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Chen Z, Yang A, Chen A, Dong J, Lin J, Huang C, Zhang J, Liu H, Zeng Z, Miao W. [ 68Ga]Pentixafor PET/CT for staging and prognostic assessment of newly diagnosed multiple myeloma: comparison to [ 18F]FDG PET/CT. Eur J Nucl Med Mol Imaging 2024; 51:1926-1936. [PMID: 38286937 DOI: 10.1007/s00259-024-06621-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 01/31/2024]
Abstract
PURPOSE To evaluate the prognostic performance of [68Ga]Pentixafor PET/CT at baseline for staging of patients with newly diagnosed multiple myeloma (MM) and to compare it with [18F]FDG PET/CT and the Revised-International Staging System (R-ISS). METHODS Patients who underwent [68Ga]Pentixafor and [18F]FDG PET/CT imaging were retrospectively included. Patient staging was performed according to the Durie-Salmon PLUS staging system based on [68Ga]Pentixafor PET/CT and [18F]FDG PET/CT images, and the R-ISS. Progression-free survival (PFS) at patient follow-up was estimated using the Kaplan-Meier estimator and compared using the log-rank test. Area under the receiver operating characteristic curve (AUC) was calculated to assess predictive performance. RESULTS Fifty-five MM patients were evaluated. Compared with [18F]FDG PET, [68Ga]Pentixafor PET detected 25 patients as the same stage, while 26 patients were upstaged and 4 patients were downstaged (P = 0.001). After considering the low-dose CT data, there was no statistically significant difference in the number of patients classified in each stage using [68Ga]Pentixafor PET/CT and [18F]FDG PET/CT (P = 0.091). [68Ga]Pentixafor PET/CT-based staging discriminated PFS outcomes in patients with different disease stages (stage I vs. stage II, stage I vs. stage III, and stage II vs. stage III; all P < 0.05), whereas for [18F]FDG PET/CT, there was only a difference in median PFS between stage I and III (P = 0.021). When staged by R-ISS, the median PFS for stage III was significantly lower than that for stage I and II (P = 0.008 and 0.035, respectively). When predicting 2-year PFS based on staging, the AUC of [68Ga]Pentixafor PET/CT was significantly higher than that of [68Ga]Pentixafor PET (0.923 vs. 0.821, P = 0.002), [18F]FDG PET (0.923 vs. 0.752 P = 0.002), and R-ISS (0.923 vs. 0.776, P = 0.005). CONCLUSIONS [68Ga]Pentixafor PET/CT-based staging possesses substantial potential to predict disease progression in newly diagnosed MM patients.
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Affiliation(s)
- Zhenying Chen
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Apeng Yang
- Department of Hematology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Aihong Chen
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Jinfeng Dong
- Department of Hematology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Junfang Lin
- Department of Hematology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Chao Huang
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Jiaying Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Huimin Liu
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Zhiyong Zeng
- Department of Hematology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
| | - Weibing Miao
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
- Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
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Wang T, Zhou B, Zhang K, Yan C, Guan X. Value of third-generation of VNCa dual-energy CT for differentiating diffuse marrow infiltration of multiple myeloma from red bone marrow. Medicine (Baltimore) 2024; 103:e38003. [PMID: 38701295 PMCID: PMC11062734 DOI: 10.1097/md.0000000000038003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
This study aims to investigate the ability of bone marrow imaging using third-generation dual-energy computed tomography (CT) virtual noncalcium (VNCa) to differentiate between multiple myeloma (MM) with diffuse bone marrow infiltration and red bone marrow (RBM). Bone marrow aspiration or follow-up results were used as reference. We retrospectively reviewed 188 regions of interests (ROIs) from 21 patients with confirmed MM and diffuse bone marrow infiltrations who underwent VNCa bone marrow imaging between May 2019 and September 2022. At the same time, we obtained 98 ROIs from 11 subjects with RBM for comparative study, and 189 ROIs from 20 subjects with normal yellow bone marrow for the control group. The ROIs were delineated by 2 radiologists independently, the interobservers reproducibility was evaluated by interclass correlation coefficients. The correlation with MRI grade results was analyzed by Spearman correlation coefficient. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal threshold for differentiating between these groups and to assess diagnostic performance. There were statistically significant differences in VNCa CT values of bone marrow among the MM, RBM, and control groups (all P < .001), with values decreasing sequentially. A strong positive rank correlation was observed between normal bone marrow, subgroup MM with moderately and severe bone marrow infiltration divided by MRI and their corresponding CT values (ρ = 0.897, 95%CI: 0.822 to 0.942, P < .001). When the CT value of VNCa bone marrow was 7.15 HU, the area under the curve (AUC) value for differentiating RBM and MM was 0.723, with a sensitivity of 50.5% and a specificity of 89.8%. When distinguishing severe bone marrow infiltration of MM from RBM, the AUC value was 0.80 with a sensitivity 70.9% and a specificity 78.9%. The AUC values for MM, RBM, and the combined group compared to the control group were all >0.99, with all diagnostic sensitivity and specificity exceeding 95%. VNCa bone marrow imaging using third-generation dual-energy CT accurately differentiates MM lesions from normal bone marrow or RBM. It demonstrates superior diagnostic performance in distinguishing RBM from MM with diffuse bone marrow infiltration.
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Affiliation(s)
- Tiantian Wang
- Department of Radiology, The Affiliated Tengzhou Hospital of Xuzhou Medical University, Tengzhou, Shandong Province, China
| | - Biao Zhou
- Department of Radiology, The Affiliated Tengzhou Hospital of Xuzhou Medical University, Tengzhou, Shandong Province, China
| | - Kui Zhang
- Department of Hematology, The Affiliated Tengzhou Hospital of Xuzhou Medical University, Tengzhou, Shandong Province, China
| | - Chen Yan
- Department of Radiology, The Affiliated Tengzhou Hospital of Xuzhou Medical University, Tengzhou, Shandong Province, China
| | - Xiangzhen Guan
- Department of Radiology, The Affiliated Tengzhou Hospital of Xuzhou Medical University, Tengzhou, Shandong Province, China
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Lv JT, Jiao YT, Han XL, Cao YJ, Lv XK, Du J, Hou J. Integrating p53-associated genes and infiltrating immune cell characterization as a prognostic biomarker in multiple myeloma. Heliyon 2024; 10:e30123. [PMID: 38699735 PMCID: PMC11063508 DOI: 10.1016/j.heliyon.2024.e30123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/05/2024] Open
Abstract
Background Tumor genetic anomalies and immune dysregulation are pivotal in the progression of multiple myeloma (MM). Accurate patient stratification is essential for effective MM management, yet current models fail to comprehensively incorporate both molecular and immune profiles. Methods We examined 776 samples from the MMRF CoMMpass database, employing univariate regression with LASSO and CIBERSORT algorithms to identify 15 p53-related genes and six immune cells with prognostic significance in MM. A p53-TIC (tumor-infiltrating immune cells) classifier was constructed by calculating scores using the bootstrap-multicox method, which was further validated externally (GSE136337) and through ten-fold internal cross-validation for its predictive reliability and robustness. Results The p53-TIC classifier demonstrated excellent performance in predicting the prognosis in MM. Specifically, patients in the p53low/TIChigh subgroup had the most favorable prognosis and the lowest tumor mutational burden (TMB). Conversely, those in the p53high/TIClow subgroup, with the least favorable prognosis and the highest TMB, were predicted to have the best anti-PD1 and anti-CTLA4 response rate (40 %), which can be explained by their higher expression of PD1 and CTLA4. The three-year area under the curve (AUC) was 0.80 in the total sample. Conclusions Our study highlights the potential of an integrated analysis of p53-associated genes and TIC in predicting prognosis and aiding clinical decision-making in MM patients. This finding underscores the significance of comprehending the intricate interplay between genetic abnormalities and immune dysfunction in MM. Further research into this area may lead to the development of more effective treatment strategies.
