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Li Y, Lin L, Zhang Y, Ren C, Zhang W, Cheng J. Preliminary exploration of amide proton transfer weighted imaging in differentiation between benign and malignant bone tumors. Front Oncol 2024; 14:1402628. [PMID: 38903728 PMCID: PMC11187086 DOI: 10.3389/fonc.2024.1402628] [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: 03/18/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024] Open
Abstract
Purpose To explore the value of 3D amide proton transfer weighted imaging (APTWI) in the differential diagnosis between benign and malignant bone tumors, and to compare the diagnostic performance of APTWI with traditional diffusion-weighted imaging (DWI). Materials and methods Patients with bone tumors located in the pelvis or lower limbs confirmed by puncture or surgical pathology were collected from January 2021 to July 2023 in the First Affiliated Hospital of Zhengzhou University. All patients underwent APTWI and DWI examinations. The magnetization transfer ratio with asymmetric analysis at the frequency offset of 3.5 ppm [MTRasym(3.5 ppm)] derived by APTWI and the apparent diffusion coefficient (ADC) derived by DWI for the tumors were measured. The Kolmogorou-Smirnou and Levene normality test was used to confirm the normal distribution of imaging parameters; and the independent sample t test was used to compare the differences in MTRasym(3.5 ppm) and ADC between benign and malignant bone tumors. In addition, the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of different imaging parameters in differentiation between benign and malignant bone tumors. P<0.05 means statistically significant. Results Among 85 bone tumor patients, 33 were benign and 52 were malignant. The MTRasym(3.5 ppm) values of malignant bone tumors were significantly higher than those of benign tumors, while the ADC values were significantly lower in benign tumors. ROC analysis shows that MTRasym(3.5 ppm) and ADC values perform well in the differential diagnosis of benign and malignant bone tumors, with the area under the ROC curve (AUC) of 0.798 and 0.780, respectively. Combination of MTRasym(3.5 ppm) and ADC values can further improve the diagnostic performance with the AUC of 0.849 (sensitivity = 84.9% and specificity = 73.1%). Conclusion MTRasym(3.5 ppm) of malignant bone tumors was significantly higher than that of benign bone tumors, reflecting the abnormal increase of protein synthesis in malignant tumors. APTWI combined with DWI can achieve a high diagnostic efficacy in differentiation between benign and malignant bone tumors.
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Affiliation(s)
- Ying Li
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liangjie Lin
- Clinical and Technical Support, Philips Healthcare, Beijing, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cuiping Ren
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenhua Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Sun M, Wang L, Wang C, Ma J, Wang W, Lin L, Ren C, Zhang Y, Cheng J. Quantitative Analysis of Whole-Body MRI for Accessing the Degree of Diffuse Infiltration Patterns and Identifying High Risk Cases of Newly Diagnosed Multiple Myeloma. J Magn Reson Imaging 2024; 59:2035-2045. [PMID: 37675995 DOI: 10.1002/jmri.28962] [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: 06/13/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Accurate identification of high-risk multiple myeloma (HRMM) is important for prognostication. The degree of diffuse infiltration patterns on magnetic resonance imaging (MRI) is associated with patient prognosis in multiple myeloma. However, objective indexes to determine the degree of diffuse infiltration patterns are unavailable. PURPOSE To investigate whether qualitative and quantitative evaluations of diffuse infiltration patterns on MRI could identify HRMM. STUDY TYPE Retrospective. SUBJECTS Totally, 180 patients (79 HRMM and 101 standard-risk MM) were assessed. The presence of del(17p), t(4;14), t(14;16), t(14;20), gain 1q, and/or p53 mutations was considered to indicate HRMM. FIELD STRENGTH/SEQUENCE 3.0 T/diffusion-weighted whole-body imaging with background body signal suppression (DWIBS), modified Dixon chemical-shift imaging Quant (mDIXON Quant), and short TI inversion recovery (STIR). ASSESSMENT Qualitative analysis involved assessing the degree of diffuse marrow infiltration (mild, moderate, or severe), and quantitative analysis involved evaluating apparent diffusion coefficient (ADC), fat fraction (FF), and T2* values. Clinical data such as sex, age, hemoglobin, serum albumin, serum calcium, serum creatinine, serum lactate dehydrogenase, β2-microglobulin, and bone marrow plasma cells (BMPCs) were also included. STATISTICAL TESTS Univariate and multivariate analyses, receiver operating characteristic (ROC) curve. P < 0.05 was considered statistically significant. RESULTS The high-risk group had significantly higher ADC and T2* and lower FF compared with the standard-risk group. Multivariate analysis indicated BMPCs as a significant independent risk factor for HRMM (odds ratio (OR) = 1.019, 95% CI 1.004-1.033), while FF was a significant independent protective factor associated with HRMM (OR = 0.972, 95% CI 0.946-0.999). The combination of BMPCs and FF achieved the highest areas under the curve (AUC) of 0.732, with sensitivity and specificity of 70.9% and 68.3%, respectively. DATA CONCLUSION Compared with qualitative analysis, FF value was independently associated with HRMM. The quantitative features of diffuse marrow infiltration on MRI scans are more effective in detecting HRMM. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Mengtian Sun
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linlin Wang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chong Wang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Ma
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weimin Wang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liangjie Lin
- Clinical and Technical Support, Philips Healthcare, Beijing, China
| | - Cuiping Ren
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Van Den Berghe T, Verberckmoes B, Kint N, Wallaert S, De Vos N, Algoet C, Behaeghe M, Dutoit J, Van Roy N, Vlummens P, Dendooven A, Van Dorpe J, Offner F, Verstraete K. Predicting cytogenetic risk in multiple myeloma using conventional whole-body MRI, spinal dynamic contrast-enhanced MRI, and spinal diffusion-weighted imaging. Insights Imaging 2024; 15:106. [PMID: 38597979 PMCID: PMC11006637 DOI: 10.1186/s13244-024-01672-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES Cytogenetic abnormalities are predictors of poor prognosis in multiple myeloma (MM). This paper aims to build and validate a multiparametric conventional and functional whole-body MRI-based prediction model for cytogenetic risk classification in newly diagnosed MM. METHODS Patients with newly diagnosed MM who underwent multiparametric conventional whole-body MRI, spinal dynamic contrast-enhanced (DCE-)MRI, spinal diffusion-weighted MRI (DWI) and had genetic analysis were retrospectively included (2011-2020/Ghent University Hospital/Belgium). Patients were stratified into standard versus intermediate/high cytogenetic risk groups. After segmentation, 303 MRI features were extracted. Univariate and model-based methods were evaluated for feature and model selection. Testing was performed using receiver operating characteristic (ROC) and precision-recall curves. Models comparing the performance for genetic risk classification of the entire MRI protocol and of all MRI sequences separately were evaluated, including all features. Four final models, including only the top three most predictive features, were evaluated. RESULTS Thirty-one patients were enrolled (mean age 66 ± 7 years, 15 men, 13 intermediate-/high-risk genetics). None of the univariate models and none of the models with all features included achieved good performance. The best performing model with only the three most predictive features and including all MRI sequences reached a ROC-area-under-the-curve of 0.80 and precision-recall-area-under-the-curve of 0.79. The highest statistical performance was reached when all three MRI sequences were combined (conventional whole-body MRI + DCE-MRI + DWI). Conventional MRI always outperformed the other sequences. DCE-MRI always outperformed DWI, except for specificity. CONCLUSIONS A multiparametric MRI-based model has a better performance in the noninvasive prediction of high-risk cytogenetics in newly diagnosed MM than conventional MRI alone. CRITICAL RELEVANCE STATEMENT An elaborate multiparametric MRI-based model performs better than conventional MRI alone for the noninvasive prediction of high-risk cytogenetics in newly diagnosed multiple myeloma; this opens opportunities to assess genetic heterogeneity thus overcoming sampling bias. KEY POINTS • Standard genetic techniques in multiple myeloma patients suffer from sampling bias due to tumoral heterogeneity. • Multiparametric MRI noninvasively predicts genetic risk in multiple myeloma. • Combined conventional anatomical MRI, DCE-MRI, and DWI had the highest statistical performance to predict genetic risk. • Conventional MRI alone always outperformed DCE-MRI and DWI separately to predict genetic risk. DCE-MRI alone always outperformed DWI separately, except for the parameter specificity to predict genetic risk. • This multiparametric MRI-based genetic risk prediction model opens opportunities to noninvasively assess genetic heterogeneity thereby overcoming sampling bias in predicting genetic risk in multiple myeloma.
