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Kim DK, Park SS, Jung JY. [Clinical Application and Limitations of Myeloma Response Assessment and Diagnosis System (MY-RADS)]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:51-74. [PMID: 36818710 PMCID: PMC9935961 DOI: 10.3348/jksr.2022.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/22/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
Multiple myeloma, which is a proliferative disease of plasma cells that originate from a single clone, is the second most common hematologic malignancy following non-Hodgkin lymphoma. In the past, its diagnosis was made based on clinical findings (so-called "CRAB") and a skeletal survey using radiographs. However, since the implementation of the International Myeloma Working Group's revised guideline regarding the radiologic diagnosis of multiple myeloma, whole-body (WB) MRI has emerged to play a central role in the early diagnosis of multiple myeloma. Diffusion-weighted imaging and fat quantification using Dixon methods enable treatment response assessment by MRI. In keeping with the trend, a multi-institutional and multidisciplinary consensus for standardized image acquisition and reporting known as the Myeloma Response Assessment and Diagnostic System (MY-RADS) has recently been proposed. This review aims to describe the clinical application of WB-MRI based on MY-RADS in multiple myeloma, discuss its limitations, and suggest future directions for improvement.
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Affiliation(s)
- Dong Kyun Kim
- Department of Radiology, Seoul St. Mary’s Hospital, and, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Soo Park
- Department of Hematology, Seoul St. Mary’s Hospital, and, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary’s Hospital, and, College of Medicine, The Catholic University of Korea, Seoul, Korea
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2
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Advanced Imaging in Multiple Myeloma: New Frontiers for MRI. Diagnostics (Basel) 2022; 12:diagnostics12092182. [PMID: 36140583 PMCID: PMC9497462 DOI: 10.3390/diagnostics12092182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/17/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Plasma cell dyscrasias are estimated to newly affect almost 40,000 people in 2022. They fall on a spectrum of diseases ranging from relatively benign to malignant, the malignant end of the spectrum being multiple myeloma (MM). The International Myeloma Working Group (IMWG) has traditionally outlined the diagnostic criteria and therapeutic management of MM. In the last two decades, novel imaging techniques have been employed for MM to provide more information that can guide not only diagnosis and staging, but also treatment efficacy. These imaging techniques, due to their low invasiveness and high reliability, have gained significant clinical attention and have already changed the clinical practice. The development of functional MRI sequences such as diffusion weighted imaging (DWI) or intravoxel incoherent motion (IVIM) has made the functional assessment of lesions feasible. Moreover, the growing availability of positron emission tomography (PET)–magnetic resonance imaging (MRI) scanners is leading to the potential combination of sensitive anatomical and functional information in a single step. This paper provides an organized framework for evaluating the benefits and challenges of novel and more functional imaging techniques used for the management of patients with plasma cell dyscrasias, notably MM.
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Guha A, Vijan A, Agarwal U, Goda JS, Mahajan A, Shetty N, Khattry N. Imaging for Plasma Cell Dyscrasias: What, When, and How? Front Oncol 2022; 12:825394. [PMID: 35402253 PMCID: PMC8987930 DOI: 10.3389/fonc.2022.825394] [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] [Received: 11/30/2021] [Accepted: 02/11/2022] [Indexed: 02/05/2023] Open
Abstract
Imaging plays a vital role in the diagnosis, response assessment, and follow-up of patients with plasma cell bone disease. The radiologic diagnostic paradigm has thus far evolved with developing technology and availability of better imaging platforms; however, the skewed availability of these imaging modalities in developed vis-à-vis the developing countries along with the lack of uniformity in reporting has led to a consensus on the imaging criteria for diagnosing and response assessment in plasma cell dyscrasia. Therefore, it is imperative for not only the radiologists but also the treating oncologist to be aware of the criteria and appropriate imaging modality to be used in accordance with the clinical question. The review will allow the treating oncologist to answer the following questions on the diagnostic, prognostic, and predictive abilities of various imaging modalities for plasma cell dyscrasia: a) What lesions can look like multiple myeloma (MM) but are not?; b) Does the patient have MM? To diagnose MM in a high-risk SMM patient with clinical suspicion, which modality should be used and why?; c) Is the patient responding to therapy on follow-up imaging once treatment is initiated?; d) To interpret commonly seen complications post-therapy, when is it a disease and when is the expected sequel to treatment? Fractures, red marrow reconversion?; and e) When is the appropriate time to flag a patient for further workup when interpreting MRI spine done for back pain in the elderly? How do we differentiate between commonly seen osteoporosis-related degenerative spine versus marrow infiltrative disorder?
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Affiliation(s)
- Amrita Guha
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- *Correspondence: Amrita Guha,
| | - Antariksh Vijan
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, India
| | - Ujjwal Agarwal
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, India
| | - Jayant Sastri Goda
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, India
| | - Nitin Shetty
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
| | - Navin Khattry
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Mumbai, India
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4
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Lecouvet FE, Vekemans MC, Van Den Berghe T, Verstraete K, Kirchgesner T, Acid S, Malghem J, Wuts J, Hillengass J, Vandecaveye V, Jamar F, Gheysens O, Vande Berg BC. Imaging of treatment response and minimal residual disease in multiple myeloma: state of the art WB-MRI and PET/CT. Skeletal Radiol 2022; 51:59-80. [PMID: 34363522 PMCID: PMC8626399 DOI: 10.1007/s00256-021-03841-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/28/2021] [Accepted: 06/06/2021] [Indexed: 02/02/2023]
Abstract
Bone imaging has been intimately associated with the diagnosis and staging of multiple myeloma (MM) for more than 5 decades, as the presence of bone lesions indicates advanced disease and dictates treatment initiation. The methods used have been evolving, and the historical radiographic skeletal survey has been replaced by whole body CT, whole body MRI (WB-MRI) and [18F]FDG-PET/CT for the detection of bone marrow lesions and less frequent extramedullary plasmacytomas.Beyond diagnosis, imaging methods are expected to provide the clinician with evaluation of the response to treatment. Imaging techniques are consistently challenged as treatments become more and more efficient, inducing profound response, with more subtle residual disease. WB-MRI and FDG-PET/CT are the methods of choice to address these challenges, being able to assess disease progression or response and to detect "minimal" residual disease, providing key prognostic information and guiding necessary change of treatment.This paper provides an up-to-date overview of the WB-MRI and PET/CT techniques, their observations in responsive and progressive disease and their role and limitations in capturing minimal residual disease. It reviews trials assessing these techniques for response evaluation, points out the limited comparisons between both methods and highlights their complementarity with most recent molecular methods (next-generation flow cytometry, next-generation sequencing) to detect minimal residual disease. It underlines the important role of PET/MRI technology as a research tool to compare the effectiveness and complementarity of both methods to address the key clinical questions.
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Affiliation(s)
- Frederic E. Lecouvet
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
| | - Marie-Christiane Vekemans
- Haematology Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Brussels, Belgium
| | - Thomas Van Den Berghe
- Radiology Department, Universiteit Ghent, Sint-Pietersnieuwstraat 33, 9000 Gent, Belgium
| | - Koenraad Verstraete
- Radiology Department, Universiteit Ghent, Sint-Pietersnieuwstraat 33, 9000 Gent, Belgium
| | - Thomas Kirchgesner
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
| | - Souad Acid
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
| | - Jacques Malghem
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
| | - Joris Wuts
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Avenue du Laerbeek 101, 1090 Jette, Belgium
| | - Jens Hillengass
- Departement of Medicine, Myeloma Unit, Park Comprehensive Cancer Center, Buffalo, NY USA
| | - Vincent Vandecaveye
- Radiology Department, Katholieke Univesiteit Leuven, Oude Markt, 13, 3000 Leuven, Belgium
| | - François Jamar
- Nuclear Medicine Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Olivier Gheysens
- Nuclear Medicine Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Bruno C. Vande Berg
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
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5
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Lin G, Zong X, Li Y, Tan W, Sun W, Zhang S, Gan Y, Zeng H. Whole-Body MRI Is an Effective Imaging Modality for Hematological Malignancy Treatment Response Assessment: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:827777. [PMID: 35251996 PMCID: PMC8894650 DOI: 10.3389/fonc.2022.827777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/11/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of whole-body MRI (WB-MRI) for assessment of hematological malignancies' therapeutic response. METHODS PubMed, Embase, and Web of Science were searched up to August 2021 to identify studies reporting the diagnostic performance of WB-MRI for the assessment of hematological malignancies' treatment response. A bivariate random-effects model was applied for the generation of the pooled diagnostic performance. RESULTS Fourteen studies with 457 patients with lymphoma, multiple myeloma, and sarcoma (very small proportion) were analyzed. Overall pooled sensitivity and specificity of WB-MRI were 0.88 (95% CI: 0.73-0.95) and 0.86 (95% CI: 0.73-0.93), respectively. Studies using whole-body diffusion-weighted imaging (WB-DWI) showed higher sensitivity than those that did not (0.94 vs. 0.55, p = 0.02). The pooled concordance rate of WB-MRI to assess hematological malignancies' treatment response with reference standard was 0.78 (95% CI: 0.59-0.96). WB-MRI and PET/CT showed similar diagnostic performance (sensitivity [0.83 vs. 0.92, p = 0.11] and specificity [0.87 vs. 0.76, p = 0.73]). CONCLUSION WB-MRI has high diagnostic performance for hematological malignancies' treatment response assessment. The adding of WB-DWI is strongly associated with increased sensitivity.
