. [DOI: 10.1007/s00330-016-4543-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 06/30/2016] [Accepted: 08/08/2016] [Indexed: 01/13/2023]
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Association between magnetic resonance imaging patterns and baseline disease features in multiple myeloma: analyzing surrogates of tumour mass and biology. Eur Radiol 2016; 26:3939-3948. [DOI: 10.1007/s00330-015-4195-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 12/09/2015] [Accepted: 12/29/2015] [Indexed: 12/14/2022]
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