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Affiliation(s)
- Thomas Van Den Berghe
- Department of Radiology and Medical Imaging, Ghent University Hospital, Building -1K12, Corneel Heymanslaan 10, Ghent, B-9000, Belgium.
| | - Bert Verberckmoes
- Department of Radiology and Medical Imaging, Ghent University Hospital, Building -1K12, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Nicolas Kint
- Department of Clinical Hematology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Steven Wallaert
- Department of Biostatistics, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Nicolas De Vos
- Department of Radiology and Medical Imaging, Ghent University Hospital, Building -1K12, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Chloé Algoet
- Department of Radiology and Medical Imaging, Ghent University Hospital, Building -1K12, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Maxim Behaeghe
- Department of Radiology and Medical Imaging, Ghent University Hospital, Building -1K12, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Julie Dutoit
- Department of Radiology and Medical Imaging, Ghent University Hospital, Building -1K12, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Nadine Van Roy
- Center for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Philip Vlummens
- Department of Clinical Hematology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Amélie Dendooven
- Department of Pathology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Fritz Offner
- Department of Clinical Hematology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
| | - Koenraad Verstraete
- Department of Radiology and Medical Imaging, Ghent University Hospital, Building -1K12, Corneel Heymanslaan 10, Ghent, B-9000, Belgium
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Cui S, Guo Y, Niu W, Li J, Bian W, Wu W, Zhang W, Zheng Q, Wang J, Niu J. The quantitative parameters based on marrow metabolism derived from synthetic MRI: A pilot study of prognostic value in participants with newly diagnosed multiple myeloma. Cancer Med 2024; 13:e7109. [PMID: 38553942 PMCID: PMC10980927 DOI: 10.1002/cam4.7109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 01/16/2024] [Accepted: 03/02/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The value of SyMRI-derived parameters from lumbar marrow for predicting early treatment response and optimizing the risk stratification of the Revised International Staging System (R-ISS) in participants with multiple myeloma (MM) is unknown. METHODS We prospectively enrolled participants with newly diagnosed MM before treatment. The SyMRI of lumbar marrow was used to calculate T1, T2, and PD values and the clinical features were collected. All participants were divided into good response (≥VGPR) and poor response ( RESULTS Fifty-nine participants (good response, n = 33; poor response, n = 26) were evaluated. The bone marrow plasma cell percentage, β2-microglobulin, T1 and T2 value were difference between two groups (all p < 0.05). The T1 (odds ratio 1.003, p = 0.005) and T2 values (odds ratio 0.910, p = 0.002) were independent predictors and the AUC and cut-off values were 0.787, 967.2 ms and 0.784, 75.9 ms, respectively. There were no significant differences in SyMRI parameters between genders. Participants with both T1 value ≥967.2 ms and T2 value ≤75.9 ms in the R-ISS II stage were potentially to get poor response. CONCLUSIONS Synthetic MRI is a promising tool for predicting early treatment response to MM and promoting R-ISS II stage risk stratification.
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Affiliation(s)
- Sha Cui
- Department of Medical ImagingShanxi Medical UniversityTaiyuanChina
- Department of RadiologySecond Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Yinnan Guo
- Department of PainFifth Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Weiran Niu
- Department of Medical ImagingShanxi Medical UniversityTaiyuanChina
| | - Jianting Li
- Department of RadiologySecond Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Wenjin Bian
- Department of Medical ImagingShanxi Medical UniversityTaiyuanChina
| | - Wenqi Wu
- Department of RadiologySecond Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Wenjia Zhang
- Department of RadiologySecond Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Qian Zheng
- Department of RadiologySecond Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Jun Wang
- Department of RadiologySecond Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Jinliang Niu
- Department of RadiologySecond Hospital of Shanxi Medical UniversityTaiyuanChina
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5
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Raya JG, Duarte A, Wang N, Mazzoli V, Jaramillo D, Blamire AM, Dietrich O. Applications of Diffusion-Weighted MRI to the Musculoskeletal System. J Magn Reson Imaging 2024; 59:376-396. [PMID: 37477576 DOI: 10.1002/jmri.28870] [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: 02/22/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 07/22/2023] Open
Abstract
Diffusion-weighted imaging (DWI) is an established MRI technique that can investigate tissue microstructure at the scale of a few micrometers. Musculoskeletal tissues typically have a highly ordered structure to fulfill their functions and therefore represent an optimal application of DWI. Even more since disruption of tissue organization affects its biomechanical properties and may indicate irreversible damage. The application of DWI to the musculoskeletal system faces application-specific challenges on data acquisition including susceptibility effects, the low T2 relaxation time of most musculoskeletal tissues (2-70 msec) and the need for sub-millimetric resolution. Thus, musculoskeletal applications have been an area of development of new DWI methods. In this review, we provide an overview of the technical aspects of DWI acquisition including diffusion-weighting, MRI pulse sequences and different diffusion regimes to study tissue microstructure. For each tissue type (growth plate, articular cartilage, muscle, bone marrow, intervertebral discs, ligaments, tendons, menisci, and synovium), the rationale for the use of DWI and clinical studies in support of its use as a biomarker are presented. The review describes studies showing that DTI of the growth plate has predictive value for child growth and that DTI of articular cartilage has potential to predict the radiographic progression of joint damage in early stages of osteoarthritis. DTI has been used extensively in skeletal muscle where it has shown potential to detect microstructural and functional changes in a wide range of muscle pathologies. DWI of bone marrow showed to be a valuable tool for the diagnosis of benign and malignant acute vertebral fractures and bone metastases. DTI and diffusion kurtosis have been investigated as markers of early intervertebral disc degeneration and lower back pain. Finally, promising new applications of DTI to anterior cruciate ligament grafts and synovium are presented. The review ends with an overview of the use of DWI in clinical routine. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- José G Raya
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Alejandra Duarte
- Division of Musculoskeletal Radiology, Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Nian Wang
- Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Indiana, USA
- Stark Neurosciences Research Institute, Indiana University, Indianapolis, Indiana, USA
| | - Valentina Mazzoli
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Diego Jaramillo
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
| | - Andrew M Blamire
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Olaf Dietrich
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
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6
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Rodríguez-Laval V, Lumbreras-Fernández B, Aguado-Bueno B, Gómez-León N. Imaging of Multiple Myeloma: Present and Future. J Clin Med 2024; 13:264. [PMID: 38202271 PMCID: PMC10780302 DOI: 10.3390/jcm13010264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Multiple myeloma (MM) is the second most common adult hematologic malignancy, and early intervention increases survival in asymptomatic high-risk patients. Imaging is crucial for the diagnosis and follow-up of MM, as the detection of bone and bone marrow lesions often dictates the decision to start treatment. Low-dose whole-body computed tomography (CT) is the modality of choice for the initial assessment, and dual-energy CT is a developing technique with the potential for detecting non-lytic marrow infiltration and evaluating the response to treatment. Magnetic resonance imaging (MRI) is more sensitive and specific than 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for the detection of small focal lesions and diffuse marrow infiltration. However, FDG-PET/CT is recommended as the modality of choice for follow-up. Recently, diffusion-weighted MRI has become a new technique for the quantitative assessment of disease burden and therapy response. Although not widespread, we address current proposals for structured reporting to promote standardization and diminish variations. This review provides an up-to-date overview of MM imaging, indications, advantages, limitations, and recommended reporting of each technique. We also cover the main differential diagnosis and pitfalls and discuss the ongoing controversies and future directions, such as PET-MRI and artificial intelligence.
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Affiliation(s)
- Víctor Rodríguez-Laval
- Department of Radiology, University Hospital La Princesa, IIS-Princesa, Calle Diego de León 62, 28005 Madrid, Spain; (B.L.-F.); (N.G.-L.)
- Department of Medicine, Autonomous University of Madrid, Calle del Arzobispo Morcillo 4, 28029 Madrid, Spain
| | - Blanca Lumbreras-Fernández
- Department of Radiology, University Hospital La Princesa, IIS-Princesa, Calle Diego de León 62, 28005 Madrid, Spain; (B.L.-F.); (N.G.-L.)
| | - Beatriz Aguado-Bueno
- Department of Hematology, University Hospital La Princesa, IIS-Princesa, Calle Diego de León 62, 28005 Madrid, Spain;
| | - Nieves Gómez-León
- Department of Radiology, University Hospital La Princesa, IIS-Princesa, Calle Diego de León 62, 28005 Madrid, Spain; (B.L.-F.); (N.G.-L.)