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Affiliation(s)
- Guisen Lin
- Department of Radiology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Xiaodan Zong
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), Guangzhou, China
| | - Yaowen Li
- Department of Radiology, Shenzhen Children’s Hospital, Shenzhen, China
| | | | - Weisheng Sun
- Shantou University Medical College, Shantou, China
| | - Siqi Zhang
- Shantou University Medical College, Shantou, China
| | - Yungen Gan
- Department of Radiology, Shenzhen Children’s Hospital, Shenzhen, China
- *Correspondence: Yungen Gan, ; Hongwu Zeng,
| | - Hongwu Zeng
- Department of Radiology, Shenzhen Children’s Hospital, Shenzhen, China
- *Correspondence: Yungen Gan, ; Hongwu Zeng,
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6
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Burns R, Mulé S, Blanc-Durand P, Tofighi M, Belhadj K, Zerbib P, Le Bras F, Baranes L, Haioun C, Itti E, Luciani A. Optimization of whole-body 2-[ 18F]FDG-PET/MRI imaging protocol for the initial staging of patients with myeloma. Eur Radiol 2021; 32:3085-3096. [PMID: 34842956 DOI: 10.1007/s00330-021-08388-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/08/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the optimal 2-[18F]FDG-PET/MRI imaging protocol for the initial staging of patients with suspected or confirmed multiple myeloma. METHODS Radiologists and nuclear medicine specialists reviewed all PET/MRI exams of 104 patients with a monoclonal gammopathy (MG). The presence of focal and diffuse bone marrow involvement (BMI) was assessed using 4 different image datasets: WB-MRI, PET, WB-PET/MRI, and WB-DCE-PET/MRI. A reference standard was established by a panel review of all baseline and follow-up imaging, and biological and pathological information. The diagnostic performance for each image dataset to detect BMI was evaluated and compared (Fisher's exact test). RESULTS Sensitivity, specificity, and accuracy for focal BMI of WB-MRI was 87%, 97%, and 92%; of PET was 78%, 97%, and 95%; of WB-PET/MRI was 93%, 97%, and 95%; and of WB-DCE-PET/MRI was 93%, 97%, and 95%, respectively. WB-PET/MRI and WB-DCE-PET/MRI were statistically superior to PET (p = 0.036) without decreasing specificity. The sensitivity, specificity, and accuracy of WB-MRI for diffuse BMI detection was 91%, 80%, and 85%; of 3DT1-PET was 53%, 89%, and 74%; of WB-PET/MRI was 98%, 66%, and 79%; and of WB-DCE-PET/MRI was 98%, 59%, and 75%, respectively. PET lacked sensitivity compared to all other dataset studies (p < 0.0001). WB-MRI had the best accuracy without reaching statistical significance when compared to the other datasets. CONCLUSION The WB-PET/MRI dataset including T1 and T2 Dixon, WB-DWI, and PET images provides optimal diagnostic performance to detect both focal lesions and diffuse BMI, with limited added value of WB-DCE for baseline staging of patients with MG. Key Points • The combination of morphological and functional MRI sequences and metabolic (2-[18F]FDG-PET) images increases the diagnostic performance of PET/MRI to detect focal bone lesions. • The adjunction of dynamic contrast-enhanced sequences did not improve diagnostic performance.
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Affiliation(s)
- Robert Burns
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France. .,Department of Medical Imaging, 51 Av. du Maréchal de Lattre de Tassigny, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.
| | - Sébastien Mulé
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Department of Medical Imaging, 51 Av. du Maréchal de Lattre de Tassigny, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Université Paris-Est Créteil, 94010, Créteil, France
| | - Paul Blanc-Durand
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Université Paris-Est Créteil, 94010, Créteil, France.,Department of Nuclear Medicine, Henri Mondor Hospital, AP-HP, 94010, Créteil, France
| | - Mojdeh Tofighi
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Department of Nuclear Medicine, Henri Mondor Hospital, AP-HP, 94010, Créteil, France
| | - Karim Belhadj
- Hematology Department, University Hospital, Creteil, France
| | - Pierre Zerbib
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Department of Medical Imaging, 51 Av. du Maréchal de Lattre de Tassigny, Henri Mondor Hospital, AP-HP, 94010, Créteil, France
| | - Fabien Le Bras
- Hematology Department, University Hospital, Creteil, France
| | - Laurence Baranes
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Department of Medical Imaging, 51 Av. du Maréchal de Lattre de Tassigny, Henri Mondor Hospital, AP-HP, 94010, Créteil, France
| | - Corinne Haioun
- Université Paris-Est Créteil, 94010, Créteil, France.,Hematology Department, University Hospital, Creteil, France
| | - Emmanuel Itti
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Université Paris-Est Créteil, 94010, Créteil, France.,Department of Nuclear Medicine, Henri Mondor Hospital, AP-HP, 94010, Créteil, France
| | - Alain Luciani
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Department of Medical Imaging, 51 Av. du Maréchal de Lattre de Tassigny, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Université Paris-Est Créteil, 94010, Créteil, France
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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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Mulé S, Reizine E, Blanc-Durand P, Baranes L, Zerbib P, Burns R, Nouri R, Itti E, Luciani A. Whole-Body Functional MRI and PET/MRI in Multiple Myeloma. Cancers (Basel) 2020; 12:cancers12113155. [PMID: 33121132 PMCID: PMC7693006 DOI: 10.3390/cancers12113155] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Whole-body magnetic resonance imaging (MRI) is recognized as the most sensitive imaging technique for the detection of bone marrow infiltration, and was therefore, recently included in the new diagnostic myeloma criteria, as proposed by the International Myeloma Working Group. The use of diffusion-weighted MRI further improved the performances of whole-body MRI in the setting of multiple myeloma, and its systematic implementation in general clinical practice is now recommended. Whole-body, dynamic, contrast-enhanced MRI might provide further information on lesions vascularity and might help evaluate response to treatment. Hybrid PET/MRI might act as the optimal imaging modality, owing to the association of the best techniques for both detecting bone marrow involvement and evaluating treatment response, providing one-stop-shop imaging in a whole-body scale. This review provides an overview on the value of whole-body MRI, including diffusion-weighted and dynamic contrast-enhanced MRI and whole-body 18F-FDG PET/MRI in diagnosis, staging, and response evaluation in multiple myeloma. Abstract Bone disease is one of the major features of multiple myeloma (MM), and imaging has a pivotal role in both diagnosis and follow-up. Whole-body magnetic resonance imaging (MRI) is recognized as the gold standard for the detection of bone marrow involvement, owing to its high sensitivity. The use of functional MRI sequences further improved the performances of whole-body MRI in the setting of MM. Whole-body diffusion-weighted (DW) MRI is the most attractive functional technique and its systematic implementation in general clinical practice is now recommended by the International Myeloma Working Group. Whole-body dynamic contrast-enhanced (DCE) MRI might provide further information on lesions vascularity and help evaluate response to treatment. Whole Body PET/MRI is an emerging hybrid imaging technique that offers the opportunity to combine information on morphology, fat content of bone marrow, bone marrow cellularity and vascularization, and metabolic activity. Whole-body PET/MRI allows a one-stop-shop examination, including the most sensitive technique for detecting bone marrow involvement, and the most recognized technique for treatment response evaluation. This review aims at providing an overview on the value of whole-body MRI, including DW and DCE MRI, and combined whole-body 18F-FDG PET/MRI in diagnosis, staging, and response evaluation in patients with MM.
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Affiliation(s)
- Sébastien Mulé
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Department of Medical Imaging, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
- Université Paris-Est Créteil, 94010 Créteil, France
- Correspondence:
| | - Edouard Reizine
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Department of Medical Imaging, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Paul Blanc-Durand
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Université Paris-Est Créteil, 94010 Créteil, France
- Department of Nuclear Medicine, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Laurence Baranes
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Department of Medical Imaging, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Pierre Zerbib
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Department of Medical Imaging, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Robert Burns
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Department of Medical Imaging, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Refaat Nouri
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Department of Medical Imaging, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Emmanuel Itti
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Université Paris-Est Créteil, 94010 Créteil, France
- Department of Nuclear Medicine, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Alain Luciani
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Department of Medical Imaging, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
- Université Paris-Est Créteil, 94010 Créteil, France
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9
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Jo A, Jung JY, Lee SY, Lee SE, Park H, Lee SE, Min CK. Prognosis Prediction in Initially Diagnosed Multiple Myeloma Patients Using Intravoxel Incoherent Motion-Diffusion Weighted Imaging and Multiecho Dixon Imaging. J Magn Reson Imaging 2020; 53:491-501. [PMID: 32812318 DOI: 10.1002/jmri.27321] [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] [Received: 04/23/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Multiparametric MRI provides complementary information for the diagnosis and management of multiple myeloma (MM). PURPOSE To evaluate the association of prognostic factors of MM and parameters derived from intravoxel-incoherent motion diffusion-weighted imaging (IVIM-DWI) and multiecho (ME) Dixon. STUDY TYPE Retrospective. POPULATION In all, 78 MM patients. FIELD STRENGTH/SEQUENCES T1 -weighted turbo spin-echo sequences (TSE), IVIM-DWI, ME 3D gradient echo sequence with multistep adaptive fitting at 3T. ASSESSMENT The region of interest (ROI) on the vertebral body was independently measured on four parametric maps (Dslow , Dfast and perfusion fraction [f], and proton-density fat-fraction [Ff] maps) by two readers. All patients were categorized into three groups based on the International Staging System (ISS). STATISTICAL TESTS Three groups were compared using analysis of variance (ANOVA) and post-hoc tests with Bonferroni correction. Logistic regression analysis was performed to predict the advancement of disease (early vs. advanced). Principal component analysis (PCA) was used to find the deterministic parameters. RESULTS Dslow and Ff were significantly different among ISS-1 (n = 38), ISS-2 (n = 22), and ISS-3 (n = 18) groups in both readers: 0.36, 0.41, and 0.58 × 10-3 mm2 /s for Dslow (P < 0.05), and 46%, 30%, and 15% for Ff (P < 0.05) in reader 1; 0.34, 0.41, and 0.58 × 10-3 mm2 /s for Dslow (P < 0.05), 43%, 27%, and 13.2% for Ff (P < 0.05) in reader 2, respectively. Dfast between ISS-3 and the other groups was significantly different in one reader only: 2.03, 2.29, and 2.85 × 10-3 mm2 /s (P < 0.05). There was no significant difference in f among the groups in both readers. Logistic regression by stepwise selection indicated Ff as the single most significant factor for differentiating early and advanced stages of MM with an accuracy of 76% and area under the curve (AUC) of 0.83 (P < 0.05). PCA revealed Ff, and Dslow as the deterministic parameters, with a cumulative proportion of 0.84. DATA CONCLUSION D slow and Ff are associated with the prognostic factor of MM. Level of Evidence 3 Technical Efficacy Stage 5. J. MAGN. RESON. IMAGING 2021;53:491-501.