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Affiliation(s)
- Jun-Ting Lv
- Zhuhai Hospital of Integrated Traditional Chinese & Western Medicine, 519000, China
| | - Yu-Tian Jiao
- Department of Clinical Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xin-Le Han
- Department of Pathology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yang-Jia Cao
- Department of Hematology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, 710061, China
| | - Xu-Kun Lv
- Department of Clinical Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jun Du
- Department of Hematology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
- Department of Hematology, Punan Hospital, Pudong New District, Shanghai, 200011, China
| | - Jian Hou
- Department of Hematology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
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Zhang T, Lin Z, Zheng Z, Wang Q, Zhou S, Zhang B, Zheng D, Chen Z, Zheng S, Zhang Y, Lin X, Dong R, Chen J, Qian H, Hu X, Zhuang Y, Zhang Q, Jin Z, Jiang S, Ma Y. Prognostic significance of β2-microglobulin decline index in multiple myeloma. Front Oncol 2024; 14:1322680. [PMID: 38562177 PMCID: PMC10982376 DOI: 10.3389/fonc.2024.1322680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose To assess the prognostic significance of β2-microglobulin decline index (β2M DI) in multiple myeloma (MM). Methods 150 MM patients diagnosed with MM were enrolled in this study. Cox proportional hazards model was used to analyze the uni- and multivariate prognosis in training cohort (n=105). A new combined prognostic model containing β2M DI was built up based on the data in training cohort. The validation group was used to verify the model. Results β2M DI showed significant correlation with prognosis in both uni- and multivariate analyses and had a good correlation with complete response (CR) rate and deep remission rate. The ROC and calibration curves in validation cohort (n=45) indicated a good predictive performance of the new model. Based on the median risk score of the training group, we classified patients into high- and low- risk groups. In both training and validation groups, patients in the low-risk group had longer overall survival (OS) time than that in the high-risk group (p<0.05). Conclusion β2M DI is a good predictive index for predicting treatment response and survival time in MM patients. The prognostic model added with β2M DI showed a better correlation with OS.
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Affiliation(s)
- Tianyu Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Neurology, The First People’s Hospital of Fuyang District, Hangzhou, Zhejiang, China
| | - Zhili Lin
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ziwei Zheng
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Quanqiang Wang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shujuan Zhou
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Bingxin Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dong Zheng
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zixing Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Sisi Zheng
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yu Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xuanru Lin
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rujiao Dong
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingjing Chen
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Honglan Qian
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xudong Hu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yan Zhuang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qianying Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhouxiang Jin
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Songfu Jiang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yongyong Ma
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- The First Affiliated Hospital of Wenzhou Medical University, Key Laboratory of Intelligent Treatment and Life Support for Critical Diseases of Zhejiang Province, Wenzhou, Zhejiang, China
- The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Engineering Research Center for Hospital Emergency and Process Digitization, Wenzhou, Zhejiang, China
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Yavorkovsky LL. The role of staging in multiple myeloma. Expert Rev Hematol 2023; 16:933-942. [PMID: 37902242 DOI: 10.1080/17474086.2023.2277876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/27/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION The importance of cancer staging is determined by how accurately it can predict prognosis, and how useful it is for treatment decisions. Compared to other malignancies, multiple myeloma (MM) staging proved more challenging because of unreliable prognostic factors and wide-ranging life expectancy. As traditional MM staging continues to evolve, it requires reassessment of its prognostic and predictive value. AREAS COVERED The studies that included prognostic and predictive value of MM stages from 1975 through 2023 were selected for this review using PubMed, MEDLINE platforms. The history and evolution of MM staging are revisited, including its role in predicting survival, treatment planning and potential practical implications for the future. The role of MM staging for oncological practice and patient counseling is discussed. EXPERT OPINION The utility of the traditional MM staging remains unsatisfactory because it lacks a strong connection with the disease biology, prognosis or treatment planning. Additionally, it demonstrates a modest value for patient counseling because individual prognosis is subject to under- or overestimation, and the median survival or survival rates are difficult concepts to grasp. Although the role of MM stages may change in the future, the current research upholds the notion that MM staging benefits more medical research and clinical trials than oncological practice.
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Affiliation(s)
- Leonid L Yavorkovsky
- Kaiser Permanente San Jose Medical Center, Oncology Division, 271 International Circle, San Jose, CA, USA
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Wu Y, Shi X, Yao X, Du X. Biological research on the occurrence and development of multiple myeloma and its treatment. Immun Inflamm Dis 2023; 11:e850. [PMID: 37249283 PMCID: PMC10165958 DOI: 10.1002/iid3.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/30/2023] [Accepted: 04/16/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION To review the pathogenesis and treatment of multiple myeloma (MM). MM is a hematological malignancy with abnormal plasma cell proliferation in bone marrow. Due to the emergence of drug resistance, MM is still an incurable malignancy, which requires further exploration of pathogenesis and effective therapeutic targets. METHODS In this paper, the method of literature review is adopted to obtain the information about MM. Based on the literature, comprehensive and systematic review is made. RESULTS MM is a complex pathophysiological process with great heterogeneity, mainly reflected in genomic instability and bone marrow microenvironment. At present, the treatment of MM has made great progress, proteasome inhibitors and immunomodulatory drugs are widely used in clinic. Allogeneic stem cell transplantation may be the only promising cure for MM, and its high transplant-related mortality limits its clinical application. CONCLUSIONS The future of MM treatment lies in the development of more targeted therapies, novel immunotherapies, and a better understanding of the disease's molecular and genetic basis.
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Affiliation(s)
- Yue Wu
- Department of OrthopaedicsBeijing Chao‐Yang HospitalBeijingChina
| | - Xiangjun Shi
- Department of OrthopaedicsBeijing Chao‐Yang HospitalBeijingChina
| | - Xinchen Yao
- Department of OrthopaedicsBeijing Chao‐Yang HospitalBeijingChina
| | - Xinru Du
- Department of OrthopaedicsBeijing Chao‐Yang HospitalBeijingChina
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Shekhawat AS, Singh B, Malhotra P, Watts A, Basher R, Kaur H, Hooda M, Radotra BD. Imaging CXCR4 receptors expression for staging multiple myeloma by using 68Ga-Pentixafor PET/CT: comparison with 18F-FDG PET/CT. Br J Radiol 2022; 95:20211272. [PMID: 35731811 PMCID: PMC10162067 DOI: 10.1259/bjr.20211272] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 06/16/2022] [Accepted: 06/19/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES 68Ga-Pentixafor positron emission tomography (PET) imaging targets CXCR4 expression which is overexpressed in multiple myeloma (MM). In this study, we evaluated the diagnostic utility of 68Ga-Pentixafor PET/CT for imaging CXCR4 expression in MM and compared results with 18F-fluorodeoxyglucose (18F-FDG) PET/CT. METHODS 34 (21M; 13F; median age = 57.5 years) treatment naive multiple myeloma patients were recruited. All the patients underwent 18F-FDG PET/CT and 68Ga-Pentixafor PET/CT imaging. Freshly prepared 68Ga-Pentixafor (148-185 MBq) was injected intravenously and whole-body PET/CT (low-dose CT) was acquired at 1 h post-injection. The pattern of uptake (diffuse, focal or mixed) and the mean SUVmax value of all the lesions (when lesions were ≤5) or of the five most tracer avid lesions (when lesions was >5) were evaluated. Tumor to background ratio (TBRmax) was calculated for both the tracers. Durie Salmon plus staging (DSPS) was used for disease staging on PET and the results were compared with International staging system (ISS). RESULTS 68Ga-Pentixafor PET/CT showed higher disease extent than seen on 18F-FDG PET/CT in 23/34 patients (68.0%), lesser disease extent in 2/34 (6%) and similar disease extent in 9/34 (26%) patients. Significantly (p < 0.001) higher TBRmax values (5.7; IQR 8.8) were observed on 68Ga-Pentixafor PET/CT as compared to 18F-FDG PET/CT values (2.9; IQR = 4.0). Both the techniques detected extramedullary lesions in six patients. On the other hand, 68Ga-Pentixafor detected medullary lesions in five, whereas, 18F-FDG PET in three patients. Further, only 68Ga-Pentixafor TBRmax correlated significantly (ρ = 0.421; 0.013) with bone marrow plasma cell percentage. 68Ga-Pentixafor PET upstaged more number (9/29) of patients as compared to (4/29) 18F-FDG PET imaging. On the other hand, 18F-FDG PET down-staged 9/29, whereas 68Ga-Pentixafor PET downstaged only 3/29 patients. CONCLUSION 68Ga-Pentixafor PET/CT evaluated the whole-body disease burden of CXCR4 receptors non-invasively which is not possible by tissue sampling methods. This novel PET tracer has also implication for disease staging. Dual 68Ga-Pentixafor/18F-FDG PET/CT imaging may help in determining the tumor heterogeneity in MM. ADVANCES IN KNOWLEDGE This CXCR4 targeting PET tracer has a promising role in the development of CXCR4 targeting theranostics and also for response assessment to these therapies including the conventional treatment.