- Department of Medicine, Autonomous University of Madrid, Calle del Arzobispo Morcillo 4, 28029 Madrid, Spain
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Xu L, Wu S. New diagnostic strategy for multiple myeloma: A review. Medicine (Baltimore) 2023; 102:e36660. [PMID: 38206744 PMCID: PMC10754592 DOI: 10.1097/md.0000000000036660] [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: 09/09/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024] Open
Abstract
Multiple myeloma (MM) is the second most prevalent hematological malignancy and is distinguished by the aberrant proliferation of monoclonal plasma cells inside the bone marrow and production of M-protein. This condition frequently results in bone deterioration, acute kidney damage, anemia, and hypercalcemia. However, the clinical manifestations and accompanying symptoms of MM vary and may change as the condition evolves. Therefore, diagnosis of MM is difficult. At present, the confirmation of MM diagnosis necessitates the use of bone marrow biopsy, a procedure that is both invasive and challenging for assessing dynamic alterations in the disease. The integration of laboratory testing technologies with imaging technology has the potential to enhance the diagnostic effectiveness and provide a thorough evaluation of disease progression and prognosis in patients with MM. All the examination methods have advantages and disadvantages. Therefore, diagnosis is determined by the application of clinical characteristics, serological tests, and imaging investigations.
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Affiliation(s)
- Ligong Xu
- Department of Radiology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Shuang Wu
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
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Grunz JP, Kunz AS, Baumann FT, Hasenclever D, Sieren MM, Heldmann S, Bley TA, Einsele H, Knop S, Jundt F. Assessing Osteolytic Lesion Size on Sequential CT Scans Is a Reliable Study Endpoint for Bone Remineralization in Newly Diagnosed Multiple Myeloma. Cancers (Basel) 2023; 15:4008. [PMID: 37568823 PMCID: PMC10417114 DOI: 10.3390/cancers15154008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
Multiple myeloma (MM) frequently induces persisting osteolytic manifestations despite hematologic treatment response. This study aimed to establish a biometrically valid study endpoint for bone remineralization through quantitative and qualitative analyses in sequential CT scans. Twenty patients (seven women, 58 ± 8 years) with newly diagnosed MM received standardized induction therapy comprising the anti-SLAMF7 antibody elotuzumab, carfilzomib, lenalidomide, and dexamethasone (E-KRd). All patients underwent whole-body low-dose CT scans before and after six cycles of E-KRd. Two radiologists independently recorded osteolytic lesion sizes, as well as the presence of cortical destruction, pathologic fractures, rim and trabecular sclerosis. Bland-Altman analyses and Krippendorff's α were employed to assess inter-reader reliability, which was high for lesion size measurement (standard error 1.2 mm) and all qualitative criteria assessed (α ≥ 0.74). After six cycles of E-KRd induction, osteolytic lesion size decreased by 22% (p < 0.001). While lesion size response did not correlate with the initial lesion size at baseline imaging (Pearson's r = 0.144), logistic regression analysis revealed that the majority of responding osteolyses exhibited trabecular sclerosis (p < 0.001). The sum of osteolytic lesion sizes on sequential CT scans defines a reliable study endpoint to characterize bone remineralization. Patient level response is strongly associated with the presence of trabecular sclerosis.
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Affiliation(s)
- Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany; (A.S.K.); (T.A.B.)
| | - Andreas Steven Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany; (A.S.K.); (T.A.B.)
| | - Freerk T. Baumann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany;
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Härtelstraße 16–18, 04107 Leipzig, Germany;
| | - Malte Maria Sieren
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23562 Lübeck, Germany;
- Institute of Interventional Radiology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Stefan Heldmann
- Fraunhofer Institute for Digital Medicine MEVIS, Maria-Goeppert-Straße 3, 23562 Lübeck, Germany;
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany; (A.S.K.); (T.A.B.)
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany; (H.E.); (S.K.); (F.J.)
| | - Stefan Knop
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany; (H.E.); (S.K.); (F.J.)
- Department of Internal Medicine, Klinikum Nürnberg Nord, Prof.-Ernst-Nathan-Str. 1, 90419 Nürnberg, Germany
| | - Franziska Jundt
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany; (H.E.); (S.K.); (F.J.)
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Zhang S, Liu M, Li S, Cui J, Zhang G, Wang X. An MRI-based radiomics nomogram for differentiating spinal metastases from multiple myeloma. Cancer Imaging 2023; 23:72. [PMID: 37488622 PMCID: PMC10367256 DOI: 10.1186/s40644-023-00585-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/19/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Spinal metastasis and multiple myeloma share many overlapping conventional radiographic imaging characteristics, thus, their differentiation may be challenging. The purpose of this study was to develop and validate an MRI-based radiomics nomogram for the differentiation of spinal metastasis and multiple myeloma. MATERIALS AND METHODS A total of 312 patients (training set: n = 146, validation set: n = 65, our center; external test set: n = 101, two other centers) with spinal metastasis (n = 196) and multiple myeloma (n = 116) were retrospectively enrolled. Demographics and MRI findings were assessed to build a clinical factor model. Radiomics features were extracted from MRI images. A radiomics model was constructed by the least absolute shrinkage and selection operator method. A radiomics nomogram combining the radiomics signature and independent clinical factors was constructed. And, one experienced radiologist reviewed the MRI images for all case. The diagnostic performance of the different models was evaluated by receiver operating characteristic curves. RESULTS A clinical factors model was built based on heterogeneous appearance and shape. Twenty-one features were used to build the radiomics signature. The area under the curve (AUC) values of the radiomics nomogram (0.853 and 0.762, respectively) were significantly higher than that of the clinical factor model (0.692 and 0.540, respectively) in both validation (p = 0.048) and external test (p < 0.001) sets. The AUC values of the radiomics nomogram model were higher than that of radiologist in training, validation and external test sets (all p < 0.05). Moreover, no significant difference in AUC values of radiomics nomogram model was found between the validation set and external test set (p = 0.212). CONCLUSION The radiomics nomogram can differentiate spinal metastasis and multiple myeloma with a moderate to good performance, and may be as a valuable method to assist in the clinical diagnosis and preoperative decision-making.
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Affiliation(s)
- Shuai Zhang
- Shandong Provincial Hospital Affliated to Shandong First Medical University, Shandong, China
| | - Menghan Liu
- Depertment of Health Management, The First Affiliated Hospital of Shandong First Medical University, Shandong, China
| | - Sha Li
- Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Jingjing Cui
- United Imaging Intelligence Co., Ltd, Beijing, China
| | - Guang Zhang
- Depertment of Health Management, The First Affiliated Hospital of Shandong First Medical University, Shandong, China.
- Depertment of Health Management, The First Affiliated Hospital of Shandong First Medical University, No. 16766, Jingshi Road, Jinan, Shandong, 250014, China.
| | - Ximing Wang
- Shandong Provincial Hospital Affliated to Shandong First Medical University, Shandong, China.
- Department of Radiology, Shandong Provincial Hospital, Shandong First Medical University, No.324 Jingwu Road, Jinan, Shandong, 250021, China.
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10
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Rashidi A, Baratto L, Jayapal P, Theruvath AJ, Greene EB, Lu R, Spunt SL, Daldrup-Link HE. Detection of bone marrow metastases in children and young adults with solid cancers with diffusion-weighted MRI. Skeletal Radiol 2023; 52:1179-1192. [PMID: 36441237 PMCID: PMC10757820 DOI: 10.1007/s00256-022-04240-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/19/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the diagnostic accuracy of diffusion-weighted (DW)-MRI with b-values of 50 s/mm2 and 800 s/mm2 for the detection of bone marrow metastases in children and young adults with solid malignancies. METHODS In an institutional review board-approved prospective study, we performed 51 whole-body DW-MRI scans in 19 children and young adults (14 males, 5 females; age range: 1-25 years) with metastasized cancers before (n = 19 scans) and after (n = 32 scans) chemotherapy. Two readers determined the presence of focal bone marrow lesions in 10 anatomical areas. A third reader measured ADC and SNR of focal lesions and normal marrow. Simultaneously acquired 18F-FDG-PET scans served as the standard of reference. Data of b = 50 s/mm2 and 800 s/mm2 images were compared with the Wilcoxon signed-rank test. Inter-reader agreement was evaluated with weighted kappa statistics. RESULTS The SNR of bone marrow metastases was significantly higher compared to normal bone marrow on b = 50 s/mm2 (mean ± SD: 978.436 ± 1239.436 vs. 108.881 ± 109.813, p < 0.001) and b = 800 s/mm2 DW-MRI (499.638 ± 612.721 vs. 86.280 ± 89.120; p < 0.001). On 30 out of 32 post-treatment DW-MRI scans, reconverted marrow demonstrated low signal with low ADC values (0.385 × 10-3 ± 0.168 × 10-3mm2/s). The same number of metastases (556/588; 94.6%; p > 0.99) was detected on b = 50 s/mm2 and 800 s/mm2 images. However, both normal marrow and metastases exhibited low signals on ADC maps, limiting the ability to delineate metastases. The inter-reader agreement was substantial, with a weighted kappa of 0.783 and 0.778, respectively. CONCLUSION Bone marrow metastases in children and young adults can be equally well detected on b = 50 s/mm2 and 800 s/mm2 images, but ADC values can be misleading.