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Affiliation(s)
- Aram Jo
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon-Yong Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Yeon Lee
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Eun Lee
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyerim Park
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Eun Lee
- Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Ki Min
- Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Takasu M, Kondo S, Akiyama Y, Takahashi Y, Maeda S, Baba Y, Kawase T, Ichinohe T, Awai K. Assessment of early treatment response on MRI in multiple myeloma: Comparative study of whole-body diffusion-weighted and lumbar spinal MRI. PLoS One 2020; 15:e0229607. [PMID: 32106239 PMCID: PMC7046272 DOI: 10.1371/journal.pone.0229607] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/10/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives To compare remission status at completion of chemotherapy for multiple myeloma (MM) with changes in total diffusion volume (tDV) calculated from whole-body diffusion-weighted imaging (WB-DWI) and fat fraction (FF) of lumbar bone marrow (BM) by modified Dixon Quant (mDixon Quant) soon after induction of chemotherapy, and to assess the predictive value of MRI. Methods Fifty patients (mean age, 66.9 ± 10.5 years) with symptomatic myeloma were examined before and after two cycles of chemotherapy. From WB-DWI data, tDV was obtained with the threshold for positive BM involvement. Mean FF was calculated from lumbar BM using the mDixon Quant sequence. At the completion of chemotherapy, patients were categorized into a CR/very good PR (VGPR) group (n = 15; mean age, 67.6 ± 10.3 years) and a PR, SD or PD group (n = 35; mean age, 69.1 ± 8.6 years). ROC curves were plotted to assess performance in predicting achievement of CR/VGPR. Results At second examination, serum M protein, β2-microglobulin, and tDV were significantly decreased and hemoglobin, mean ADC, and FF were significantly increased in the CR/VGPR group and serum M protein was significantly increased in the PR/SD/PD group. The general linear model demonstrated that percentage changes in FF and M protein contributed significantly to achieving CR/VGPR (P = 0.02, P = 0.04, respectively). AUCs of ROC curves were 0.964 for FF and 0.847 for M protein. Conclusions Early change in FF of lumbar BM and serum M protein soon after induction of chemotherapy contributed significantly to prediction of CR/VGPR.
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Affiliation(s)
- Miyuki Takasu
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
- * E-mail:
| | - Shota Kondo
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Akiyama
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Takahashi
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Maeda
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Takakazu Kawase
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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11
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Park HY, Kim KW, Yoon MA, Lee MH, Chae EJ, Lee JH, Chung HW, Yoon DH. Role of whole-body MRI for treatment response assessment in multiple myeloma: comparison between clinical response and imaging response. Cancer Imaging 2020; 20:14. [PMID: 32000858 PMCID: PMC6993415 DOI: 10.1186/s40644-020-0293-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/20/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Whole-body MRI (WB-MRI) including diffusion-weighted image (DWI) have been widely used in patients with multiple myeloma. However, evidence for the value of WB-MRI in the evaluation of treatment response remains sparse. Therefore, we evaluated the role of WB-MRI in the response assessment. METHODS In our WB-MRI registry, we searched multiple myeloma patients treated with chemotherapy who underwent both baseline and follow-up WB-MRI scans. Clinical responses were categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD), using IMWG criteria. Using RECIST 1.1, MD Anderson (MDA) criteria, and MDA-DWI criteria, imaging responses on WB-MRI were rated as CR, PR, SD, or PD by two radiologists independently. Then, discrepancy cases were resolved by consensus. Weighted Kappa analysis was performed to evaluate agreement between the imaging and clinical responses. The diagnostic accuracy of image responses in the evaluation of clinical CR, objective response (CR and PR), and PD was calculated. RESULTS Forty-two eligible patients were included. There was moderate agreement between imaging and clinical responses (κ = 0.54 for RECIST 1.1, κ = 0.58 for MDA criteria, κ = 0.69 for MDA-DWI criteria). WB-MRI showed excellent diagnostic accuracy in assessment of clinical PD (sensitivity 88.9%, specificity 94.7%, positive predictive value [PPV] 84.2%, negative predictive value [NPV] 96.4% in all three imaging criteria). By contrast, WB-MRI showed low accuracy in assessment of clinical CR (sensitivity 4.5%, specificity 98.1%, PPV 50.0%, NPV 71.2% in all three imaging criteria). As to the clinical objective response, the diagnostic accuracy was higher in MDA-DWI criteria than RECIST 1.1 and MDA criteria (sensitivity/specificity/PPV/NPV, 84.2%/94.4%/98.0%/65.4, 54.4%/100%/100%/40.9, and 61.4%/94.4%/97.2%/43.6%, respectively). CONCLUSIONS In the imaging response assessment of multiple myeloma, WB-MRI showed excellent performance in the evaluation of PD, but not in the assessment of CR or objective response. When adding DWI to imaging response criteria, diagnostic accuracy for objective response was improved and agreement between imaging and clinical responses was increased.
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Affiliation(s)
- Ho Young Park
- Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Min A Yoon
- Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Min Hee Lee
- Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Eun Jin Chae
- Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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12
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Abstract
Bone disease is the most frequent feature of multiple myeloma (MM) and represents a marker of end-organ damage; it is used to establish the diagnosis and to dictate the immediate need for therapy. For this reason, imaging plays a significant role in the management of MM patients. Although conventional radiography has traditionally been the standard imaging modality, its low sensitivity in detecting osteolytic lesions and inability to evaluate response to therapy has called for the use of more sophisticated techniques, such as whole-body low-dose computed tomography (WBLDCT), whole-body magnetic resonance imaging, and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT). In this review, the advantages, indications of use, and applications of the 3 techniques in the management of patients with MM in different settings will be discussed. The European Myeloma Network and the European Society for Medical Oncology guidelines have recommended WBLDCT as the imaging modality of choice for the initial assessment of MM-related lytic bone lesions. Magnetic resonance imaging is the gold-standard imaging modality for detection of bone marrow involvement, whereas PET/CT provides valuable prognostic data and is the preferred technique for assessment of response to therapy. Standardization of most of the techniques is ongoing.
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13
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Petralia G, Padhani AR, Pricolo P, Zugni F, Martinetti M, Summers PE, Grazioli L, Colagrande S, Giovagnoni A, Bellomi M. Whole-body magnetic resonance imaging (WB-MRI) in oncology: recommendations and key uses. Radiol Med 2018; 124:218-233. [PMID: 30430385 DOI: 10.1007/s11547-018-0955-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/23/2018] [Indexed: 12/16/2022]
Abstract
The past decade has witnessed a growing role and increasing use of whole-body magnetic resonance imaging (WB-MRI). Driving these successes are developments in both hardware and software that have reduced overall examination times and significantly improved MR imaging quality. In addition, radiologists and clinicians have continued to find promising new applications of this innovative imaging technique that brings together morphologic and functional characterization of tissues. In oncology, the role of WB-MRI has expanded to the point of being recommended in international guidelines for the assessment of several cancer histotypes (multiple myeloma, melanoma, prostate cancer) and cancer-prone syndromes (Li-Fraumeni and hereditary paraganglioma-pheochromocytoma syndromes). The literature shows growing use of WB-MRI for the staging and follow-up of other cancer histotypes and cancer-related syndromes (including breast cancer, lymphoma, neurofibromatosis, and von Hippel-Lindau syndromes). The main aim of this review is to examine the current scientific evidence for the use of WB-MRI in oncology.