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Affiliation(s)
- Amit Singh Shekhawat
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Baljinder Singh
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Haematology & Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankit Watts
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Basher
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harneet Kaur
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Monika Hooda
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bishan D Radotra
- Histopathology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Wang Q, Zhang L, Li S, Sun Z, Wu X, Zhao A, Benkert T, Zhou D, Xue H, Jin Z, Li J. Histogram Analysis Based on Apparent Diffusion Coefficient Maps of Bone Marrow in Multiple Myeloma: An Independent Predictor for High-risk Patients Classified by the Revised International Staging System. Acad Radiol 2022; 29:e98-e107. [PMID: 34452820 DOI: 10.1016/j.acra.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES The revised International Staging System (R-ISS) is the current risk stratifier for patients with newly diagnosed multiple myeloma (NDMM). We used histogram analysis based on apparent diffusion coefficient (ADC) maps of bone marrow to predict high-risk NDMM patients staged as R-ISS stage III. MATERIAL AND METHODS Sixty-one NDMM patients were recruited prospectively and underwent whole-body diffusion-weighted MRI. Mean ADC and four ADC-based histogram parameters of representative background bone marrow were quantified with TexRAD software, including ADC entropy, ADC standard deviation (SD), ADC skewness and ADC kurtosis. Diagnostic performance to discriminate R-ISS III from I/II disease was evaluated by receiver-operating characteristics curve (ROC). Univariate and multivariate analysis using stepwise logistic regression model was performed to identify predictors for R-ISS III. RESULTS ADC entropy of background marrow showed the highest areas under the ROC (0.784, sensitivity = 93.3%, specificity = 63.0%) for the detection of R-ISS stage III disease. Multivariate analysis showed that increased ADC entropy (>3.612) of background marrow can independently predict R-ISS stage III disease in the overall patients (Model 1 corrected for diffuse infiltration [DI] pattern: odds ratio [OR], 10.647; p = 0.008; Model 2 corrected for mean ADC: OR, 10.485; p = 0.010) and in the subgroup with DI pattern (OR, 7.043; p = 0.037). CONCLUSION ADC entropy of background marrow may serve as a sensitive imaging biomarker facilitating the detection of high-risk NDMM patients staged as R-ISS stage III. Increased ADC entropy of background marrow can independently predict R-ISS stage III in the overall patients and in the subgroup with DI pattern.
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Affiliation(s)
- Qin Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuo Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhaoyong Sun
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xia Wu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ailin Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Thomas Benkert
- Development of Application, Siemens Healthcare GmbH, Erlangen, Germany
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yoon MA, Chee CG, Chung HW, Lee DH, Kim KW. Diagnostic performance of computed tomography and diffusion-weighted imaging as first-line imaging modality according to the International Myeloma Working Group (IMWG) imaging algorithm for monoclonal plasma cell disorders. Acta Radiol 2022; 63:672-683. [PMID: 33853375 DOI: 10.1177/02841851211008383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The latest International Myeloma Working Group (IMWG) guideline recommends low-dose whole-body (WB) computed tomography (CT) as the first-line imaging technique for the initial diagnosis of plasma cell disorders. PURPOSE To evaluate diagnostic performances of CT and diffusion-weighted imaging (DWI) as the first-line imaging modalities and assess misclassification rates obtained following the guideline. MATERIAL AND METHODS Two independent radiologists analyzed CT (acquired as PET/CT) and DWI (3-T; b-values = 50 and 900 s/mm2) of patients newly diagnosed with plasma cell disorder, categorizing the number of bone lesions. Diagnostic performance of CT and DWI was compared using the McNemar test, and misclassification rates were calculated with a consensus WB-MRI reading as the reference standard. Differences in lesion number categories were assessed using marginal homogeneity and kappa statistics. RESULTS Of 56 patients (36 men; mean age = 63.5 years), 39 had myeloma lesions. DWI showed slightly higher sensitivity for detecting myeloma lesions (97.4%) than CT (84.6%-92.3%; P > 0.05). CT showed significantly higher specificity (88.2%) than DWI (52.9%-58.8%; P<0.05). CT had a higher additional study requirement rate than DWI (7.7%-15.4% vs. 2.6%), but a lower unnecessary treatment rate (11.8% vs. 41.2%-47.1%). Both readers showed significant differences in categorization of the number of lesions on CT compared with the reference standard (P < 0.001), and one reader showed a significant difference on DWI (P = 0.006 and 0.098). CONCLUSION CT interpreted according to the IMWG guideline is a diagnostically effective first-line modality with relatively high sensitivity and specificity. DWI alone may not be an acceptable first-line imaging modality because of low specificity.
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Affiliation(s)
- Min A Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Choong Guen Chee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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10
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Review of diffusion-weighted imaging and dynamic contrast-enhanced MRI for multiple myeloma and its precursors (monoclonal gammopathy of undetermined significance and smouldering myeloma). Skeletal Radiol 2022; 51:101-122. [PMID: 34523007 DOI: 10.1007/s00256-021-03903-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/25/2021] [Accepted: 09/04/2021] [Indexed: 02/02/2023]
Abstract
The last decades, increasing research has been conducted on dynamic contrast-enhanced and diffusion-weighted MRI techniques in multiple myeloma and its precursors. Apart from anatomical sequences which are prone to interpretation errors due to anatomical variants, other pathologies and subjective evaluation of signal intensities, dynamic contrast-enhanced and diffusion-weighted MRI provide additional information on microenvironmental changes in bone marrow and are helpful in the diagnosis, staging and follow-up of plasma cell dyscrasias. Diffusion-weighted imaging provides information on diffusion (restriction) of water molecules in bone marrow and in malignant infiltration. Qualitative evaluation by visually assessing images with different diffusion sensitising gradients and quantitative evaluation of the apparent diffusion coefficient are studied extensively. Dynamic contrast-enhanced imaging provides information on bone marrow vascularisation, perfusion, capillary resistance, vascular permeability and interstitial space, which are systematically altered in different disease stages and can be evaluated in a qualitative and a (semi-)quantitative manner. Both diffusion restriction and abnormal dynamic contrast-enhanced MRI parameters are early biomarkers of malignancy or disease progression in focal lesions or in regions with diffuse abnormal signal intensities. The added value for both techniques lies in better detection and/or characterisation of abnormal bone marrow otherwise missed or misdiagnosed on anatomical MRI sequences. Increased detection rates of focal lesions or diffuse bone marrow infiltration upstage patients to higher disease stages, provide earlier access to therapy and slower disease progression and allow closer monitoring of high-risk patients. Despite promising results, variations in imaging protocols, scanner types and post-processing methods are large, thus hampering universal applicability and reproducibility of quantitative imaging parameters. The myeloma response assessment and diagnosis system and the international myeloma working group provide a systematic multicentre approach on imaging and propose which parameters to use in multiple myeloma and its precursors in an attempt to overcome the pitfalls of dynamic contrast-enhanced and diffusion-weighted imaging.Single sentence summary statementDiffusion-weighted imaging and dynamic contrast-enhanced MRI provide important additional information to standard anatomical MRI techniques for diagnosis, staging and follow-up of patients with plasma cell dyscrasias, although some precautions should be taken on standardisation of imaging protocols to improve reproducibility and application in multiple centres.