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Affiliation(s)
- Ali Rashidi
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Lucia Baratto
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Praveen Jayapal
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Ashok Joseph Theruvath
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Elton Benjamin Greene
- Department of Radiology, Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA, USA
| | - Rong Lu
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | - Sheri L Spunt
- Department of Pediatrics, Hematology/Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Pediatrics, Hematology/Oncology, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA, 94305-5654, USA.
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11
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Diffusion-weighted imaging (DWI) in diagnosis, staging, and treatment response assessment of multiple myeloma: a systematic review and meta-analysis. Skeletal Radiol 2023; 52:565-583. [PMID: 35881152 DOI: 10.1007/s00256-022-04119-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the role of diffusion-weighted imaging (DWI) in the initial diagnosis, staging, and assessment of treatment response in patients with multiple myeloma (MM). MATERIALS AND METHODS A systematic literature review was conducted in PubMed, the Cochrane Library, EMBASE, Scopus, and Web of Science databases. The primary endpoints were defined as the diagnostic performance of DWI for disease detection, staging of MM, and assessing response to treatment in these patients. RESULTS Of 5881 initially reviewed publications, 33 were included in the final qualitative and quantitative meta-analysis. The diagnostic performance of DWI in the detection of patients with MM revealed pooled sensitivity and specificity of 86% (95% CI: 84-89) and 63% (95% CI: 56-70), respectively, with a diagnostic odds ratio (OR) of 14.98 (95% CI: 4.24-52.91). The pooled risk difference of 0.19 (95% CI: - 0.04-0.42) was reported in favor of upstaging with DWI compared to conventional MRI (P value = 0.1). Treatment response evaluation and ADCmean value changes across different studies showed sensitivity and specificity of approximately 78% (95% CI: 72-83) and 73% (95% CI: 61-83), respectively, with a diagnostic OR of 7.21 in distinguishing responders from non-responders. CONCLUSIONS DWI is not only a promising tool for the diagnosis of MM, but it is also useful in the initial staging and re-staging of the disease and treatment response assessment. This can aid clinicians with earlier initiation or change in treatment strategy, which could have prognostic significance for patients.
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12
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Kim DK, Park SS, Jung JY. [Clinical Application and Limitations of Myeloma Response Assessment and Diagnosis System (MY-RADS)]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:51-74. [PMID: 36818710 PMCID: PMC9935961 DOI: 10.3348/jksr.2022.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/22/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
Multiple myeloma, which is a proliferative disease of plasma cells that originate from a single clone, is the second most common hematologic malignancy following non-Hodgkin lymphoma. In the past, its diagnosis was made based on clinical findings (so-called "CRAB") and a skeletal survey using radiographs. However, since the implementation of the International Myeloma Working Group's revised guideline regarding the radiologic diagnosis of multiple myeloma, whole-body (WB) MRI has emerged to play a central role in the early diagnosis of multiple myeloma. Diffusion-weighted imaging and fat quantification using Dixon methods enable treatment response assessment by MRI. In keeping with the trend, a multi-institutional and multidisciplinary consensus for standardized image acquisition and reporting known as the Myeloma Response Assessment and Diagnostic System (MY-RADS) has recently been proposed. This review aims to describe the clinical application of WB-MRI based on MY-RADS in multiple myeloma, discuss its limitations, and suggest future directions for improvement.
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Affiliation(s)
- Dong Kyun Kim
- Department of Radiology, Seoul St. Mary’s Hospital, and, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Soo Park
- Department of Hematology, Seoul St. Mary’s Hospital, and, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary’s Hospital, and, College of Medicine, The Catholic University of Korea, Seoul, Korea
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13
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Ataei F, Sharma A, Stanborough R, Parent EE. FDG PET-MRI evaluation of synchronous gallbladder adenocarcinoma and POEMS syndrome. Radiol Case Rep 2022; 17:4294-4298. [PMID: 36132063 PMCID: PMC9483593 DOI: 10.1016/j.radcr.2022.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022] Open
Abstract
POEMS syndrome is a rare paraneoplastic syndrome associated with a plasma cell proliferative disorder. Gallbladder adenocarcinoma is a rare malignancy, with no association with POEMS syndrome. The plasma cell dyscrasia is routinely evaluated with advanced hybrid imaging to assess both anatomic and functional components. We present a case of a 59-year-old female with a known diagnosis of POEMS syndrome who underwent a whole-body restaging evaluation with hybrid positron emission tomography (PET) and magnetic resonance imaging (MR) to restage her plasma cell dyscrasia. She also had a prior diagnosis of gallbladder adenocarcinoma. Our case focuses on the value of PET/MR in this scenario as well as a rare case of osseous metastasis from gallbladder carcinoma.
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14
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Wennmann M, Klein A, Bauer F, Chmelik J, Grözinger M, Uhlenbrock C, Lochner J, Nonnenmacher T, Rotkopf LT, Sauer S, Hielscher T, Götz M, Floca RO, Neher P, Bonekamp D, Hillengass J, Kleesiek J, Weinhold N, Weber TF, Goldschmidt H, Delorme S, Maier-Hein K, Schlemmer HP. Combining Deep Learning and Radiomics for Automated, Objective, Comprehensive Bone Marrow Characterization From Whole-Body MRI: A Multicentric Feasibility Study. Invest Radiol 2022; 57:752-763. [PMID: 35640004 DOI: 10.1097/rli.0000000000000891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Disseminated bone marrow (BM) involvement is frequent in multiple myeloma (MM). Whole-body magnetic resonance imaging (wb-MRI) enables to evaluate the whole BM. Reading of such whole-body scans is time-consuming, and yet radiologists can transfer only a small fraction of the information of the imaging data set to the report. This limits the influence that imaging can have on clinical decision-making and in research toward precision oncology. The objective of this feasibility study was to implement a concept for automatic, comprehensive characterization of the BM from wb-MRI, by automatic BM segmentation and subsequent radiomics analysis of 30 different BM spaces (BMS). MATERIALS AND METHODS This retrospective multicentric pilot study used a total of 106 wb-MRI from 102 patients with (smoldering) MM from 8 centers. Fifty wb-MRI from center 1 were used for training of segmentation algorithms (nnU-Nets) and radiomics algorithms. Fifty-six wb-MRI from 8 centers, acquired with a variety of different MRI scanners and protocols, were used for independent testing. Manual segmentations of 2700 BMS from 90 wb-MRI were performed for training and testing of the segmentation algorithms. For each BMS, 296 radiomics features were calculated individually. Dice score was used to assess similarity between automatic segmentations and manual reference segmentations. RESULTS The "multilabel nnU-Net" segmentation algorithm, which performs segmentation of 30 BMS and labels them individually, reached mean dice scores of 0.88 ± 0.06/0.87 ± 0.06/0.83 ± 0.11 in independent test sets from center 1/center 2/center 3-8 (interrater variability between radiologists, 0.88 ± 0.01). The subset from the multicenter, multivendor test set (center 3-8) that was of high imaging quality was segmented with high precision (mean dice score, 0.87), comparable to the internal test data from center 1. The radiomic BM phenotype consisting of 8880 descriptive parameters per patient, which result from calculation of 296 radiomics features for each of the 30 BMS, was calculated for all patients. Exemplary cases demonstrated connections between typical BM patterns in MM and radiomic signatures of the respective BMS. In plausibility tests, predicted size and weight based on radiomics models of the radiomic BM phenotype significantly correlated with patients' actual size and weight ( P = 0.002 and P = 0.003, respectively). CONCLUSIONS This pilot study demonstrates the feasibility of automatic, objective, comprehensive BM characterization from wb-MRI in multicentric data sets. This concept allows the extraction of high-dimensional phenotypes to capture the complexity of disseminated BM disorders from imaging. Further studies need to assess the clinical potential of this method for automatic staging, therapy response assessment, or prediction of biopsy results.