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Affiliation(s)
- Giuseppe Petralia
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hematology, University of Milan, Milan, Italy.,Advanced Screening Centers - ASC Italia, Castelli Calepio, Bergamo, Italy
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
| | - Paola Pricolo
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Fabio Zugni
- Postgraduate School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Marco Martinetti
- Advanced Screening Centers - ASC Italia, Castelli Calepio, Bergamo, Italy
| | - Paul E Summers
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Luigi Grazioli
- First Department of Radiology, Civic and University Hospital of Brescia, Brescia, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Massimo Bellomi
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hematology, University of Milan, Milan, Italy.,Advanced Screening Centers - ASC Italia, Castelli Calepio, Bergamo, Italy
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14
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Detappe A, Bustoros M, Mouhieddine TH, Ghoroghchian PP. Advancements in Nanomedicine for Multiple Myeloma. Trends Mol Med 2018; 24:560-574. [DOI: 10.1016/j.molmed.2018.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 12/16/2022]
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15
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Gariani J, Westerland O, Natas S, Verma H, Cook G, Goh V. Comparison of whole body magnetic resonance imaging (WBMRI) to whole body computed tomography (WBCT) or 18F-fluorodeoxyglucose positron emission tomography/CT ( 18F-FDG PET/CT) in patients with myeloma: Systematic review of diagnostic performance. Crit Rev Oncol Hematol 2018; 124:66-72. [PMID: 29548488 DOI: 10.1016/j.critrevonc.2018.02.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 12/05/2017] [Accepted: 02/22/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES To undertake a systematic review to determine the diagnostic performance of whole body MRI (WBMRI) including diffusion weighted sequences (DWI) compared to whole body computed tomography (WBCT) or 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) in patients with myeloma. METHODS Two researchers searched the primary literature independently for WBMRI studies of myeloma. Data were extracted focusing on the diagnostic ability of WBMRI versus WBCT and 18F-FDG PET/CT. Meta-analysis was intended. RESULTS 6 of 2857 articles were eligible that included 147 patients, published from 2008 to 2016. Studies were heterogeneous including both newly diagnosed & relapsed patients. All were single centre studies. Four of the six studies (66.7%) accrued prospectively and 5/6 (83.3%, 3 prospective) included WBMRI and 18F-FDG PET/CT. Three of seven (42.9%) included DWI. The lack of an independent reference standard for individual lesions was noted in 5/6 (83.3%) studies. Studies reported that WBMRI detected more lesions than 18F-FDG PET/CT (sensitivity 68-100% versus 47-100%) but was less specific (specificity 37-83% versus 62-85.7%). No paper assessed impact on management. CONCLUSIONS Studies were heterogeneous, the majority lacking an independent reference standard. Future prospective trials should address these limitations and assess the impact of WBMRI on management.
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Affiliation(s)
- Joanna Gariani
- Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom; Division of Radiology, Department of Imaging and Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland
| | - Olwen Westerland
- Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom; Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sarah Natas
- Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom; Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Hema Verma
- Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom; Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gary Cook
- Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom; The PET Centre, St Thomas' Hospital, London, United Kingdom
| | - Vicky Goh
- Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom; Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
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16
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Comparison of qualitative and quantitative CT and MRI parameters for monitoring of longitudinal spine involvement in patients with multiple myeloma. Skeletal Radiol 2018; 47:351-361. [PMID: 29222688 DOI: 10.1007/s00256-017-2827-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 11/05/2017] [Accepted: 11/14/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare qualitative and quantitative computed tomography (CT) and magnetic resonance imaging (MRI) parameters for longitudinal disease monitoring of multiple myeloma (MM) of the axial skeleton. MATERIALS AND METHODS We included 31 consecutive patients (17 m; mean age 59.20 ± 8.08 years) with MM, who underwent all baseline (n = 31) and at least one or more (n = 47) follow-up examinations consisting of multi-parametric non-enhanced whole-body MRI (WBMRI) and non-enhanced whole-body reduced-dose thin-section MDCT (NEWBMDCT) between 06/2013 and 09/2016. We classified response according to qualitative CT criteria into progression (PD), stable(SD), partial/very good partial (PR/VGPR) and complete response(CR), grouping the latter three together for statistical analysis because CT cannot reliably assess PR and CR. Qualitative MR-response criteria were defined and grouped similarly to CT using longitudinal quantification of signal-intensity changes on T1w/STIR/ T2*w and calculating ADC-values. Standard of reference was the hematological laboratory (M-gradient). RESULTS Hematological response categories were CR (14/47, 29.7%), PR (2/47, 4.2%), SD (16/47, 34.0%) and PD (15/47, 29.9%). Qualitative-CT-evaluation showed PD in 12/47 (25.5%) and SD/PR/VGPR/CR in 35/47 (74.5%) cases. These results were confirmed by quantitative-CT in all focal lytic lesions (p < 0.001). Quantitative-CT at sites with diffuse bone involvement showed significant increase of maximum bone attenuation (p < 0.001*) and significant decrease of minimal bone (p < 0.002*) in the SD/PR/VGPR/CR group. Qualitative MRI showed PD in 14/47 (29.7%) and SD/PR/VGPR/CR in 33/47 (70.3%). Quantitative MRI diagnosis showed a statistically significant decrease in signal intensity on short tau inversion recovery sequences (STIR) in bone marrow in patients with diffuse bone marrow involvement achieving SD/PR/VGPR/CR (p < 0.001*). CONCLUSION Imaging response monitoring using MRI is superior to CT only if qualitative parameters are used, whereas there was no definite benefit from using quantitative parameters with either CT or MRI.
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Bustoros M, Mouhieddine TH, Detappe A, Ghobrial IM. Established and Novel Prognostic Biomarkers in Multiple Myeloma. Am Soc Clin Oncol Educ Book 2017; 37:548-560. [PMID: 28561668 DOI: 10.1200/edbk_175175] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Multiple myeloma (MM) is an incurable plasma cell malignancy characterized by notable interpatient heterogeneity. There have been important advances in therapy and overall survival, but some patients with high-risk features still have poor survival rates. Therefore, accurate identification of this subset of patients has been integral to improvement of patient outcome. During the last few years, cytogenetics, gene expression profiling, MRI and PET/CT, as well as serum free light chain assays have been used as accurate biomarkers to better characterize the diverse course and outcome of the disease. With the recent advances of massive parallel sequencing techniques, the development of new models that better stratify high-risk groups are beginning to be developed. The use of multiparameter flow cytometry and next-generation sequencing have paved the way for assessment of minimal residual disease and better prognostication of post-therapeutic outcomes. Circulating tumor cells and circulating tumor DNA are promising potential biomarkers that demonstrate the spatial and temporal heterogeneity of MM. Finally, more prognostic markers are being developed that are specific to immunotherapeutic agents. In this review, we discuss these traditional and novel biomarkers that have been developed for MM and also those that can predict disease progression from precursor stages. Together, these biomarkers will help improve our understanding of the intrapatient and interpatient variabilities and help develop precision medicine for patients with high-risk MM.
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Affiliation(s)
- Mark Bustoros
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Tarek H Mouhieddine
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Alexandre Detappe
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Irene M Ghobrial
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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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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Non-Secretory Myeloma: Ready for a new Definition? Mediterr J Hematol Infect Dis 2017; 9:e2017053. [PMID: 28894562 PMCID: PMC5584772 DOI: 10.4084/mjhid.2017.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/28/2017] [Indexed: 12/24/2022] Open
Abstract
Non-secretory myeloma is a rare myeloma subtype whose diagnosis, until a few years ago, was established by demonstration of monoclonal plasma cells ≥10% in the bone marrow and by negative results on serum and urine electrophoresis and immunofixation studies. However, this type of myeloma could be misdiagnosed if the workup does not include an accurate study of serum free light chain test since some of the patients diagnosed as non-secretory could be light chain only with small amounts monoclonal proteinuria. Due to this limit in classification, all the information available today, generally coming from retrospective studies including patients studied completely and incompletely, could be misleading. A new definition is, thus, needed to distinguish between the true non-secretory, with a possible better prognosis, and the other forms of oligo-secretory myeloma with a prognosis more similar to the secretory form of myeloma. With all the data of the literature, the availability of laboratory and radiological tools, times are mature to depict a new definition of nonsecretory myeloma that deserves a peculiar work up and different response evaluation and, may be, a different therapeutic approach.
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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
Radiology provides a crucial clinical adjunct in patients with plasma cell disorders, in particular multiple myeloma, and its uses are evolving and expanding. This pictorial review illustrates the role of imaging throughout the patient's clinical course, with specific reference to recently updated international diagnostic criteria. At presentation, imaging optimises characterisation and staging of the plasma-cell disorder, while later in the course of the disease, its roles include the monitoring of disease progression, assessment of post-treatment response and the investigation of clinical deterioration.
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Affiliation(s)
- Arian Lasocki
- 1 Department of Cancer Imaging, Peter MacCallum Cancer Centre, Australia.,2 Monash Imaging, Monash Health, Australia
| | - Frank Gaillard
- 3 Department of Radiology, The Royal Melbourne Hospital, Australia.,4 Department of Radiology, The University of Melbourne, Australia
| | - Simon J Harrison
- 5 Department of Cancer Medicine, Peter MacCallum Cancer Centre, Australia.,6 Sir Peter MacCallum Department of Oncology, The University of Melbourne, Australia
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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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Latifoltojar A, Hall‐Craggs M, Rabin N, Popat R, Bainbridge A, Dikaios N, Sokolska M, Rismani A, D'Sa S, Punwani S, Yong K. Whole body magnetic resonance imaging in newly diagnosed multiple myeloma: early changes in lesional signal fat fraction predict disease response. Br J Haematol 2017; 176:222-233. [PMID: 27766627 PMCID: PMC5244686 DOI: 10.1111/bjh.14401] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/26/2016] [Indexed: 12/24/2022]
Abstract
Cross-sectional imaging techniques are being increasingly used for disease evaluation in patients with multiple myeloma. Whole body magnetic resonance imaging (WB-MRI) scanning is superior to plain radiography in baseline assessment of patients but changes following treatment have not been systematically explored. We carried out paired WB-MRI scans in 21 newly diagnosed patients prior to, and 8-weeks after, starting chemotherapy, and analysed stringently selected focal lesions (FLs) for parametric changes. A total of 323 FLs were evaluated, median 20 per patient. At 8 weeks, there was a reduction in estimated tumour volume (eTV), and an increase in signal fat fraction (sFF) and apparent diffusion coefficient (ADC) in the group as a whole (P < 0·001). Patients who achieved complete/very good partial response (CR/VGPR) to induction had a significantly greater increase in sFF compared to those achieving ≤ partial response (PR; P = 0·001). When analysed on a per-patient basis, all patients achieving CR/VGPR had a significant sFF increase in their FL's, in contrast to patients achieving ≤PR. sFF changes in patients reaching maximal response within 100 days (fast responders) were greater compared to slow responders (P = 0·001). Receiver Operator Characteristic analysis indicated that sFF changes at 8 weeks were the best biomarker (area under the Curve 0·95) for an inferior response (≤PR). We conclude that early lesional sFF changes may provide important information on depth of response, and are worthy of further prospective study.