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11
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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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12
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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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13
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Next-Generation Biomarkers in Multiple Myeloma: Understanding the Molecular Basis for Potential Use in Diagnosis and Prognosis. Int J Mol Sci 2021; 22:ijms22147470. [PMID: 34299097 PMCID: PMC8305153 DOI: 10.3390/ijms22147470] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 12/19/2022] Open
Abstract
Multiple myeloma (MM) is considered to be the second most common blood malignancy and it is characterized by abnormal proliferation and an accumulation of malignant plasma cells in the bone marrow. Although the currently utilized markers in the diagnosis and assessment of MM are showing promising results, the incidence and mortality rate of the disease are still high. Therefore, exploring and developing better diagnostic or prognostic biomarkers have drawn global interest. In the present review, we highlight some of the recently reported and investigated novel biomarkers that have great potentials as diagnostic and/or prognostic tools in MM. These biomarkers include angiogenic markers, miRNAs as well as proteomic and immunological biomarkers. Moreover, we present some of the advanced methodologies that could be utilized in the early and competent diagnosis of MM. The present review also focuses on understanding the molecular concepts and pathways involved in these biomarkers in order to validate and efficiently utilize them. The present review may also help in identifying areas of improvement for better diagnosis and superior outcomes of MM.
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14
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Wennmann M, Hielscher T, Kintzelé L, Menze BH, Langs G, Merz M, Sauer S, Kauczor HU, Schlemmer HP, Delorme S, Goldschmidt H, Weinhold N, Hillengass J, Weber MA. Analyzing Longitudinal wb-MRI Data and Clinical Course in a Cohort of Former Smoldering Multiple Myeloma Patients: Connections between MRI Findings and Clinical Progression Patterns. Cancers (Basel) 2021; 13:961. [PMID: 33668879 PMCID: PMC7956649 DOI: 10.3390/cancers13050961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to analyze size and growth dynamics of focal lesions (FL) as well as to quantify diffuse infiltration (DI) in untreated smoldering multiple myeloma (SMM) patients and correlate those MRI features with timepoint and cause of progression. We investigated 199 whole-body magnetic resonance imaging (wb-MRI) scans originating from longitudinal imaging of 60 SMM patients and 39 computed tomography (CT) scans for corresponding osteolytic lesions (OL) in 17 patients. All FLs >5 mm were manually segmented to quantify volume and growth dynamics, and DI was scored, rating four compartments separately in T1- and fat-saturated T2-weighted images. The majority of patients with at least two FLs showed substantial spatial heterogeneity in growth dynamics. The volume of the largest FL (p = 0.001, c-index 0.72), the speed of growth of the fastest growing FL (p = 0.003, c-index 0.75), the DI score (DIS, p = 0.014, c-index 0.67), and its dynamic over time (DIS dynamic, p < 0.001, c-index 0.67) all significantly correlated with the time to progression. Size and growth dynamics of FLs correlated significantly with presence/appearance of OL in CT within 2 years after the respective MRI assessment (p = 0.016 and p = 0.022). DIS correlated with decrease of hemoglobin (p < 0.001). In conclusion, size and growth dynamics of FLs correlate with prognosis and local bone destruction. Connections between MRI findings and progression patterns (fast growing FL-OL; DIS-hemoglobin decrease) might enable more precise diagnostic and therapeutic approaches for SMM patients in the future.
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Affiliation(s)
- Markus Wennmann
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (H.-P.S.); (S.D.)
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; (L.K.); (H.-U.K.); (M.-A.W.)
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany;
| | - Laurent Kintzelé
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; (L.K.); (H.-U.K.); (M.-A.W.)
| | - Bjoern H. Menze
- Department of Computer Science, Technical University of Munich, Boltzmannstrasse 3, 85748 Garching, Germany;
| | - Georg Langs
- Department of Biomedical Imaging and Image-Guided Therapy, Computational Imaging Research Laboratory, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
| | - Maximilian Merz
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (M.M.); (S.S.); (H.G.); (N.W.)
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Sandra Sauer
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (M.M.); (S.S.); (H.G.); (N.W.)
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; (L.K.); (H.-U.K.); (M.-A.W.)
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (H.-P.S.); (S.D.)
| | - Stefan Delorme
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (H.-P.S.); (S.D.)
| | - Hartmut Goldschmidt
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (M.M.); (S.S.); (H.G.); (N.W.)
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Niels Weinhold
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (M.M.); (S.S.); (H.G.); (N.W.)
| | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA;
| | - Marc-André Weber
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; (L.K.); (H.-U.K.); (M.-A.W.)
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
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15
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Wennmann M, Hielscher T, Kintzelé L, Menze BH, Langs G, Merz M, Sauer S, Kauczor HU, Schlemmer HP, Delorme S, Goldschmidt H, Weinhold N, Hillengass J, Weber MA. Spatial Distribution of Focal Lesions in Whole-Body MRI and Influence of MRI Protocol on Staging in Patients with Smoldering Multiple Myeloma According to the New SLiM-CRAB-Criteria. Cancers (Basel) 2020; 12:cancers12092537. [PMID: 32906608 PMCID: PMC7563298 DOI: 10.3390/cancers12092537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/20/2020] [Accepted: 09/03/2020] [Indexed: 11/26/2022] Open
Abstract
Simple Summary According to the current SLiM-CRAB-criteria, asymptomatic multiple myeloma patients who show >1 focal lesion in MRI are now upstaged to multiple myeloma with treatment indication. While the anatomic coverage of MRI protocols differs from spine over spine plus pelvis to whole-body between different institutions, the cutoff for the number of focal lesions which is currently used for the staging decision is not adapted according to the protocol. We found that usage of different MRI protocols leads to markedly different staging decisions according to current SLiM-CRAB-criteria. Adapting the cutoff for the number of focal lesions according to the MRI protocol enables to select comparable risk groups when using different MRI protocols. The combination of >3FL in spine and pelvis or >4FLs in the whole body came closest to select patients with an 80% probability to develop CRAB-criteria within 2 years, which was the original goal of the IMWG. Abstract The purpose of this study was to assess how different MRI protocols (spinal vs. spinal plus pelvic vs. whole-body (wb)-MRI) affect staging in patients with smoldering multiple myeloma (SMM), according to the SLiM-CRAB-criterion ‘>1 focal lesion (FL) in MRI’. In this retrospective study, a baseline cohort of 147 SMM patients with wb-MRI at initial diagnosis was investigated, including prognostic data regarding development of CRAB-criteria. Fifty-two patients formed a follow-up cohort with a median of three wb-MRIs. The locations of all FLs were determined and it was calculated how staging decisions regarding the criterion ‘>1 FL in MRI’ would have been made if only a limited anatomic area (spine vs. spine plus pelvis) would have been covered by the MRI protocol. Furthermore, subgroups of patients selected by different cutoff-protocol-combinations were compared regarding their prognosis for development of CRAB-criteria. With an MRI protocol limited to spine/spine plus pelvis, only 28%/64% of patients who actually had >1 FL in wb-MRI would have been rated correctly as having ‘>1 FL in MRI’. Fifty-four percent/36% of patients with exactly 1 FL in spine/spine plus pelvis revealed >1 FL when the entire wb-MRI was analyzed. During follow-up, four more patients developed >1 FL in wb-MRI; both limited MRI protocols would have detected only one of these four patients as having >1 FL at the correct timepoint. Having >1 FL in spine/in spine plus pelvis/in the whole body was associated with a 43%/57%/49% probability of developing CRAB-criteria within 2 years. Patients with >3 FL in spine plus pelvis and patients with >4 FL in the whole body had an 80% probability to develop CRAB-criteria within 2 years. MRI protocols limited to the spine or to spine plus pelvis lead to substantial underdiagnoses of patients who actually have >1 FL in wb-MRI at baseline and during follow-up, which influences staging and treatment decisions according to the current SLiM-CRAB criteria. However, given the spatial distribution of FLs and the analysis on clinical course of patients indicates that the cutoff for the number of FLs should be adopted according to the MRI protocol when using MRI for staging in SMM.
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Affiliation(s)
- Markus Wennmann
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (H.-P.S.); (S.D.)
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; (L.K.); (H.-U.K.)
- Correspondence:
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany;
| | - Laurent Kintzelé
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; (L.K.); (H.-U.K.)
| | - Bjoern H. Menze
- Department of Computer Science, Technical University of Munich, Boltzmannstrasse 3, 85748 Garching, Germany;
| | - Georg Langs
- Department of Biomedical Imaging and Image-Guided Therapy, Computational Imaging Research Laboratory, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
| | - Maximilian Merz
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (M.M.); (S.S.); (H.G.); (N.W.)
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Sandra Sauer
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (M.M.); (S.S.); (H.G.); (N.W.)