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Affiliation(s)
| | - André Klein
- Medical Image Computing, German Cancer Research Center
| | | | | | | | | | | | - Tobias Nonnenmacher
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg
| | | | - Sandra Sauer
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center, Heidelberg
| | | | | | - Peter Neher
- Medical Image Computing, German Cancer Research Center
| | | | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY
| | | | - Niels Weinhold
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg
| | - Tim Frederik Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg
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15
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Advanced Imaging in Multiple Myeloma: New Frontiers for MRI. Diagnostics (Basel) 2022; 12:diagnostics12092182. [PMID: 36140583 PMCID: PMC9497462 DOI: 10.3390/diagnostics12092182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/17/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Plasma cell dyscrasias are estimated to newly affect almost 40,000 people in 2022. They fall on a spectrum of diseases ranging from relatively benign to malignant, the malignant end of the spectrum being multiple myeloma (MM). The International Myeloma Working Group (IMWG) has traditionally outlined the diagnostic criteria and therapeutic management of MM. In the last two decades, novel imaging techniques have been employed for MM to provide more information that can guide not only diagnosis and staging, but also treatment efficacy. These imaging techniques, due to their low invasiveness and high reliability, have gained significant clinical attention and have already changed the clinical practice. The development of functional MRI sequences such as diffusion weighted imaging (DWI) or intravoxel incoherent motion (IVIM) has made the functional assessment of lesions feasible. Moreover, the growing availability of positron emission tomography (PET)–magnetic resonance imaging (MRI) scanners is leading to the potential combination of sensitive anatomical and functional information in a single step. This paper provides an organized framework for evaluating the benefits and challenges of novel and more functional imaging techniques used for the management of patients with plasma cell dyscrasias, notably MM.
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16
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Du D, Gao Y, Zheng T, Yang L, Wang Z, Shi Q, Wu S, Liang X, Yao X, Lu J, Liu L. The Value of First-Order Features Based on the Apparent Diffusion Coefficient Map in Evaluating the Therapeutic Effect of Low-Intensity Pulsed Ultrasound for Acute Traumatic Brain Injury With a Rat Model. Front Comput Neurosci 2022; 16:923247. [PMID: 35814344 PMCID: PMC9259978 DOI: 10.3389/fncom.2022.923247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/06/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose In order to evaluate the neuroprotective effect of low-intensity pulsed ultrasound (LIPUS) for acute traumatic brain injury (TBI), we studied the potential of apparent diffusion coefficient (ADC) values and ADC-derived first-order features regarding this problem. Methods Forty-five male Sprague Dawley rats (sham group: 15, TBI group: 15, LIPUS treated: 15) were enrolled and underwent magnetic resonance imaging. Scanning layers were acquired using a multi-shot readout segmentation of long variable echo trains (RESOLVE) to decrease distortion. The ultrasound transducer was applied to the designated region in the injured cortical areas using a conical collimator and was filled with an ultrasound coupling gel. Regions of interest were manually delineated in the center of the damaged cortex on the diffusion weighted images (b = 800 s/mm2) layer by layer for the TBI and LIPUS treated groups using the open-source software ITK-SNAP. Before analysis and modeling, the features were normalized using a z-score method, and a logistic regression model with a backward filtering method was employed to perform the modeling. The entire process was completed using the R language. Results During the observation time, the ADC values ipsilateral to the trauma in the TBI and LIPUS groups increased rapidly up to 24 h. After statistical analysis, the 10th percentile, 90th percentile, mean, skewness, and uniformity demonstrated a significant difference among three groups. The receiver operating characteristic curve (ROC) analysis shows that the combined LR model exhibited the highest area under the curve value (AUC: 0.96). Conclusion The combined LR model of first-order features based on the ADC map can acquire a higher diagnostic performance than each feature only in evaluating the neuroprotective effect of LIPUS for TBI. Models based on first-order features may have potential value in predicting the therapeutic effect of LIPUS in clinical practice in the future.
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Affiliation(s)
- Dan Du
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Yajuan Gao
- Department of Radiology, Peking University Third Hospital, Beijing, China
- NMPA Key Laboratory for Evaluation of Medical Imaging Equipment and Technique, Beijing, China
- Peking University Shenzhen Graduate School, Shenzhen, China
| | - Tao Zheng
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Linsha Yang
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Zhanqiu Wang
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Qinglei Shi
- MR Scientific Marketing, Siemens Healthineers Ltd., Beijing, China
| | - Shuo Wu
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Xin Liang
- Graduate School of Chengde Medical University, Chengde, China
| | - Xinyu Yao
- Graduate School of Chengde Medical University, Chengde, China
| | - Jiabin Lu
- Beijing Key Laboratory of Magnetic Resonance Imaging Device and Technique, Beijing, China
| | - Lanxiang Liu
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
- *Correspondence: Lanxiang Liu,
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17
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Wennmann M, Thierjung H, Bauer F, Weru V, Hielscher T, Grözinger M, Gnirs R, Sauer S, Goldschmidt H, Weinhold N, Bonekamp D, Schlemmer HP, Weber TF, Delorme S, Rotkopf LT. Repeatability and Reproducibility of ADC Measurements and MRI Signal Intensity Measurements of Bone Marrow in Monoclonal Plasma Cell Disorders: A Prospective Bi-institutional Multiscanner, Multiprotocol Study. Invest Radiol 2022; 57:272-281. [PMID: 34839306 DOI: 10.1097/rli.0000000000000838] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVES Apparent diffusion coefficient (ADC) and signal intensity (SI) measurements play an increasing role in magnetic resonance imaging (MRI) of monoclonal plasma cell disorders. The purpose of this study was to assess interrater variability, repeatability, and reproducibility of ADC and SI measurements from bone marrow (BM) under variation of MRI protocols and scanners. PATIENTS AND METHODS Fifty-five patients with suspected or confirmed monoclonal plasma cell disorder were prospectively included in this institutional review board-approved study and underwent several measurements after the standard clinical whole-body MR scan, including repeated scan after repositioning, scan with a second MRI protocol, scan at a second 1.5 T scanner with a harmonized MRI protocol, and scan at a 3 T scanner. For T1-weighted, T2-weighted STIR, B800 images, and ADC maps, regions of interest were placed in the BM of the iliac crest and sacral bone, and in muscle tissue for image normalization. Bland-Altman plots were constructed, and absolute bias, relative bias to mean, limits of agreement, and coefficients of variation were calculated. RESULTS Interrater variability and repeatability experiments showed a maximal relative bias of -0.077 and a maximal coefficient of variation of 16.2% for all sequences. Although the deviations at the second 1.5 T scanner with harmonized MRI protocol to the first 1.5 T scanner showed a maximal relative bias of 0.124 for all sequences, the variation of the MRI protocol and scan at the 3 T scanner led to large relative biases of up to -0.357 and -0.526, respectively. When comparing the 3 T scanner to the 1.5 T scanner, normalization to muscle reduced the bias of T1-weighted and T2-weighted sequences, but not of ADC maps. CONCLUSIONS The MRI scanners with identical field strength and harmonized MRI protocols can provide relatively stable quantitative measurements of BM ADC and SI. Deviations in MRI field strength and MRI protocol should be avoided when applying ADC cutoff values, which were established at other scanners or when performing multicentric imaging trials.
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Affiliation(s)
- Markus Wennmann
- From the Division of Radiology, German Cancer Research Center (DKFZ)
| | - Heidi Thierjung
- From the Division of Radiology, German Cancer Research Center (DKFZ)
| | | | - Vivienn Weru
- Division of Biostatistics, German Cancer Research Center (DKFZ)
| | | | - Martin Grözinger
- From the Division of Radiology, German Cancer Research Center (DKFZ)
| | - Regula Gnirs
- From the Division of Radiology, German Cancer Research Center (DKFZ)
| | - Sandra Sauer
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg
| | | | - Niels Weinhold
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg
| | - David Bonekamp
- From the Division of Radiology, German Cancer Research Center (DKFZ)
| | | | - Tim Frederik Weber
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Delorme
- From the Division of Radiology, German Cancer Research Center (DKFZ)
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18
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Sun M, Cheng J, Ren C, Zhang Y, Li Y, Wang L, Zhang S, Lin L. Evaluation of Diffuse Bone Marrow Infiltration Pattern in Monoclonal Plasma Cell Diseases by Quantitative Whole-body Magnetic Resonance Imaging. Acad Radiol 2022; 29:490-500. [PMID: 34362664 DOI: 10.1016/j.acra.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/18/2021] [Accepted: 06/13/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES To analyze diffuse infiltration pattern in monoclonal plasma cell diseases by diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) and quantitative chemical-shift encoded MRI. MATERIALS AND METHODS Ninety-nine patients with monoclonal plasma cell diseases and 15 healthy control subjects were retrospectively analyzed. All patients underwent whole-body MRI (including DWIBS and mDIXON Quant) and were divided into three groups: monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), and multiple myeloma (MM). Apparent diffusion coefficient (ADC), fat fraction (FF), and T2* values for each group were calculated then analyzed by one-way ANOVA and receiver operating characteristic curve. Correlations of ADC, FF, and T2* with clinical indices were analyzed with Spearman correlation test. RESULTS The ADC and T2* values of MM were significantly higher than those of the healthy control, MGUS and SMM (ADC: p = 0.003, p = 0.003, and p = 0.042; T2*: all with p < 0.001). The FF values of MM were significantly lower than those of the healthy control, MGUS and SMM (p < 0.001, p < 0.001 and p = 0.034). The ADC, FF, and T2* thresholds for recognizing MM and MGUS+SMM were 0.51 × 10-3 mm2/s, 31.14%, and 10.53 ms, respectively. The ADC, FF, and T2* values were identified to be significantly associated with bone marrow plasma cells and hemoglobin in patients (all with p < 0.001). CONCLUSION ADC, FF, and T2* were significantly correlated with clinical indices related to monoclonal plasma cell diseases. MM with the diffuse infiltration pattern can be distinguished more objectively from MGUS and SMM by quantitative functional MRI parameters.