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Affiliation(s)
| | - Margaret Hall‐Craggs
- Centre for Medical ImagingUniversity College LondonLondonUK
- Department of Clinical RadiologyUniversity College London HospitalsLondonUK
| | - Neil Rabin
- Department of HaematologyUniversity College London HospitalsLondonUK
| | - Rakesh Popat
- Department of HaematologyUniversity College London HospitalsLondonUK
| | - Alan Bainbridge
- Department of Medical PhysicsUniversity College London HospitalsLondonUK
| | | | - Magdalena Sokolska
- Department of Medical PhysicsUniversity College London HospitalsLondonUK
| | - Ali Rismani
- Department of HaematologyUniversity College London HospitalsLondonUK
| | - Shirley D'Sa
- Department of HaematologyUniversity College London HospitalsLondonUK
| | - Shonit Punwani
- Centre for Medical ImagingUniversity College LondonLondonUK
- Department of Clinical RadiologyUniversity College London HospitalsLondonUK
| | - Kwee Yong
- UCL Cancer Institute, HaematologyUniversity College LondonLondonUK
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Dupuis MM, Tuchman SA. Non-secretory multiple myeloma: from biology to clinical management. Onco Targets Ther 2016; 9:7583-7590. [PMID: 28008276 PMCID: PMC5171196 DOI: 10.2147/ott.s122241] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Multiple myeloma (MM) is the second most common hematologic malignancy in the US. It is typically characterized by production of large amounts of defective immunoglobulin (Ig). Diagnosing MM and monitoring treatment response, including eventual relapse, are largely based on sequential measurements of Ig. However, a small subset of MM called non-secretory multiple myeloma (NSMM) produces no detectable Ig. This subset of true NSMM has become even smaller over time, as the advent of the serum free light chain assay has resulted in the majority of NSMM patients being recategorized as light-chain MM – that is, MM cells that produce only the light-chain component of Ig. True forms of NSMM, meaning MM that secretes no monoclonal proteins whatsoever, constitute a distinct entity that is reviewed; definition of NSMM using current detection methods, discuss the biology underpinning NSMM development, and share recommendations for how NSMM should be managed clinically with respect to detection, treatment, and monitoring.
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Affiliation(s)
| | - Sascha A Tuchman
- Division of Hematology/Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Lin C, Shih YY, Huang SL, Huang HM. Total variation-based method for generation of intravoxel incoherent motion parametric images in MRI. Magn Reson Med 2016; 78:1383-1391. [DOI: 10.1002/mrm.26528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 09/22/2016] [Accepted: 10/04/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Chieh Lin
- Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation; Chang Gung Memorial Hospital, No. 5 Fu-Shin Street; Kwei-Shan Taoyuan County Taiwan
| | - Yi-Yu Shih
- Siemens Shenzhen Magnetic Resonance Ltd. Siemens MR Center, Gaoxin C. Ave., 2nd; Hi-Tech Industrial Park Shenzhen 518057 P.R. China
| | - Siao-Lan Huang
- Department of Medical Imaging and Radiological Sciences; Chang Gung University, 259 Wen-Hwa 1st Road; Kwei-Shan Taoyuan County Taiwan
| | - Hsuan-Ming Huang
- Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation; Chang Gung Memorial Hospital, No. 5 Fu-Shin Street; Kwei-Shan Taoyuan County Taiwan
- Medical Physics Research Center, Institute of Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, 259 Wen-Hwa 1st Road; Kwei-Shan Taoyuan County Taiwan
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Simplified response monitoring criteria for multiple myeloma in patients undergoing therapy with novel agents using computed tomography. Eur J Radiol 2016; 85:2195-2199. [PMID: 27842666 DOI: 10.1016/j.ejrad.2016.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/24/2016] [Accepted: 10/14/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Multiple myeloma is a malignant hematological disorder of the mature B-cell lymphocytes originating in the bone marrow. While therapy monitoring is still mainly based on laboratory biomarkers, the additional use of imaging has been advocated due to inaccuracies of serological biomarkers or in a-secretory myelomas. Non-enhanced CT and MRI have similar sensitivities for lesions in yellow marrow-rich bone marrow cavities with a favourable risk and cost-effectiveness profile of CT. Nevertheless, these methods are still limited by frequently high numbers of medullary lesions and its time consumption for proper evaluation. OBJECTIVE To establish simplified response criteria by correlating size and CT attenuation changes of medullary multiple myeloma lesions in the appendicular skeleton with the course of lytic bone lesions in the entire skeleton. Furthermore to evaluate these criteria with respect to established hematological myeloma-specific parameters for the prediction of treatment response to bortezomib or lenalidomide. MATERIALS AND METHODS Non-enhanced reduced-dose whole-body CT examinations of 78 consecutive patients (43 male, 35 female, mean age 63.69±9.2years) with stage III multiple myeloma were retrospectively re-evaluated. On per patient basis, size and mean CT attenuation of 2-4 representative lesions in the limbs were measured at baseline and at a follow-up after a mean of 8 months. Results were compared with the course of lytical bone lesions as well with that of specific hematological biomarkers. Myeloma response was assessed according to the International Myeloma Working Group (IMWG) uniform response criteria. Testing for correlation between response of medullary lesions (Respmed) and response of all myeloma manifestations including osteolyses (Resptotal) was performed using the corrected contingency coefficient (Ccorr). RESULTS The correlation between Respmed based on length diameter and transverse diameter and Resptotal was perfect (Ccorr=1.0; p<0.0001) whereas the correlation based on density was moderate (Ccorr=0.54; p<0.0001). The evaluation of simplified response criteria with a measurement of only 2 medullary lesions yielded the best sensitivity and specificity valued for treatment-induced changes for the length diameter evaluation with 94.4%/95.7% for prediction of progressive disease and 78.6%/93.3% for prediction of therapy response. There were no significant differences between patients treated with bortezomib and lenalidomide (p>0.05). CONCLUSION Measurements of size of a minimum of two medullary lesions is sufficient for response assessment and correlates very well with the course of lytic bone lesions and that of hematologic parameters.
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Dutoit JC, Verstraete KL. MRI in multiple myeloma: a pictorial review of diagnostic and post-treatment findings. Insights Imaging 2016; 7:553-69. [PMID: 27164915 PMCID: PMC4956620 DOI: 10.1007/s13244-016-0492-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/11/2016] [Accepted: 04/20/2016] [Indexed: 01/04/2023] Open
Abstract
Magnetic resonance imaging (MRI) is increasingly being used in the diagnostic work-up of patients with multiple myeloma. Since 2014, MRI findings are included in the new diagnostic criteria proposed by the International Myeloma Working Group. Patients with smouldering myeloma presenting with more than one unequivocal focal lesion in the bone marrow on MRI are considered having symptomatic myeloma requiring treatment, regardless of the presence of lytic bone lesions. However, bone marrow evaluation with MRI offers more than only morphological information regarding the detection of focal lesions in patients with MM. The overall performance of MRI is enhanced by applying dynamic contrast-enhanced MRI and diffusion weighted imaging sequences, providing additional functional information on bone marrow vascularization and cellularity. This pictorial review provides an overview of the most important imaging findings in patients with monoclonal gammopathy of undetermined significance, smouldering myeloma and multiple myeloma, by performing a ‘total’ MRI investigation with implications for the diagnosis, staging and response assessment. Main message • Conventional MRI diagnoses multiple myeloma by assessing the infiltration pattern. • Dynamic contrast-enhanced MRI diagnoses multiple myeloma by assessing vascularization and perfusion. • Diffusion weighted imaging evaluates bone marrow composition and cellularity in multiple myeloma. • Combined morphological and functional MRI provides optimal bone marrow assessment for staging. • Combined morphological and functional MRI is of considerable value in treatment follow-up.
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Affiliation(s)
- Julie C Dutoit
- Department of Radiology, MR -1K12, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Koenraad L Verstraete
- Department of Radiology, MR -1K12, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium
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Bone Metastases of Hepatocellular Carcinoma: Appearance on MRI Using a Standard Abdominal Protocol. AJR Am J Roentgenol 2016; 206:1003-12. [PMID: 26999036 DOI: 10.2214/ajr.15.15502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study is to describe the MRI features of hepatocellular carcinoma (HCC) bone metastases. MATERIALS AND METHODS Thirty-three consecutive patients were included. Two radiologists performed qualitative and quantitative analysis. The coordinator searched for clinical and epidemiologic features related to patients and their primary liver tumors. Earlier MRI studies were also reviewed to determine whether bone metastases were already present and prospectively identified. Descriptive statistics and the Lin concordance correlation coefficient were used. RESULTS Chronic hepatitis C virus infection was the most common cause of liver disease (20/32; 62.5%), and diffuse and multifocal HCC were the most frequent types of liver HCCs (28/33; 84.8%). Most lesions were located at the spine (109/155; 70.3%), with high signal intensity on fat-suppressed T1-weighted (54/62; 87.1%) and T2-weighted (53/62; 85.5%) images. Bone metastases were predominantly nodular (48/62; 77.4%), confined to the vertebral body (40/60; 66.7%), and best visualized at the arterial phase (40/62; 64.5%). The ring pattern of enhancement was present in 23 of 62 lesions, and the remaining lesions showed diffuse enhancement. Thirty-five of 62 (56.4%) bone metastases showed arterial peak of enhancement. In 13 of 33 (39.9%) patients, bone metastases were not prospectively reported. CONCLUSION Most patients with bone metastases had chronic hepatitis C virus infection and diffuse or multifocal HCC. Metastases are most commonly appreciated as hypervascular focal moderately intensely enhancing nodular masses on the hepatic arterial dominant phase images, with concomitant moderately high signal intensity on fat-suppressed T1- and T2-weighted images.