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; (L.K.); (H.-U.K.)
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (H.-P.S.); (S.D.)
| | - Stefan Delorme
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (H.-P.S.); (S.D.)
| | - Hartmut Goldschmidt
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (M.M.); (S.S.); (H.G.); (N.W.)
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Niels Weinhold
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (M.M.); (S.S.); (H.G.); (N.W.)
| | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA;
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany;
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16
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Rossi F, Torri L, Dominietto A, Tagliafico AS. Spectrum of magnetic resonance imaging findings in transplanted multiple myeloma patients with hip/pelvic pain (according to MY-RADS): A single center experience. Eur J Radiol 2020; 130:109154. [PMID: 32629214 DOI: 10.1016/j.ejrad.2020.109154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/05/2020] [Accepted: 06/22/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of our study is to evaluate the spectrum of MRI findings in transplanted Multiple Myeloma (MM) patients with hip/pelvic pain and to correlate these findings with standard prognostic clinical outcomes. METHODS A retrospective interpretation of the MRI findings of 54 MM patients with hip/pelvic pain were done according to MY-RADS guidelines. MRI findings included: type of bone marrow involvement and incidental findings (osteonecrosis and fractures). Inter- and intra-reader agreement were calculated using Cohen's kappa test. Survival and relapse rates, type of transplantation and days of hospitalization were correlated with MRI findings. RESULTS 1/52 patient presented normal bone marrow pattern, 10/52 focal pattern, 26/52 diffuse pattern and 15/52 mixed. No cases of micronodular was reported. Among the incidental findings, n = 6 osteonecrosis and n = 5 pathological fractures were found, with average length of stay higher. The intra- and inter-reader agreement assessing MY-RADS, were good (k value between 0.61-0.8). Focal pattern was most represented in patients with osteonecrosis and the worst survival rate. Diffuse pattern was most represented in relapses. No statistically significant correlations were found between bone marrow infiltration patterns and the type of transplantation. CONCLUSION MRI can recognize different infiltration patterns and complications in transplanted MM patients with hip/pelvic pain, correlating with clinical parameters.
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Affiliation(s)
- Federica Rossi
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy; Department of Experimental Medicine (DIMES), University of Genoa, Genova, Italy.
| | - Lorenzo Torri
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Alida Dominietto
- Second Division of Hematology and Bone Marrow Transplantation, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Alberto Stefano Tagliafico
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy; Department of Radiology, IRCCS San Martino Hospital, Genova, Italy
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Messiou C, Hillengass J, Delorme S, Lecouvet FE, Moulopoulos LA, Collins DJ, Blackledge MD, Abildgaard N, Østergaard B, Schlemmer HP, Landgren O, Asmussen JT, Kaiser MF, Padhani A. Guidelines for Acquisition, Interpretation, and Reporting of Whole-Body MRI in Myeloma: Myeloma Response Assessment and Diagnosis System (MY-RADS). Radiology 2019; 291:5-13. [PMID: 30806604 DOI: 10.1148/radiol.2019181949] [Citation(s) in RCA: 193] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acknowledging the increasingly important role of whole-body MRI for directing patient care in myeloma, a multidisciplinary, international, and expert panel of radiologists, medical physicists, and hematologists with specific expertise in whole-body MRI in myeloma convened to discuss the technical performance standards, merits, and limitations of currently available imaging methods. Following guidance from the International Myeloma Working Group and the National Institute for Clinical Excellence in the United Kingdom, the Myeloma Response Assessment and Diagnosis System (or MY-RADS) imaging recommendations are designed to promote standardization and diminish variations in the acquisition, interpretation, and reporting of whole-body MRI in myeloma and allow response assessment. This consensus proposes a core clinical protocol for whole-body MRI and an extended protocol for advanced assessments. Published under a CC BY 4.0 license. Online supplemental material is available for this article.
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Affiliation(s)
- Christina Messiou
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Jens Hillengass
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Stefan Delorme
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Frédéric E Lecouvet
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Lia A Moulopoulos
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - David J Collins
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Matthew D Blackledge
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Niels Abildgaard
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Brian Østergaard
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Heinz-Peter Schlemmer
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Ola Landgren
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Jon Thor Asmussen
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Martin F Kaiser
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Anwar Padhani
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
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Behzadi AH, Raza SI, Carrino JA, Kosmas C, Gholamrezanezhad A, Basques K, Matcuk GR, Patel J, Jadvar H. Applications of PET/CT and PET/MR Imaging in Primary Bone Malignancies. PET Clin 2018; 13:623-634. [PMID: 30219192 DOI: 10.1016/j.cpet.2018.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary bone malignancies are characterized with anatomic imaging. However, in recent years, there has been an increased interest in PET/computed tomography scanning and PET/MRI with fludeoxyglucose F 18 for evaluating and staging musculoskeletal neoplasms. These hybrid imaging modalities have shown promise largely owing to their high sensitivity, ability to perform more thorough staging, and ability to monitor treatment response. This article reviews the current role of PET/computed tomography scanning and PET/MRI in primary malignancies of bone, with an emphasis on imaging characteristics, clinical usefulness, and current limitations.
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Affiliation(s)
| | - Syed Imran Raza
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA
| | - John A Carrino
- Department of Radiology and Imaging, 535 East 70th Street, Hospital for Special Surgery, New York, NY 10021, USA
| | - Christos Kosmas
- Department of Radiology and Imaging, University Hospitals of Cleveland, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Ali Gholamrezanezhad
- Division of Musculoskeletal Radiology, Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA
| | - Kyle Basques
- Department of Radiology and Imaging, University Hospitals of Cleveland, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - George R Matcuk
- Division of Musculoskeletal Radiology, Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA
| | - Jay Patel
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA
| | - Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
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The Role of 18F-FDG PET/CT in Multiple Myeloma Staging according to IMPeTUs: Comparison of the Durie-Salmon Plus and Other Staging Systems. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:4198673. [PMID: 30154686 PMCID: PMC6091330 DOI: 10.1155/2018/4198673] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/23/2018] [Accepted: 05/31/2018] [Indexed: 12/30/2022]
Abstract
We aimed at comparing the Durie–Salmon Plus (DS Plus) staging system based on Italian Myeloma criteria for PET USe (IMPeTUs) with other two staging systems in predicting prognosis of patients with all stages of newly diagnosed multiple myeloma (MM). A total of 33 MM patients were enrolled in this retrospective study. The variation between the DS Plus classification and Durie–Salmon staging system (DSS) or Revised International Staging System (RISS) classification was assessed. When staged by the DSS, patients in stage I and stage II did not reach the median overall survival (OS), and the median OS was 33 months for stage III (p=0.3621). When staged by the DS Plus, patients in stage I did not reach the median OS of stage I, and the median OS for stages II and III was 38 and nine months, respectively (p=0.0064). When staged by the RISS, patients in stage I did not reach the median OS, and the median OS was 33 and 16 months for stage II and stage III, respectively (p=0.0319). The concordances between two staging systems were 0.07 (DS Plus versus DSS) and 0.37 (DS Plus versus RISS), respectively. Multivariate analysis revealed that DS Plus stage III (HR: 11.539, p=0.021) and the Deauville score of bone marrow ≥4 (HR: 3.487, p=0.031) were independent prognostic factors associated with OS. Both the DS Plus based on IMPeTUs and RISS possessed a better potential in characterizing and stratifying MM patients compared with the DSS. Moreover, DS Plus stage III and the Deauville score of bone marrow ≥4 were reliable prognostic factors in newly diagnosed MM patients.