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19
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Guha A, Vijan A, Agarwal U, Goda JS, Mahajan A, Shetty N, Khattry N. Imaging for Plasma Cell Dyscrasias: What, When, and How? Front Oncol 2022; 12:825394. [PMID: 35402253 PMCID: PMC8987930 DOI: 10.3389/fonc.2022.825394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/11/2022] [Indexed: 02/05/2023] Open
Abstract
Imaging plays a vital role in the diagnosis, response assessment, and follow-up of patients with plasma cell bone disease. The radiologic diagnostic paradigm has thus far evolved with developing technology and availability of better imaging platforms; however, the skewed availability of these imaging modalities in developed vis-à-vis the developing countries along with the lack of uniformity in reporting has led to a consensus on the imaging criteria for diagnosing and response assessment in plasma cell dyscrasia. Therefore, it is imperative for not only the radiologists but also the treating oncologist to be aware of the criteria and appropriate imaging modality to be used in accordance with the clinical question. The review will allow the treating oncologist to answer the following questions on the diagnostic, prognostic, and predictive abilities of various imaging modalities for plasma cell dyscrasia: a) What lesions can look like multiple myeloma (MM) but are not?; b) Does the patient have MM? To diagnose MM in a high-risk SMM patient with clinical suspicion, which modality should be used and why?; c) Is the patient responding to therapy on follow-up imaging once treatment is initiated?; d) To interpret commonly seen complications post-therapy, when is it a disease and when is the expected sequel to treatment? Fractures, red marrow reconversion?; and e) When is the appropriate time to flag a patient for further workup when interpreting MRI spine done for back pain in the elderly? How do we differentiate between commonly seen osteoporosis-related degenerative spine versus marrow infiltrative disorder?
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Affiliation(s)
- Amrita Guha
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- *Correspondence: Amrita Guha,
| | - Antariksh Vijan
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, India
| | - Ujjwal Agarwal
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, India
| | - Jayant Sastri Goda
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, India
| | - Nitin Shetty
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
| | - Navin Khattry
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Mumbai, India
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Zhang B, Bian B, Zhang Y, Zhang L, Zhang R, Wang J. The Apparent Diffusion Coefficient of Diffusion-Weighted Whole-Body Magnetic Resonance Imaging Affects the Survival of Multiple Myeloma Independently. Front Oncol 2022; 12:780078. [PMID: 35311101 PMCID: PMC8931198 DOI: 10.3389/fonc.2022.780078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/07/2022] [Indexed: 02/03/2023] Open
Abstract
Background Diffusion-weighted whole-body MRI (DW-MRI) is increasingly used to evaluate bone diseases of multiple myeloma (MM), but there is lack of quantitative indicator for DW-MRI to reflect the prognosis of MM. Apparent diffusion coefficient (ADC) values in DW-MRI has potential correlations between some indexes of MM, but the influence of ADC on MM survival needs to be further verified. Methods A total of 381 newly diagnosed MM patients were enrolled in the study to analyze the effect of ADC values in DW-MRI on progression-free survival (PFS) and overall survival (OS). The Kaplan–Meier method was used to perform univariate survival analysis, and the Cox proportional hazards model was used for multivariate analysis. In addition to the ADC value, genetic and serological indexes were also included. Results The survivals were observed in univariate ADC stratification with median PFS of 52.0, 45.0, 34.0, and 26.0 months (the unit of ADC value was 10−3 mm2/s; the ADC ranges were ADC < 0.4886, 0.4886 ≤ ADC < 0.6545, 0.6545 ≤ ADC < 0.7750, and ADC ≥ 0.7750; 95% CI, 43.759–62.241, 46.336–53.664, 39.753–46.247, and 27.812–32.188). The OS were 81.0, 61.0, 47.0, and 36.0 months (p < 0.001; 95% CI, 71.356–82.644, 67.630–70.370, 57.031–60.969, and 36.107–43.893). In Cox proportional hazards model, the ADC value was considered to be an independent risk factor affecting PFS and OS of MM (both p < 0.001). Conclusions This study supports that ADC in DW-MRI may independently stratify MM patients and better predict their prognosis. The combined use of DW-MRI and other parameters allows more accurate evaluation of MM survival. Trial Registration http://www.chictr.org.cn/showproj.aspx?proj=49012, ChiCTR2000029587.
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Affiliation(s)
- Bei Zhang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Bingyang Bian
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Yanjiao Zhang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Li Zhang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Rongkui Zhang
- Department of Hematology, First Hospital of Jilin University, Changchun, China
| | - Jiping Wang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
- *Correspondence: Jiping Wang,
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21
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Mena E, Turkbey EB, Lindenberg L. Modern radiographic imaging in multiple myeloma, what is the minimum requirement? Semin Oncol 2022; 49:86-93. [PMID: 35190200 PMCID: PMC9149049 DOI: 10.1053/j.seminoncol.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/09/2022] [Indexed: 02/03/2023]
Abstract
Imaging innovations offer useful techniques applicable to many oncology specialties. Treatment advances in the field of multiple myeloma (MM) have increased the need for accurate diagnosis, particularly in the bone marrow, which is an essential component in myeloma-defining criteria. Modern imaging identifies osteolytic lesions, distinguishes solitary plasmacytoma from MM, and evaluates the presence of extramedullary disease. Furthermore, imaging is increasingly valuable in post-treatment response assessment. Detection of minimal residual disease after therapy carries prognostic implications and influences subsequent treatment planning. Whole-body low-dose Computed Tomography is now recommended over the conventional skeletal survey, and more sophisticated functional imaging methods, such as 18F-Fluorodeoxyglucose Positron Emission Tomography , and diffusion-weighted Magnetic Resonance Imaging are proving effective in the assessment and monitoring of MM disease. This review focuses on understanding indications and advantages of these imaging modalities for diagnosing and managing myeloma.
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Affiliation(s)
- Esther Mena
- Molecular Imaging Branch. National Cancer Institute, NIH, Bethesda, MD, USA
| | - Evrim B. Turkbey
- Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Liza Lindenberg
- Molecular Imaging Branch. National Cancer Institute, NIH, Bethesda, MD, USA
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22
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Identification of abnormal BMD and osteoporosis in postmenopausal women with T2*-corrected Q-Dixon and reduced-FOV IVIM: correlation with QCT. Eur Radiol 2022; 32:4707-4717. [DOI: 10.1007/s00330-021-08531-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 02/07/2023]
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23
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Application of diffusion-weighted whole-body MRI for response monitoring in multiple myeloma after chemotherapy: a systematic review and meta-analysis. Eur Radiol 2022; 32:2135-2148. [PMID: 35028748 DOI: 10.1007/s00330-021-08311-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/27/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Myeloma Response Assessment and Diagnosis System recently published provides a framework for the standardised interpretation of DW-WBMRI in response assessment of multiple myeloma (MM) based on expert opinion. However, there is a lack of meta-analysis providing higher-level evidence to support the recommendations. In addition, some disagreement exists in the literature regarding the effect of timing and lesion subtypes on apparent diffusion coefficient (ADC) value changes post-treatment. METHOD Medline, Cochrane and Embase were searched from inception to 20th July 2021, using terms reflecting multiple myeloma and DW-WBMRI. Using PRISMA reporting guidelines, data were extracted by two investigators. Quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 method. RESULTS Of the 74 papers screened, 10 studies were included comprising 259 patients (127 males and 102 females) and 1744 reported lesions. Responders showed a significant absolute ADC change of 0.21×10-3 mm/s2 (95% CI, 0.01-0.41) with little evidence of heterogeneity (Cochran Q, p = 0.12, I2 = 45%) or publication bias (p = 0.737). Non-responders did not show a significant absolute difference in ADC (0.06 ×10-3 mm/s2, 95% CI, -0.07 to 0.19). A percentage ADC increase of 34.78% (95% CI, 10.75-58.81) was observed in responders. Meta-regression showed an inverse trend between ADC increases and time since chemotherapy initiation which did not reach statistical significance (R2 = 20.46, p = 0.282). CONCLUSIONS This meta-analysis supports the use of the DW-WBMRI as an imaging biomarker for response assessment. More evidence is needed to further characterise ADC changes by lesion subtypes over time. KEY POINTS • In multiple myeloma patients who received chemotherapy, responders have a significant absolute increase in ADC values that is not seen in non-responders. • A 35% increase in ADC from baseline values is found to classify response post-induction chemotherapy which corroborates with expert opinion from the Myeloma Response Assessment and Diagnosis System. • More evidence is needed to further characterise ADC changes by lesion subtypes over time after induction of therapy.