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Hillengass J, Ritsch J, Merz M, Wagner B, Kunz C, Hielscher T, Laue H, Bäuerle T, Zechmann CM, Ho AD, Schlemmer HP, Goldschmidt H, Moehler TM, Delorme S. Increased microcirculation detected by dynamic contrast-enhanced magnetic resonance imaging is of prognostic significance in asymptomatic myeloma. Br J Haematol 2016; 174:127-35. [PMID: 26991959 DOI: 10.1111/bjh.14038] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/15/2016] [Indexed: 02/06/2023]
Abstract
This prospective study aimed to investigate the prognostic significance of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) as a non-invasive imaging technique delivering the quantitative parameters amplitude A (reflecting blood volume) and exchange rate constant kep (reflecting vascular permeability) in patients with asymptomatic monoclonal plasma cell diseases. We analysed DCE-MRI parameters in 33 healthy controls and 148 patients with monoclonal gammopathy of undetermined significance (MGUS) or smouldering multiple myeloma (SMM) according to the 2003 IMWG guidelines. All individuals underwent standardized DCE-MRI of the lumbar spine. Regions of interest were drawn manually on T1-weighted images encompassing the bone marrow of each of the 5 lumbar vertebrae sparing the vertebral vessel. Prognostic significance for median of amplitude A (univariate: P < 0·001, hazard ratio (HR) 2·42, multivariate P = 0·02, HR 2·7) and exchange rate constant kep (univariate P = 0·03, HR 1·92, multivariate P = 0·46, HR 1·5) for time to progression of 79 patients with SMM was found. Patients with amplitude A above the optimal cut-off point of 0·89 arbitrary units had a 2-year progression rate into symptomatic disease of 80%. In conclusion, DCE-MRI parameters are of prognostic significance for time to progression in patients with SMM but not in individuals with MGUS.
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Affiliation(s)
- Jens Hillengass
- Department of Haematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.,Department of Radiology, German Cancer Research Centre, Heidelberg, Germany
| | - Judith Ritsch
- Department of Radiology, German Cancer Research Centre, Heidelberg, Germany
| | - Maximilian Merz
- Department of Haematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.,Department of Radiology, German Cancer Research Centre, Heidelberg, Germany
| | - Barbara Wagner
- Department of Haematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Christina Kunz
- Department of Biostatistics, German Cancer Research Centre, Heidelberg, Germany
| | - Thomas Hielscher
- Department of Biostatistics, German Cancer Research Centre, Heidelberg, Germany
| | - Hendrik Laue
- Fraunhofer Institute for Medical Image Computing MEVIS, Bremen, Germany
| | - Tobias Bäuerle
- Institute of Radiology, University Medical Centre Erlangen, Erlangen, Germany
| | | | - Anthony D Ho
- Department of Haematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | | | - Hartmut Goldschmidt
- Department of Haematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.,National Centre for Tumor Diseases, Heidelberg, Germany
| | | | - Stefan Delorme
- Department of Radiology, German Cancer Research Centre, Heidelberg, Germany
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Dutoit JC, Claus E, Offner F, Noens L, Delanghe J, Verstraete KL. Combined evaluation of conventional MRI, dynamic contrast-enhanced MRI and diffusion weighted imaging for response evaluation of patients with multiple myeloma. Eur J Radiol 2016; 85:373-82. [DOI: 10.1016/j.ejrad.2015.11.040] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/24/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
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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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Zhou C, Chan HP, Dong Q, Couriel DR, Pawarode A, Hadjiiski LM, Wei J. Quantitative Analysis of MR Imaging to Assess Treatment Response for Patients with Multiple Myeloma by Using Dynamic Intensity Entropy Transformation: A Preliminary Study. Radiology 2015; 278:449-57. [PMID: 26192897 DOI: 10.1148/radiol.2015142804] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To develop a quantitative measure of bone marrow changes in magnetic resonance (MR) images and investigate its capability for assessment of treatment response for patients with multiple myeloma (MM). MATERIALS AND METHODS This study was retrospective, institutional review board approved, and HIPAA compliant. Informed consent was waived. Patients (n = 64; mean age, 58.8 years [age range, 27-75 years]) who were diagnosed with MM and underwent autologous bone marrow stem cell transplantation (BMT) were evaluated. A pair of spinal MR examinations performed before and after BMT was collected from each patient's records. A three-dimensional dynamic intensity entropy transformation (DIET) method was developed to transform MR T1-weighted signal voxel by voxel to a quantitative entropy enhancement value (qEEV), from which predictor variables were derived to train a linear discriminant analysis classifier by using a leave-one-out method. The output of the linear discriminant analysis provided a qEEV-based response index for quantitative assessment of treatment response. The performance of quantitative response index for the discrimination of responder and nonresponder patients was evaluated by receiver operating characteristic curve analysis. RESULTS Among the 46 and 18 clinically diagnosed responder and nonresponder patients, the quantitative response index at a chosen decision threshold correctly identified 42 responder and 17 nonresponder patients. The agreement between the DIET method and the clinical outcome reached 0.922 (59 of 64; κ = 0.816; area under the receiver operating characteristic curve, 0.886 ± 0.042). CONCLUSION This study demonstrated the feasibility of quantitative response index to differentiate responder and nonresponder patients and had substantial agreement with clinical outcomes, which indicated that this quantitative measure has the potential to be an image biomarker to assess MM treatment response.
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Affiliation(s)
- Chuan Zhou
- From the Departments of Radiology (C.Z., H.C., Q.D., L.M.H., J.W.) and Internal Medicine (D.R.C., A.P.), University of Michigan Health System, Med Inn Building C479, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Heang-Ping Chan
- From the Departments of Radiology (C.Z., H.C., Q.D., L.M.H., J.W.) and Internal Medicine (D.R.C., A.P.), University of Michigan Health System, Med Inn Building C479, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Qian Dong
- From the Departments of Radiology (C.Z., H.C., Q.D., L.M.H., J.W.) and Internal Medicine (D.R.C., A.P.), University of Michigan Health System, Med Inn Building C479, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Daniel R Couriel
- From the Departments of Radiology (C.Z., H.C., Q.D., L.M.H., J.W.) and Internal Medicine (D.R.C., A.P.), University of Michigan Health System, Med Inn Building C479, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Attaphol Pawarode
- From the Departments of Radiology (C.Z., H.C., Q.D., L.M.H., J.W.) and Internal Medicine (D.R.C., A.P.), University of Michigan Health System, Med Inn Building C479, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Lubomir M Hadjiiski
- From the Departments of Radiology (C.Z., H.C., Q.D., L.M.H., J.W.) and Internal Medicine (D.R.C., A.P.), University of Michigan Health System, Med Inn Building C479, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Jun Wei
- From the Departments of Radiology (C.Z., H.C., Q.D., L.M.H., J.W.) and Internal Medicine (D.R.C., A.P.), University of Michigan Health System, Med Inn Building C479, 1500 E Medical Center Dr, Ann Arbor, MI 48109
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Bourillon C, Rahmouni A, Lin C, Belhadj K, Beaussart P, Vignaud A, Zerbib P, Pigneur F, Cuenod CA, Bessalem H, Cavet M, Boutekadjirt A, Haioun C, Luciani A. Intravoxel Incoherent Motion Diffusion-weighted Imaging of Multiple Myeloma Lesions: Correlation with Whole-Body Dynamic Contrast Agent-enhanced MR Imaging. Radiology 2015; 277:773-83. [PMID: 26131910 DOI: 10.1148/radiol.2015141728] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To correlate intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) parameters with the enhancement patterns of bone marrow and focal lesion obtained on whole-body (WB) dynamic contrast agent-enhanced (DCE) magnetic resonance (MR) images in patients with stage-III multiple myeloma (MM) before and after systemic therapy. MATERIALS AND METHODS Twenty-seven patients with MM were retrospectively included in this institutional review board-approved study. Requirement for written informed consent was waived. All patients underwent WB DCE MR imaging before treatment and 18 patients underwent repeat MR imaging 3 months after treatment. A transverse IVIM DWI sequence with 10 b values (0, 10, 20, 30, 50, 80, 100, 200, 400, and 800 sec/mm(2)) was acquired within bone marrow and focal lesions. The IVIM parameters (perfusion fraction [f], molecular diffusion coefficient [D], and perfusion-related D [D*]) and apparent diffusion coefficient (ADC) were extracted for both focal lesions and bone marrow and correlated with focal lesions and maximal bone marrow enhancement (BMEmax) (Spearman correlation coefficient) at baseline and at follow-up (Wilcoxon signed-rank test). RESULTS D and ADC values positively correlated with BMEmax (r = 0.7, P < .001; and r = 0.455, P = .0435, respectively). Patients with increased BMEmax showed significantly increased ADC and D within bone marrow versus patients who did not have increased BMEmax (ADC, 0.67 × 10(-3) mm(2)/sec vs 0.54 × 10(-3) mm(2)/sec, P = .03; D, 0.58 × 10(-3) mm(2)/sec vs 0.42 × 10(-3) mm(2)/sec, P < .001). Within focal lesions, f was the maximum in lesions that showed enhancement followed by washout. After treatment in good responders, the significant decrease in maximal enhancement value of focal lesions (baseline vs after treatment, 213.9% ± 78.7 [standard deviation] vs 131% ± 53.6, respectively; P < .001) was accompanied by a significant decrease in f (baseline vs after treatment, 11% ± 3.8 vs 5.8% ± 4.7, respectively; P < .001). CONCLUSION Diffuse bone marrow involvement is associated with increased D. Hypervascular focal lesions with high maximal enhancement value of focal lesions also show high f value. Likewise, the decreased maximal enhancement value of focal lesions after treatment is accompanied by decreased f.