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Wennmann M, Kintzelé L, Piraud M, Menze BH, Hielscher T, Hofmanninger J, Wagner B, Kauczor HU, Merz M, Hillengass J, Langs G, Weber MA. Volumetry based biomarker speed of growth: Quantifying the change of total tumor volume in whole-body magnetic resonance imaging over time improves risk stratification of smoldering multiple myeloma patients. Oncotarget 2018; 9:25254-25264. [PMID: 29861868 PMCID: PMC5982766 DOI: 10.18632/oncotarget.25402] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/25/2018] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to improve risk stratification of smoldering multiple myeloma patients, introducing new 3D-volumetry based imaging biomarkers derived from whole-body MRI. Two-hundred twenty whole-body MRIs from 63 patients with smoldering multiple myeloma were retrospectively analyzed and all focal lesions >5mm were manually segmented for volume quantification. The imaging biomarkers total tumor volume, speed of growth (development of the total tumor volume over time), number of focal lesions, development of the number of focal lesions over time and the recent imaging biomarker ‘>1 focal lesion’ of the International Myeloma Working Group were compared, taking 2-year progression rate, sensitivity and false positive rate into account. Speed of growth, using a cutoff of 114mm3/month, was able to isolate a high-risk group with a 2-year progression rate of 82.5%. Additionally, it showed by far the highest sensitivity in this study and in comparison to other biomarkers in the literature, detecting 63.2% of patients who progress within 2 years. Furthermore, its false positive rate (8.7%) was much lower compared to the recent imaging biomarker ‘>1 focal lesion’ of the International Myeloma Working Group. Therefore, speed of growth is the preferable imaging biomarker for risk stratification of smoldering multiple myeloma patients.
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Affiliation(s)
- Markus Wennmann
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Laurent Kintzelé
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marie Piraud
- Department of Computer Science, Technical University of Munich, Munich, Germany
| | - Bjoern H Menze
- Department of Computer Science, Technical University of Munich, Munich, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Johannes Hofmanninger
- Department of Biomedical Imaging and Image-Guided Therapy, Computational Imaging Research Laboratory, Medical University of Vienna, Vienna, Austria
| | - Barbara Wagner
- Department of Medicine V, Multiple Myeloma Section, University of Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Merz
- Department of Medicine V, Multiple Myeloma Section, University of Heidelberg, Heidelberg, Germany
| | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Georg Langs
- Department of Biomedical Imaging and Image-Guided Therapy, Computational Imaging Research Laboratory, Medical University of Vienna, Vienna, Austria
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany
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Lacognata C, Crimì F, Guolo A, Varin C, De March E, Vio S, Ponzoni A, Barilà G, Lico A, Branca A, De Biasi E, Gherlinzoni F, Scapin V, Bissoli E, Berno T, Zambello R. Diffusion-weighted whole-body MRI for evaluation of early response in multiple myeloma. Clin Radiol 2017; 72:850-857. [DOI: 10.1016/j.crad.2017.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 04/12/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
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Filonzi G, Mancuso K, Zamagni E, Nanni C, Spinnato P, Cavo M, Fanti S, Salizzoni E, Bazzocchi A. A Comparison of Different Staging Systems for Multiple Myeloma: Can the MRI Pattern Play a Prognostic Role? AJR Am J Roentgenol 2017; 209:152-158. [DOI: 10.2214/ajr.16.17219] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Giacomo Filonzi
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
- Diagnostic and Interventional Radiology, The “Rizzoli” Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy
- Ospedale di Porretta Terme, UOC Radiologia O. Bellaria e Area Sud-Est, Ausl Bologna, Bologna, Italy
| | - Katia Mancuso
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Elena Zamagni
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Cristina Nanni
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, The “Rizzoli” Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy
| | - Michele Cavo
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Fanti
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Eugenio Salizzoni
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, The “Rizzoli” Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy
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Radiologic and clinical characteristics of vertebral fractures in multiple myeloma. Spine J 2015; 15:2149-56. [PMID: 26008684 DOI: 10.1016/j.spinee.2015.05.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/27/2015] [Accepted: 05/19/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Nearly 80% of patients with newly diagnosed multiple myeloma (MM) have bony lesions on magnetic resonance imaging (MRI). These lesions may progress to debilitating vertebral fractures. No studies have quantitatively characterized these fractures or identified predictors of fracture burden and severity. PURPOSE The purpose of this study was to characterize the clinical and radiologic features of these fractures and to identify independent predictors of fracture burden and severity. STUDY DESIGN/SETTING A consecutive retrospective chart review was conducted from January 2007 to December 2013 at a single tertiary-care institution. PATIENT SAMPLE Patients with diagnoses of both MM and vertebral fracture were included in this study. Those with a history of non-MM vertebral fracture were excluded. OUTCOME MEASURES The primary outcome measure was height loss of the fractured vertebral body, whereas secondary outcome measures included number of fractures and morphology. METHODS Data were collected at fracture presentation. Radiologic data were obtained from T1-weighted MRI. Anterior, middle, and posterior vertebral body height losses were recorded, and a Genant grading was made. Multivariable Poisson and logistic regression were performed to identify predictors of fracture burden and severity. RESULTS Among 50 patients presenting with vertebral fracture, 124 fractures were observed. The majority (76%) of these patients did not have a previous MM diagnosis. The most common presenting symptom was back pain (84%), followed by neurologic (54%) and constitutional (50%) symptoms. The mean anterior, middle, and posterior height losses of the fractured vertebral body were 30%, 37%, and 16%, respectively. Twenty percent of fractures were Genant Grade 1 (mild), whereas 32% and 48% were grades 2 (moderate) and 3 (severe). Fifty-five percent of fractures were biconcave, whereas 32% and 13% were wedge and crush fractures. Lower body mass index and albumin and increased myeloma protein, light chains, and creatinine predicted an increased number of fractures at presentation. Increased β2-microglobulin and creatinine predicted more severe vertebral fractures. CONCLUSIONS In the present study, 124 fractures were observed among 50 patients. These fractures were generally severe, biconcave, and in the thoracic spine. Laboratory signs of advanced MM predict greater fracture burden and severity. In the future, monitoring of these predictors may raise suspicion for an MM-associated vertebral fracture.
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Pasoglou V, Michoux N, Peeters F, Larbi A, Tombal B, Selleslagh T, Omoumi P, Vande Berg BC, Lecouvet FE. Whole-Body 3D T1-weighted MR Imaging in Patients with Prostate Cancer: Feasibility and Evaluation in Screening for Metastatic Disease. Radiology 2015; 275:155-66. [DOI: 10.1148/radiol.14141242] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Saksena A, Mahajan N, Agarwal S, Jain S. Solitary bone plasmacytoma: An interesting case report with unusual clinico-cytological features. J Cytol 2014; 31:158-60. [PMID: 25538386 PMCID: PMC4274528 DOI: 10.4103/0970-9371.145650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Solitary bone plasmacytoma (SBP) is a rare entity characterized by localized proliferation of monoclonal plasma cells primarily occurring in the axial skeleton without systemic involvement. Involvement of the distal extremity is unusual. In the absence of typical clinical presentation, diagnosis may not be suspected clinico-radiologically; hence, fine-needle aspiration cytology may help in early and definitive diagnosis, hastening meticulous diagnostic workup and appropriate management of these patients. Intracytoplasmic crystalline inclusions (CI) have been reported in multiple myeloma and lymphoproliferative disorders. The present case highlights unusual clinico-cytological features of SBP with primary involvement of humerus, progression to tibia, and presence of extracellular and intracytoplasmic CI in plasma cells, a morphologic finding not reported in SBP earlier.
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Affiliation(s)
- Annapurna Saksena
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nidhi Mahajan
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Shyama Jain
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
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Tumor load in patients with multiple myeloma: β2-microglobulin levels versus whole-body MRI. AJR Am J Roentgenol 2014; 203:854-62. [PMID: 25247952 DOI: 10.2214/ajr.13.10724] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Beta-2-microglobulin is a serum maker of tumor burden in hematologic malignancies. We aimed to correlate serum β2-microglobulin levels in patients with multiple myeloma (MM) to tumor mass determined by whole-body MRI. MATERIALS AND METHODS We retrospectively included patients with newly diagnosed, untreated MM who underwent whole-body MRI at our institution between 2003 and 2011. Patients with a glomerular filtration rate of less than 60 mL/min were excluded from analysis because β2-microglobulin levels are increased in renal failure. Thirty patients could be included. Whole-body MRI examinations (T1-weighted turbo spin-echo and STIR sequences) were assessed by two musculoskeletal radiologists in consensus for focal lesions and the presence of diffuse myeloma infiltration. The presence of diffuse infiltration was confirmed by histology as the reference standard. MM was staged according to the Durie and Salmon PLUS staging system. RESULTS According to whole-body MRI findings, MM was classified as Durie and Salmon PLUS stage I (low grade) in 13 patients, stage II (intermediate grade) in six patients, and stage III (high grade) in 11 patients. As we expected, most patients with stage I disease (12/13) had normal β2-microglobulin levels (≤ 3 mg/L). Higher β2-microglobulin values were associated with a higher stage of disease (p < 0.05). However, five of six patients with stage II MM and five of 11 patients with stage III MM showed normal β2-microglobulin levels. Thus, 10 of 17 patients (58.8%) with substantial infiltration in the bone marrow showed false-negative β2-microglobulin levels. CONCLUSION Serum β2-microglobulin levels correlate with tumor stage in MM. However, it may be misleading as a marker of tumor load in a subset of patients with substantial myeloma infiltration in the bone marrow. Whole-body MRI may display the full tumor load and correctly show the extension of myeloma infiltrates.