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24
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Lecouvet FE, Vekemans MC, Van Den Berghe T, Verstraete K, Kirchgesner T, Acid S, Malghem J, Wuts J, Hillengass J, Vandecaveye V, Jamar F, Gheysens O, Vande Berg BC. Imaging of treatment response and minimal residual disease in multiple myeloma: state of the art WB-MRI and PET/CT. Skeletal Radiol 2022; 51:59-80. [PMID: 34363522 PMCID: PMC8626399 DOI: 10.1007/s00256-021-03841-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/28/2021] [Accepted: 06/06/2021] [Indexed: 02/02/2023]
Abstract
Bone imaging has been intimately associated with the diagnosis and staging of multiple myeloma (MM) for more than 5 decades, as the presence of bone lesions indicates advanced disease and dictates treatment initiation. The methods used have been evolving, and the historical radiographic skeletal survey has been replaced by whole body CT, whole body MRI (WB-MRI) and [18F]FDG-PET/CT for the detection of bone marrow lesions and less frequent extramedullary plasmacytomas.Beyond diagnosis, imaging methods are expected to provide the clinician with evaluation of the response to treatment. Imaging techniques are consistently challenged as treatments become more and more efficient, inducing profound response, with more subtle residual disease. WB-MRI and FDG-PET/CT are the methods of choice to address these challenges, being able to assess disease progression or response and to detect "minimal" residual disease, providing key prognostic information and guiding necessary change of treatment.This paper provides an up-to-date overview of the WB-MRI and PET/CT techniques, their observations in responsive and progressive disease and their role and limitations in capturing minimal residual disease. It reviews trials assessing these techniques for response evaluation, points out the limited comparisons between both methods and highlights their complementarity with most recent molecular methods (next-generation flow cytometry, next-generation sequencing) to detect minimal residual disease. It underlines the important role of PET/MRI technology as a research tool to compare the effectiveness and complementarity of both methods to address the key clinical questions.
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Affiliation(s)
- Frederic E. Lecouvet
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
| | - Marie-Christiane Vekemans
- Haematology Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Brussels, Belgium
| | - Thomas Van Den Berghe
- Radiology Department, Universiteit Ghent, Sint-Pietersnieuwstraat 33, 9000 Gent, Belgium
| | - Koenraad Verstraete
- Radiology Department, Universiteit Ghent, Sint-Pietersnieuwstraat 33, 9000 Gent, Belgium
| | - Thomas Kirchgesner
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
| | - Souad Acid
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
| | - Jacques Malghem
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
| | - Joris Wuts
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Avenue du Laerbeek 101, 1090 Jette, Belgium
| | - Jens Hillengass
- Departement of Medicine, Myeloma Unit, Park Comprehensive Cancer Center, Buffalo, NY USA
| | - Vincent Vandecaveye
- Radiology Department, Katholieke Univesiteit Leuven, Oude Markt, 13, 3000 Leuven, Belgium
| | - François Jamar
- Nuclear Medicine Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Olivier Gheysens
- Nuclear Medicine Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Bruno C. Vande Berg
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
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25
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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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26
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Vande Berg BC, Kirchgesner T, Acid S, Malghem J, Vekemans MC, Lecouvet FE. Diffuse vertebral marrow changes at MRI: Multiple myeloma or normal? Skeletal Radiol 2022; 51:89-99. [PMID: 34550397 DOI: 10.1007/s00256-021-03886-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 02/02/2023]
Abstract
Five MRI patterns of marrow involvement (diffuse, focal, combined diffuse and focal, variegated, and normal) are observed in patients with a marrow proliferative disorder including MM. The wide range of marrow involvement patterns in monoclonal plasma cell proliferative disorders mirrors that of their natural histories that can vary from indolent to rapidly lethal. MRI of the axial bone marrow contributes to stage these disorders, but it should not be obtained for disease detection and characterization because of its limited specificity and sensitivity. At MRI, diffuse benign hematopoietic marrow hyperplasia and marrow heterogeneities in elderly patients mimic the diffuse and variegated patterns observed in MM patients. Careful analysis of fat- and fluid-sensitive MR images and quantitative marrow assessment by using MRI and FDG-PET can contribute in differentiating these changes from those associated with neoplastic marrow infiltration, with some residual overlapping findings.
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Affiliation(s)
- B C Vande Berg
- Department of Radiology, IREC, Saint Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue 10/2942, 1200, Brussels, Belgium.
| | - T Kirchgesner
- Department of Radiology, IREC, Saint Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue 10/2942, 1200, Brussels, Belgium
| | - S Acid
- Department of Radiology, IREC, Saint Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue 10/2942, 1200, Brussels, Belgium
| | - J Malghem
- Department of Radiology, IREC, Saint Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue 10/2942, 1200, Brussels, Belgium
| | - M C Vekemans
- Department of Hematology, IREC, Saint Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue 10/2942, 1200, Brussels, Belgium
| | - F E Lecouvet
- Department of Radiology, IREC, Saint Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue 10/2942, 1200, Brussels, Belgium
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27
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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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Sun M, Cheng J, Ren C, Zhang Y, Li Y, Wang L, Liu Y. Differentiation of Diffuse Infiltration Pattern in Multiple Myeloma From Hyperplastic Hematopoietic Bone Marrow: Qualitative and Quantitative Analysis Using Whole-Body MRI. J Magn Reson Imaging 2021; 55:1213-1225. [PMID: 34558141 DOI: 10.1002/jmri.27934] [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: 07/19/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The visual assessment used for diffuse infiltration of multiple myeloma (MM) is inadequate. It can be difficult to differentiate MM from hyperplastic hematopoietic bone marrow (HHBM) because the MRI signal characteristics overlap. PURPOSE To analyze the bone marrow diffuse signal changes on whole-body MRI caused by MM and HHBM. STUDY TYPE Retrospective. SUBJECTS Thirty Four patients with MM (21 men and 13 women), 22 patients with HHBM (9 men and 13 women), and 15 healthy controls (9 men and 6 women). FIELD STRENGTH/SEQUENCE A 3.0 T MRI; diffusion-weighted whole-body imaging with background body signal suppression (DWIBS), modified Dixon T1 fast field echo, and T2 STIR. ASSESSMENT Three radiologists analyzed the whole-body MRI alone and in combination with apparent diffusion coefficient (ADC) and fat fraction (FF) with qualitative and quantitative analysis. Normalized T1 and T2 signal intensities (nT1 and nT2) and signal-to-noise ratio (SNR) were obtained. STATISTICAL TESTS Kruskal-Wallis and chi-square tests. RESULTS The MM group had significantly higher ADC and significantly lower FF than HHBM and control groups. There was no significant difference in nT1, nT2 or SNR between MM and HHBM (P = 0.932, P = 0.097, and P = 0.110, respectively). Receiver operating characteristic (ROC) analysis using ADC and FF cut-off values of 0.47 × 10-3 mm2 /sec and 20.63%, respectively. The AUC was 0.866 for ADC and 0.886 for FF. The quantitative analysis yielded better specificity (observer 1: 81.8% vs. 27.3%; observer 2: 68.2% vs. 22.7%; and observer 3: 72.7% vs. 18.2%) and a higher diagnostic accuracy (observer 1: 82.1% vs. 51.8%; observer 2: 80.4% vs. 50.0%; observer 3: 76.8% vs. 44.6%) than the qualitative analysis. DATA CONCLUSION Whole-body MRI combined with DWIBS and mDIXON could be used to differentiate between MM and HHBM. Combining the quantitative ADC and FF with the whole-body MRI improved the specificity and accuracy in differentiating these conditions. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Mengtian Sun
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1st, Jianshe Dong Road, Zhengzhou, Henan Province, 450052, China
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1st, Jianshe Dong Road, Zhengzhou, Henan Province, 450052, China
| | - Cuiping Ren
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1st, Jianshe Dong Road, Zhengzhou, Henan Province, 450052, China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1st, Jianshe Dong Road, Zhengzhou, Henan Province, 450052, China
| | - Yinhua Li
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1st, Jianshe Dong Road, Zhengzhou, Henan Province, 450052, China
| | - Linlin Wang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1st, Jianshe Dong Road, Zhengzhou, Henan Province, 450052, China
| | - Yu Liu
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, 1st, Jianshe Dong Road, Zhengzhou, Henan Province, 450052, China
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29