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Affiliation(s)
- Camille Bourillon
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Alain Rahmouni
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Chieh Lin
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Karim Belhadj
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Pauline Beaussart
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Alexandre Vignaud
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Pierre Zerbib
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Frédéric Pigneur
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Charles-André Cuenod
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Hocine Bessalem
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Madeleine Cavet
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Amal Boutekadjirt
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Corinne Haioun
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
| | - Alain Luciani
- From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.)
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Imaging myeloma and related monoclonal plasma cell disorders using MRI, low-dose whole-body CT and FDG PET/CT. Clin Transl Imaging 2015. [DOI: 10.1007/s40336-015-0119-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Merz M, Ritsch J, Kunz C, Wagner B, Sauer S, Hose D, Moehler T, Delorme S, Goldschmidt H, Zechmann C, Hillengass J. Dynamic contrast-enhanced magnetic resonance imaging for assessment of antiangiogenic treatment effects in multiple myeloma. Clin Cancer Res 2014; 21:106-12. [PMID: 25351744 DOI: 10.1158/1078-0432.ccr-14-1029] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To noninvasively assess bone marrow microcirculation before and after therapy in patients with newly diagnosed multiple myeloma with dynamic contrast-enhanced MRI (DCE-MRI). EXPERIMENTAL DESIGN Ninety-six patients received DCE-MRI before and after primary treatment for newly diagnosed multiple myeloma. For the 91 evaluable patients, treatment consisted of high-dose therapy (HDT) with autologous stem cell transplantation (ASCT) in 82 patients and chemotherapy without ASCT in 9 patients. In addition, 33 healthy volunteers were imaged as the control group. Analysis of DCE-MRI was performed according to the two-compartment model by Brix to quantify amplitude A (associated with blood volume) and exchange rate constant kep (reflecting vessel permeability and perfusion). RESULTS Nonresponders showed significantly higher A-values before the start of therapy compared with responders (P = 0.02). In both responders and nonresponders to therapy, A-values dropped significantly (P = 0.004 and <0.001, respectively) after primary therapy, whereas lower values for kep were found only in responders (P < 0.001). Depth of remission was significantly correlated to decreased bone marrow microcirculation: Patients in near complete response (nCR) or complete remission (CR) after treatment showed significantly lower values for A compared with patients not achieving nCR+CR. The application of HDT or novel agents had no significant effect on DCE-MRI parameters after therapy, although patients treated with novel agents more often achieved nCR+CR (42%/12.5%; P < 0.002). Higher kep-values at second MRI were positively correlated to shorter overall survival (HR 3.53; 95% confidence intervals, 1.21-10.33; P = 0.02). CONCLUSION Parameters from DCE-MRI are correlated to remission after primary therapy and outcome in newly diagnosed multiple myeloma.
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Affiliation(s)
- Maximilian Merz
- Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany. Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
| | - Judith Ritsch
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Christina Kunz
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Barbara Wagner
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Sandra Sauer
- Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Dirk Hose
- Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Thomas Moehler
- Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Stefan Delorme
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany. National Center for Tumor Diseases, Heidelberg, Germany
| | | | - Jens Hillengass
- Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany. Department of Radiology, German Cancer Research Center, Heidelberg, Germany
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Mesguich C, Fardanesh R, Tanenbaum L, Chari A, Jagannath S, Kostakoglu L. State of the art imaging of multiple myeloma: comparative review of FDG PET/CT imaging in various clinical settings. Eur J Radiol 2014; 83:2203-2223. [PMID: 25308249 DOI: 10.1016/j.ejrad.2014.09.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 09/19/2014] [Indexed: 12/24/2022]
Abstract
18-Flurodeoxyglucose Positron Emission Tomography with computed tomography (FDG PET/CT) and Magnetic Resonance Imaging (MRI) have higher sensitivity and specificity than whole-body X-ray (WBXR) survey in evaluating disease extent in patients with multiple myeloma (MM). Both modalities are now recommended by the Durie-Salmon Plus classification although the emphasis is more on MRI than PET/CT. The presence of extra-medullary disease (EMD) as evaluated by PET/CT imaging, initial SUVmax and number of focal lesions (FL) are deemed to be strong prognostic parameters at staging. MRI remains the most sensitive technique for the detection of diffuse bone marrow involvement in both the pre and post-therapy setting. Compression fractures are best characterized with MRI signal changes, for determining vertebroplasty candidates. While PET/CT allows for earlier and more specific evaluation of therapeutic efficacy compared to MRI, when signal abnormalities persist years after treatment. PET/CT interpretation, however, can be challenging in the vertebral column and pelvis as well as in cases with post-therapy changes. Hence, a reading approach combining the high sensitivity of MRI and superior specificity of FDG PET/CT would be preferred to increase the diagnostic accuracy. In summary, the established management methods in MM, mainly relying on biological tumor parameters should be complemented with functional imaging data, both at staging and restaging for optimal management of MM.
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Affiliation(s)
- Charles Mesguich
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Reza Fardanesh
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Lawrence Tanenbaum
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ajai Chari
- Department of Medicine Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sundar Jagannath
- Department of Medicine Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Lale Kostakoglu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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Derlin T, Bannas P. Imaging of multiple myeloma: Current concepts. World J Orthop 2014; 5:272-282. [PMID: 25035830 PMCID: PMC4095020 DOI: 10.5312/wjo.v5.i3.272] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/11/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Medical imaging is of crucial importance for diagnosis and initial staging as well as for differentiation of multiple myeloma (MM) from other monoclonal plasma cell diseases. Conventional radiography represents the reference standard for diagnosis of MM due to its wide availability and low costs despite its known limitations such as low sensitivity, limited specificity and its inability to detect extraosseous lesions. Besides conventional radiography, newer cross-sectional imaging modalities such as whole-body low-dose computed tomography (CT), whole-body magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT are available for the diagnosis of osseous and extraosseous manifestations of MM. Whole-body low-dose CT is used increasingly, replacing conventional radiography at selected centers, due to its higher sensitivity for the detection of osseous lesions and its ability to diagnose extraosseous lesions. The highest sensitivity for both detection of bone marrow disease and extraosseous lesions can be achieved with whole-body MRI and 18F-FDG PET/CT. According to current evidence, MRI is the most sensitive method for initial staging while 18F-FDG PET/CT allows monitoring of treatment of MM. There is an evolving role for assessment of treatment response using newer MR imaging techniques. Future studies are needed to further define the exact role of the different imaging modalities for individual risk stratification and therapy monitoring.
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Caers J, Withofs N, Hillengass J, Simoni P, Zamagni E, Hustinx R, Beguin Y. The role of positron emission tomography-computed tomography and magnetic resonance imaging in diagnosis and follow up of multiple myeloma. Haematologica 2014; 99:629-37. [PMID: 24688111 PMCID: PMC3971072 DOI: 10.3324/haematol.2013.091918] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 11/29/2013] [Indexed: 12/25/2022] Open
Abstract
Multiple myeloma is the second most common hematologic malignancy and occurs most commonly in elderly patients. Almost all multiple myeloma patients develop bone lesions in the course of their disease or have evidence of bone loss at initial diagnosis. Whole-body conventional radiography remains the gold standard in the diagnostic evaluation, but computed tomography, magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography are increasingly used as complementary techniques in the detection of bone lesions. Moreover, the number of lesions detected and the presence of extramedullary disease give strong prognostic information. These new techniques may help to assess treatment response in solitary plasmacytoma or in multiple myeloma. In this article, we review recent data on the different imaging techniques used at diagnosis and in the assessment of treatment response, and discuss some current issues.
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Byrne M, Katz J, Moreb J. Multiple Myeloma and Evolution of Novel Biomarkers and Therapies. Cancer Biomark 2014. [DOI: 10.1201/b16389-39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mulligan M. Imaging of myeloma: beyond lytic lesions. Int J Hematol Oncol 2013. [DOI: 10.2217/ijh.13.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY This review will focus on the imaging findings present in patients with typical symptomatic multiple myeloma. The emphasis will be on recent developments related to advanced imaging techniques. There are several different ways to stage or risk-stratify patients with symptomatic multiple myeloma after the diagnosis has been established. The International Myeloma Working Group issued a consensus statement regarding imaging of myeloma patients in 2009. The consensus was that the conventional radiographic survey should still be carried out as the baseline imaging study and that MRI should be added whenever possible. Many other imaging exams are available including: CT, PET/CT, MRI and sestamibi. The strengths and weaknesses of all of the available imaging techniques will be summarized.