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Pianko MJ, Terpos E, Roodman GD, Divgi CR, Zweegman S, Hillengass J, Lentzsch S. Whole-Body Low-Dose Computed Tomography and Advanced Imaging Techniques for Multiple Myeloma Bone Disease. Clin Cancer Res 2014; 20:5888-97. [DOI: 10.1158/1078-0432.ccr-14-1692] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Créteur V, Borens B, Bouchaibi SE, Hulet F. Osteolytic femoral lesion detected by sonography in a case of light chain deposition disease. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:444-448. [PMID: 24449208 DOI: 10.1002/jcu.22129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 09/07/2013] [Accepted: 12/05/2013] [Indexed: 06/03/2023]
Abstract
We describe a case of light chain deposition disease presenting as worsening of renal failure with a lytic femoral bone lesion discovered by sonography. Although sonography cannot be considered to be the test of choice in evaluating multiple myeloma, this technique may allow the detection and the biopsy of osteolytic bone lesions, particularly in accessible locations. Differential diagnosis is discussed.
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Affiliation(s)
- Viviane Créteur
- Erasme Hospital Radiology, Erasme Hospital, 808 Route de Lennik, 1070, Brussels, Belgium
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Kloth JK, Hillengass J, Listl K, Kilk K, Hielscher T, Landgren O, Delorme S, Goldschmidt H, Kauczor HU, Weber MA. Appearance of monoclonal plasma cell diseases in whole-body magnetic resonance imaging and correlation with parameters of disease activity. Int J Cancer 2014; 135:2380-6. [DOI: 10.1002/ijc.28877] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/20/2014] [Indexed: 01/25/2023]
Affiliation(s)
- Jost K. Kloth
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
- Department of Radiology; German Cancer Research Center (dkfz); Heidelberg Germany
| | - Jens Hillengass
- Department of Radiology; German Cancer Research Center (dkfz); Heidelberg Germany
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Karin Listl
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
| | - Kerstin Kilk
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
| | - Thomas Hielscher
- Department of Biostatistics; German Cancer Research Center (dkfz); Heidelberg Germany
| | - Ola Landgren
- Multiple Myeloma Section; National Cancer Institute, Nationl Institutes of Health; Bethesda MD
| | - Stefan Delorme
- Department of Radiology; German Cancer Research Center (dkfz); Heidelberg Germany
| | - Hartmut Goldschmidt
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
- Department of Radiology; German Cancer Research Center (dkfz); Heidelberg Germany
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Andrulis M, Bäuerle T, Goldschmidt H, Delorme S, Landgren O, Schirmacher P, Hillengass J. Infiltration patterns in monoclonal plasma cell disorders: correlation of magnetic resonance imaging with matched bone marrow histology. Eur J Radiol 2014; 83:970-974. [PMID: 24725673 DOI: 10.1016/j.ejrad.2014.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 02/27/2014] [Accepted: 03/07/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To investigate how plasma cell infiltration patterns detected by MRI match the plasma cell distribution in bone marrow biopsy. METHODS We assessed 50 patients with monoclonal plasma cell disorders of all clinical stages. MRI infiltration pattern was compared with matched BM histology from the same anatomic region. RESULTS MRI revealed a minimal (n=11, 22%), focal (n=5, 10%), diffuse (n=14, 28%) and mixed (n=20, 40%) infiltration pattern. Diffuse MRI pattern was predominant in smoldering myeloma patients whereas the MRI patterns with "focal component" (i.e. focal and mixed) were most common in symptomatic myeloma (p<0.01). In histology an interstitial (n=13, 26%), nodular (n=23, 46%) and packed marrow (n=14, 28%) was found respectively. All three histological types of infiltration were observed in patients with diffuse and mixed MRI patterns. Minimal MRI pattern was found in all MGUS patients and was associated with an interstitial BM infiltration. In two patients with minimal MRI pattern an extensive micro-nodular BM infiltration was found in histology. CONCLUSIONS Infiltration patterns in MRI represent different histological growth patterns of plasma cells, but the MRI resolution is not sufficient to visualize micro-nodular aggregates of plasma cells.
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Affiliation(s)
| | - Tobias Bäuerle
- Department of Diagnostic and Interventional Radiology, University of Hamburg, Hamburg, Germany
| | - Hartmut Goldschmidt
- Department of Hematology and Oncology, University of Heidelberg, Heidelberg, Germany
| | - Stefan Delorme
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ola Landgren
- Multiple Myeloma Section, Metabolism Branch, National Cancer Institute, Bethesda, USA
| | - Peter Schirmacher
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Jens Hillengass
- Department of Hematology and Oncology, University of Heidelberg, Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Hillengass J, Weber MA, Kilk K, Listl K, Wagner-Gund B, Hillengass M, Hielscher T, Farid A, Neben K, Delorme S, Landgren O, Goldschmidt H. Prognostic significance of whole-body MRI in patients with monoclonal gammopathy of undetermined significance. Leukemia 2013; 28:174-8. [DOI: 10.1038/leu.2013.244] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/24/2013] [Accepted: 08/14/2013] [Indexed: 12/19/2022]
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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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Terpos E, Morgan G, Dimopoulos MA, Drake MT, Lentzsch S, Raje N, Sezer O, García-Sanz R, Shimizu K, Turesson I, Reiman T, Jurczyszyn A, Merlini G, Spencer A, Leleu X, Cavo M, Munshi N, Rajkumar SV, Durie BGM, Roodman GD. International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease. J Clin Oncol 2013; 31:2347-57. [PMID: 23690408 DOI: 10.1200/jco.2012.47.7901] [Citation(s) in RCA: 235] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The aim of the International Myeloma Working Group was to develop practice recommendations for the management of multiple myeloma (MM) -related bone disease. METHODOLOGY An interdisciplinary panel of clinical experts on MM and myeloma bone disease developed recommendations based on published data through August 2012. Expert consensus was used to propose additional recommendations in situations where there were insufficient published data. Levels of evidence and grades of recommendations were assigned and approved by panel members. RECOMMENDATIONS Bisphosphonates (BPs) should be considered in all patients with MM receiving first-line antimyeloma therapy, regardless of presence of osteolytic bone lesions on conventional radiography. However, it is unknown if BPs offer any advantage in patients with no bone disease assessed by magnetic resonance imaging or positron emission tomography/computed tomography. Intravenous (IV) zoledronic acid (ZOL) or pamidronate (PAM) is recommended for preventing skeletal-related events in patients with MM. ZOL is preferred over oral clodronate in newly diagnosed patients with MM because of its potential antimyeloma effects and survival benefits. BPs should be administered every 3 to 4 weeks IV during initial therapy. ZOL or PAM should be continued in patients with active disease and should be resumed after disease relapse, if discontinued in patients achieving complete or very good partial response. BPs are well tolerated, but preventive strategies must be instituted to avoid renal toxicity or osteonecrosis of the jaw. Kyphoplasty should be considered for symptomatic vertebral compression fractures. Low-dose radiation therapy can be used for palliation of uncontrolled pain, impending pathologic fracture, or spinal cord compression. Orthopedic consultation should be sought for long-bone fractures, spinal cord compression, and vertebral column instability.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece.
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Regelink JC, Minnema MC, Terpos E, Kamphuis MH, Raijmakers PG, Pieters-van den Bos IC, Heggelman BGF, Nievelstein RJ, Otten RHJ, van Lammeren-Venema D, Zijlstra JM, Arens AIJ, de Rooy JW, Hoekstra OS, Raymakers R, Sonneveld P, Ostelo RW, Zweegman S. Comparison of modern and conventional imaging techniques in establishing multiple myeloma-related bone disease: a systematic review. Br J Haematol 2013; 162:50-61. [PMID: 23617231 DOI: 10.1111/bjh.12346] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/26/2013] [Indexed: 01/17/2023]
Abstract
This systematic review of studies compared magnetic resonance imaging (MRI), (18) F-fluorodeoxyglucose positron emission tomography (FDG-PET), FDG-PET with computerized tomography (PET-CT) and CT with whole body X-Ray (WBXR) or (whole body) CT in order to provide evidence-based diagnostic guidelines in multiple myeloma bone disease. A comprehensive search of 3 bibliographic databases was performed; methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria (score 1-14). Data from 32 directly comparative studies were extracted. The mean QUADAS score was 7·1 (3-11), with quality hampered mainly by a poor description of selection and execution criteria. All index tests had a higher detection rate when compared to WBXR, with up to 80% more lesions detected by the newer imaging techniques; MRI (1·12-1·82) CT (1·04-1·33), PET (1·00-1·58) and PET-CT (1·27-1·45). However, the modern imaging techniques detected fewer lesions in the skull and ribs. In a direct comparison CT and MRI performed equally with respect to detection rate and sensitivity. This systematic review supports the International Myeloma Working Group guidelines, which recommend that WBCT can replace WBXR. In our opinion, the equal performance of MRI also indicates that it is a valuable alternative. As lesions of the skull and ribs are underdiagnosed by modern imaging techniques we advise additional X-rays of these regions. The consequences of this approach are discussed.
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Affiliation(s)
- Josien C Regelink
- Department of Haematology, VU University Medical Centre, Amsterdam, The Netherlands.
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Spinnato P, Bazzocchi A, Brioli A, Nanni C, Zamagni E, Albisinni U, Cavo M, Fanti S, Battista G, Salizzoni E. Contrast enhanced MRI and 18F-FDG PET-CT in the assessment of multiple myeloma: A comparison of results in different phases of the disease. Eur J Radiol 2012; 81:4013-8. [DOI: 10.1016/j.ejrad.2012.06.028] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/06/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
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Garcia B, Bancroft LW, Cole JD. Radiologic case study. Multiple myeloma with cadaveric graft reconstruction of the ilium. Orthopedics 2012; 35:729, 819-23. [PMID: 22955378 DOI: 10.3928/01477447-20120822-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Bryan Garcia
- Florida State University College of Medicine, Tallahassee, USA
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Wirk B, Bush CH, Hou W, Pettiford L, Moreb JS. Detection of Skeletal Lesions by Whole Body Multidetector Computed Tomography in Multiple Myeloma has no Impact on Long-Term Outcomes Post Autologous Hematopoietic Cell Transplantation. World J Oncol 2012; 3:147-157. [PMID: 29147298 PMCID: PMC5649837 DOI: 10.4021/wjon551w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2012] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Multiple myeloma (MM), a plasma cell malignancy, is the most common cancer to involve the skeleton. Skeletal related events such as pathologic fractures and lytic bone lesions have been associated with poor prognosis. Whole body multidetector computed tomography (WBCT) has been shown to be the most sensitive imaging modality in detecting small osteolytic lesions (< 5 mm) in the spine. The significance of lytic lesions detected only by CT is unknown as is their impact on overall survival of MM. The aim of this study was to evaluate the impact of lytic bone lesions seen only by WBCT on progression free survival (PFS) and overall survival (OS) in MM patients after hematopoietic cell transplantation (HCT). METHODS We evaluated 72 patients who had WBCT and conventional radiographic skeletal survey (CSS) after initial or salvage chemotherapy prior to HCT. RESULTS Forty-one patients (57%) had more findings on WBCT than CSS, 31 patients (43%) had no differences in the two imaging techniques, 9 patients had no bone lesions on either modality, and 5 patients had lesions only identified by WBCT and not on CSS. PFS and OS were similar in patients with lesions seen by CSS irrespective of whether additional lesions were noted by WBCT; similarly, in patients without lesions on CSS, OS and PFS were better than patients with lytic lesions, but detection of occult lesions by WBCT did not adversely affect PFS or OS. CONCLUSIONS Our study shows that although WBCT is more sensitive in defining existing myelomatous bony disease in MM, these additional findings may not have any impact on PFS and OS of MM patients. Only patients without any bone lesions on conventional skeletal survey had significantly better PFS and OS. This suggests CSS remains the gold standard for evaluating myeloma bone disease.
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Affiliation(s)
- Baldeep Wirk
- Department of Medicine, College of Medicine, University of Florida, USA
| | - Charles H. Bush
- Department of Radiology, College of Medicine, University of Florida, USA
| | - Wei Hou
- Department of Biostatistics, College of Medicine, University of Florida, USA
| | - Leslie Pettiford
- Department of Medicine, College of Medicine, University of Florida, USA
| | - Jan S. Moreb
- Department of Medicine, College of Medicine, University of Florida, USA
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Kazeminezhad B, Zare-mirzaie A, Mirafsharieh A, Soleimantabar H, Zahedifard S. Bilateral ovarian involvement: A rare presentation of disseminated multiple myeloma. J Obstet Gynaecol Res 2012; 39:446-9. [DOI: 10.1111/j.1447-0756.2012.01972.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Spira D, Weisel K, Brodoefel H, Schulze M, Kaufmann S, Horger M. Can whole-body low-dose multidetector CT exclude the presence of myeloma bone disease in patients with monoclonal gammopathy of undetermined significance (MGUS)? Acad Radiol 2012; 19:89-94. [PMID: 22142681 DOI: 10.1016/j.acra.2011.09.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 09/27/2011] [Accepted: 09/27/2011] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES To determine the benefit of using whole-body low-dose computed tomography (WBLD-CT) in patients with monoclonal gammopathy of undetermined significance (MGUS) for exclusion of multiple myeloma (MM) bone disease. MATERIALS AND METHODS Seventy-one consecutive patients with confirmed MGUS (as defined by the latest criteria of the International Myeloma Working Group) who underwent WBLD-CT for diagnosis were identified retrospectively by a search of our institution's electronic medical record database (2002-2009). Patients were classified as low-risk or intermediate/high-risk and followed over a ≥2-year period with additional CT imaging and/or laboratory parameters. Presence of osteolysis, medullary, or extramedullary abnormalities compatible with involvement by MM was recorded. A diffuse or focal increase in medullary density to Hounsfield unit (HU) values >20 HU/>0 HU was considered suspicious for bone marrow infiltration if no other causes identifiable. RESULTS The presence of osteolysis was excluded in all 71 patients with MGUS at initial diagnosis and patients were surveilled for ≥2 years. Lytic changes were observed at follow-up in 1/71 patients that progressed to MM and were detectable via WBLD-CT at an early stage (even before a significant rise in M-protein was recorded). In 3/71 patients with MGUS (4%) suspicious bone marrow attenuation values were measured, disclosing disease progression to smoldering myeloma in another patient and false-positive results in 2/71 patients. Bone marrow attenuation assessment resulted in a specificity and negative predictive value of 97%, respectively. No significant difference with respect to bone marrow attenuation was observed in patients with low-risk MGUS versus intermediate- to high-risk MGUS. One of 71 patients showed serologic disease progression to active MM without bone abnormalities detectable. CONCLUSION WBLD-CT reliably excludes findings compatible with myeloma in MGUS and thereby complements hematologic laboratory analysis.
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Affiliation(s)
- Daniel Spira
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
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Kim SH, Smith SE, Mulligan ME. Hematopoietic tumors and metastases involving bone. Radiol Clin North Am 2011; 49:1163-83, vi. [PMID: 22024293 DOI: 10.1016/j.rcl.2011.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This review explores in depth the most common malignant process involving the bone, namely metastatic disease, as well as some of the more common proliferative forms of hematopoietic disease of bone marrow. These are commonly encountered pathologic processes that often have vague nonspecific symptoms. Imaging findings are frequently subtle on initial radiographs; however, advanced imaging techniques, including CT, MR, and positron emission tomography, allow for accurate diagnosis, staging, and follow-up in most cases.
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Affiliation(s)
- Sung H Kim
- Department of Radiology, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA
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