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Cuenod C, Balvay D. Perfusion and vascular permeability: Basic concepts and measurement in DCE-CT and DCE-MRI. Diagn Interv Imaging 2013; 94:1187-204. [DOI: 10.1016/j.diii.2013.10.010] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Lin C, Ho CL, Ng SH, Wang PN, Huang Y, Lin YC, Tang TC, Tsai SF, Rahmouni A, Yen TC. (11)C-acetate as a new biomarker for PET/CT in patients with multiple myeloma: initial staging and postinduction response assessment. Eur J Nucl Med Mol Imaging 2013; 41:41-9. [PMID: 24129710 DOI: 10.1007/s00259-013-2520-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/11/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE We investigated the potential value of (11)C-acetate (ACT) PET/CT in characterizing multiple myeloma (MM) compared with (18)F-FDG PET/CT. Bone marrow histological and whole-body (WB) MRI findings served as the reference standards. METHODS In this prospective study, 15 untreated MM patients (10 men and 5 women, age range 48-69 years) underwent dual-tracer (11)C-ACT and (18)F-FDG PET/CT and WB MRI for pretreatment staging, and 13 of them had repeated examinations after induction therapy. Diffuse and focal bone marrow uptake was assessed by visual and quantitative analyses, including measurement of the maximum standardized uptake value (SUVmax). Between-group differences and correlations were assessed with the Mann-Whitney U test and the Pearson test. RESULTS At staging, all 15 patients had diffuse myeloma involvement upon bone marrow examination with 30-90 % of plasma cell infiltrates. Diffuse infiltration was detected in all of them (100 %) using (11)C-ACT with a positive correlation between bone marrow uptake values and percentages of plasma cell infiltrates (r = +0.63, p=0.01). In contrast, a diagnosis of diffuse infiltration could be established using (18)F-FDG in only six patients (40 %). Focal lesions were shown in 13 patients on both (11)C-ACT PET/CT and WB MRI, and in 10 patients on (18)F-FDG PET/CT. Focal lesions demonstrated (11)C-ACT uptake with a mean SUVmax of 11.4 ± 3.3 (range 4.6-19.6, n=59), which was significantly higher than the (18)F-FDG uptake (mean SUVmax 6.6 ± 3.1, range 2.3-13.7, n=29; p<0.0001). After treatment, the diffuse bone marrow (11)C-ACT uptake showed a mean SUVmax reduction of 66 % in patients with at least a very good partial response versus 34 % in those with at most a partial response only (p=0.01). CONCLUSION PET/CT using (11)C-ACT as a biomarker showed a higher detection rate for both diffuse and focal myeloma lesions at diagnosis than using (18)F-FDG, and may be valuable for response assessment.
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Affiliation(s)
- Chieh Lin
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, No. 5 Fusing Street, Gueishan, 33305, Taiwan
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Fayad LM, Blakeley J, Plotkin S, Widemann B, Jacobs MA. Whole Body MRI at 3T with Quantitative Diffusion Weighted Imaging and Contrast-Enhanced Sequences for the Characterization of Peripheral Lesions in Patients with Neurofibromatosis Type 2 and Schwannomatosis. ISRN RADIOLOGY 2013; 2013:627932. [PMID: 24967287 PMCID: PMC4045550 DOI: 10.5402/2013/627932] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/13/2013] [Indexed: 12/15/2022]
Abstract
Purpose. WB-MRI is mainly used for tumor detection and surveillance. The purpose of this study is to establish the feasibility of WB-MRI at 3T for lesion characterization, with DWI/ADC-mapping and contrast-enhanced sequences, in patients with neurofibromatosis type 2 (NF-2) and schwannomatosis. Materials and Methods. At 3T, WB-MRI was performed in 11 subjects (10 NF-2 and 1 schwannomatosis) with STIR, T1, contrast-enhanced T1, and DWI/ADC mapping (b = 50, 400, 800 s/mm(2)). Two readers reviewed imaging for the presence and character of peripheral lesions. Lesion size and features (signal intensity, heterogeneity, enhancement characteristics, and ADC values) were recorded. Descriptive statistics were reported. Results. Twenty-three lesions were identified, with average size of 4.6 ± 2.8 cm. Lesions were characterized as tumors (21/23) or cysts (2/23) by contrast-enhancement properties (enhancement in tumors, no enhancement in cysts). On T1, tumors were homogeneously isointense (5/21) or hypointense (16/21); on STIR, tumors were hyperintense and homogeneous (10/21) or heterogeneous (11/21); on postcontrast T1, tumors enhanced homogeneously (14/21) or heterogeneously (7/21); on DWI, tumor ADC values were variable (range 0.8-2.7), suggesting variability in intrinsic tumor properties. Conclusion. WB-MRI with quantitative DWI and contrast-enhanced sequences at 3T is feasible and advances the utility of WB-MRI not only to include detection, but also to provide additional metrics for lesion characterization.
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Affiliation(s)
- Laura M. Fayad
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jaishri Blakeley
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- The Johns Hopkins Hospital Comprehensive Neurofibromatosis Center, Department of Neurology, The Johns Hopkins Hospital, CRB II, Suite 1M16, 1550 Orleans Street, Baltimore, MD 21231, USA
| | - Scott Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA, USA
- Neurofibromatosis Clinic, Pappas Center for Neuro-Oncology, Massachusetts General Hospital, 55 Fruit Street, YAW 9, Boston, MA 02114, USA
| | - Brigitte Widemann
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
- Pharmacology & Experimental Therapeutics Section, Pediatric Oncology Branch, NCI, CCR, Room 1-5750, 10 Center Drive, 10-CRC, MSC 1101, Bethesda, MD 20892, USA
| | - Michael A. Jacobs
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Cascini GL, Falcone C, Console D, Restuccia A, Rossi M, Parlati A, Tamburrini O. Whole-body MRI and PET/CT in multiple myeloma patients during staging and after treatment: personal experience in a longitudinal study. Radiol Med 2013; 118:930-48. [DOI: 10.1007/s11547-013-0946-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 08/17/2012] [Indexed: 01/30/2023]
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Dutoit JC, Vanderkerken MA, Verstraete KL. Value of whole body MRI and dynamic contrast enhanced MRI in the diagnosis, follow-up and evaluation of disease activity and extent in multiple myeloma. Eur J Radiol 2013; 82:1444-52. [PMID: 23726124 DOI: 10.1016/j.ejrad.2013.04.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the significance of dynamic contrast enhanced MRI (DCE-MRI) and whole body MRI (WB-MRI) in the diagnosis, prognosis and assessment of therapy for patients with monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM). MATERIALS AND METHODS The retrospective study includes 219 patients providing 463 WB-MRI and DCE-MRI investigations for the subgroups MGUS (n=70), MM active disease (n=126; this includes 70 patients with new diagnosis of MM, according to the International Staging System (ISS): 41.4% ISS stage I, 20.0% ISS stage II, 7.1% ISS stage III, 31.4% insufficient for staging; and 56 patients with '(re-)active disease': 16.07% relapse, 32.14% progressive disease and 51.79% stable disease) and MM remission (n=23; 60.87% complete remission, 17.39% very good partial remission and 21.74% partial remission). Investigations of patients with hereditary multiple exostoses (n=5), neurofibromatosis (n=7) and healthy persons (n=9) were added as control subjects (n=21). WB-MRI evaluation was done by evaluating thirteen skeletal regions, providing a 'skeletal score'. DCE-MRI images of the spine, were analyzed with regions-of-interest and time-intensity-curves (TIC). RESULTS All TIC parameters can significantly differentiate between the predefined subgroups (p<0.001). One hundred days after autologous stem cell transplantation a 75% decrease of the slope wash-in value (p<0.001) can be seen. A cubic regression trend between 'skeletal score' and slope wash-in (adj.R(2)=0.412) could demonstrate a significant increase bone marrow perfusion if MM affects more than 10 skeletal regions (p<0.001), associated with a poorer prognosis (p<0.001). CONCLUSION DCE-MRI evaluation of the spine is useful for diagnosis of MM, follow-up after stem cell transplantation and evaluation of disease activity. A combined evaluation with WB-MRI and DCE-MRI provides additional micro-vascular information on the morphologic lesions and could help categorize patients with MM in two different groups to offer useful therapeutic and prognostic advise.
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Affiliation(s)
- Julie C Dutoit
- Department of Radiology, MR-1K12, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium.
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Zamagni E, Cavo M. The role of imaging techniques in the management of multiple myeloma. Br J Haematol 2012; 159:499-513. [PMID: 22881361 DOI: 10.1111/bjh.12007] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Bone disease is the major feature of multiple myeloma (MM). Imaging is required for correct staging, in the follow-up after treatment and, as recently highlighted, is predictor of prognosis. In the near future, whole-body X-Ray may be replaced by more sensitive techniques, such as whole-body low-dose computerized tomography (CT). Magnetic resonance imaging (MRI) is the gold standard method for assessing bone marrow infiltration of the spine, predicting the risk of vertebral fracture and distinguishing between benign and malignant osteoporosis. Positron emission tomography (PET) with CT (PET/CT) provides important information about the extent of whole-body disease, including soft tissue masses, and is the best tool to distinguish between active or inactive disease after therapy. Both MRI and PET/CT are predictors of clinical outcome. A prospective use of these newer imaging techniques in both clinical trials and clinical practice may help optimize MM management in the near future.
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Affiliation(s)
- Elena Zamagni
- Seràgnoli Institute of Haematology, Bologna University School of Medicine, Bologna, Italy.
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Comparative diagnostic performance of 18F-FDG PET/CT versus whole-body MRI for determination of remission status in multiple myeloma after stem cell transplantation. Eur Radiol 2012; 23:570-8. [DOI: 10.1007/s00330-012-2600-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 06/26/2012] [Accepted: 07/10/2012] [Indexed: 01/07/2023]
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