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Messiou C, Porta N, Sharma B, Levine D, Koh DM, Boyd K, Pawlyn C, Riddell A, Downey K, Croft J, Morgan V, Stern S, Cheung B, Kyriakou C, Kaczmarek P, Winfield J, Blackledge M, Oyen WJG, Kaiser MF. Prospective Evaluation of Whole-Body MRI versus FDG PET/CT for Lesion Detection in Participants with Myeloma. Radiol Imaging Cancer 2021; 3:e210048. [PMID: 34559006 PMCID: PMC8489453 DOI: 10.1148/rycan.2021210048] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 05/22/2023]
Abstract
Purpose To compare disease detection of myeloma using contemporary whole-body (WB) MRI and fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT protocols and to correlate imaging with laboratory estimates of disease burden, including molecular characteristics. Materials and Methods In this observational, prospective study, participants were recruited from November 2015 to March 2018 who had a diagnosis of myeloma, who were planned to undergo chemotherapy and autologous stem cell transplantation, and who underwent baseline WB-MRI and FDG PET/CT (ClinicalTrials.gov identifier NCT02403102). Baseline clinical data, including genetics, were collected. Paired methods were used to compare burden and patterns of disease. Results Sixty participants (mean age, 60 years ± 9 [standard deviation]; 35 men) underwent baseline WB-MRI and FDG PET/CT. WB-MRI showed significantly higher detection for focal lesions at all anatomic sites (except ribs, scapulae, and clavicles) and for diffuse disease at all sites. Two participants presented with two or more focal lesions smaller than 5 mm only at WB-MRI but not FDG PET/CT. Participants with diffuse disease at MRI had higher plasma cell infiltration (percentage of nucleated cells: median, 60% [interquartile range {IQR}, 50%-61%] vs 15% [IQR, 4%-50%]; P = .03) and paraprotein levels (median, 32.0 g/L [IQR, 24.0-48.0 g/L] vs 20.0 g/L [IQR, 12.0-22.6 g/L]; P = .02) compared with those without diffuse disease. All genetically high-risk tumors showed diffuse infiltration at WB-MRI. Conclusion WB-MRI helped detect a higher number of myeloma lesions than FDG PET/CT, and diffuse disease detected at WB-MRI correlated with laboratory measures of disease burden and molecular markers of risk. Keywords: MR-Imaging, Skeletal-Appendicular, Skeletal-Axial, Bone Marrow, Hematologic Diseases, Oncology Clinical trial registration no. NCT02403102. Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Christina Messiou
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Nuria Porta
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Bhupinder Sharma
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Daniel Levine
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Dow-Mu Koh
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Kevin Boyd
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Charlotte Pawlyn
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Angela Riddell
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Katherine Downey
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - James Croft
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Veronica Morgan
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Simon Stern
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Betty Cheung
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Charalampia Kyriakou
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Pawel Kaczmarek
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Jessica Winfield
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Matthew Blackledge
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Wim J. G. Oyen
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Martin F. Kaiser
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
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30
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Lee K, Kim KW, Ko Y, Park HY, Chae EJ, Lee JH, Ryu JS, Chung HW. Comprehensive Updates in the Role of Imaging for Multiple Myeloma Management Based on Recent International Guidelines. Korean J Radiol 2021; 22:1497-1513. [PMID: 34448381 PMCID: PMC8390819 DOI: 10.3348/kjr.2020.0886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 01/18/2021] [Accepted: 01/31/2021] [Indexed: 02/02/2023] Open
Abstract
The diagnostic and treatment methods of multiple myeloma (MM) have been rapidly evolving owing to advances in imaging techniques and new therapeutic agents. Imaging has begun to play an important role in the management of MM, and international guidelines are frequently updated. Since the publication of 2015 International Myeloma Working Group (IMWG) criteria for the diagnosis of MM, whole-body magnetic resonance imaging (MRI) or low-dose whole-body computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/CT have entered the mainstream as diagnostic and treatment response assessment tools. The 2019 IMWG guidelines also provide imaging recommendations for various clinical settings. Accordingly, radiologists have become a key component of MM management. In this review, we provide an overview of updates in the MM field with an emphasis on imaging modalities.
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Affiliation(s)
- Koeun Lee
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.,Department of Nuclear Medicine, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Yousun Ko
- Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Ho Young Park
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jin Chae
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Won Chung
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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31
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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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32
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Li J, Tan H, Xu T, Shi H, Liu P. Bone marrow tracer uptake pattern of PET-CT in multiple myeloma: image interpretation and prognostic value. Ann Hematol 2021; 100:2979-2988. [PMID: 34415386 DOI: 10.1007/s00277-021-04629-2] [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: 03/09/2021] [Accepted: 07/31/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the prognostic value of bone marrow (BM) imaging pattern and other imaging findings assessed by 18F-FDG PET-CT in multiple myeloma(MM) and to find out the image interpretation cut-off to define different BM tracer uptake pattern. MATERIALS AND METHODS We retrospectively studied PET-CT examinations and clinical data of 100 healthy individuals and 172 newly diagnosed MM patients. A BM uptake > liver SUVmean was selected as the positivity cut-off of pathological uptake in BM after comparing BM uptake in normal control and MM patients. With this interpretation cut-off, we defined the BM FDG uptake pattern as four types: normal, focal, diffuse, and mixed. The clinical correlation and prognostic value of BM uptake pattern were evaluated. The findings were validated in an independent prospective cohort with 72 MM patients. RESULTS In MM cohort, 34.9% patients had focal BM uptake pattern, 3.5% had diffuse pattern, 38.4% had mixed pattern, and 23.3% had normal BM uptake. Diffuse/mixed pattern was correlated with clinical and imaging parameters indicating high tumor burden, and inferior progression free survival (PFS; 3-year-PFS 26.8%) and overall survival (OS; 3-year-OS 50.6%). BM uptake pattern was an independent prognostic factor and diffuse/mixed pattern was associated with inferior OS (P = 0.037, HR 7.16) and PFS (P = 0.015, HR 7.77). The prognostic value of BM uptake pattern was also confirmed in validation set. CONCLUSION We propose an FDG uptake higher than liver as the positivity cut-off to discriminate between physiological and pathological uptake in BM and defined four BM FDG uptake pattern. BM FDG uptake pattern is a reliable prognostic predictor of MM.
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Affiliation(s)
- Jing Li
- Department of Hematology, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Hui Tan
- Department of Nuclear Medicine, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Institute of Nuclear Medicine, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, People's Republic of China
| | - Tianhong Xu
- Department of Hematology, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China. .,Institute of Nuclear Medicine, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, People's Republic of China.
| | - Peng Liu
- Department of Hematology, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
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33
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Sun M, Cheng J, Ren C, Zhang Y, Li Y, Li Y, Zhang S. Quantitative whole-body MR imaging for assessment of tumor burden in patients with multiple myeloma: correlation with prognostic biomarkers. Quant Imaging Med Surg 2021; 11:3767-3780. [PMID: 34341748 DOI: 10.21037/qims-20-1361] [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: 12/15/2020] [Accepted: 04/01/2021] [Indexed: 12/18/2022]
Abstract
Background To assess the quantification of tumor burden in multiple myeloma (MM) patients using whole-body magnetic resonance imaging (MRI) and to identify the correlation between MRI parameters and prognostic biomarkers. Methods We retrospectively analyzed 95 newly diagnosed MM patients treated at our hospital from June 2018 to March 2020. All patients underwent whole-body MRI examination, including diffusion-weighted whole-body imaging with background body signal suppression (DWIBS), modified Dixon chemical-shift imaging (mDIXON), and short TI inversion recovery (STIR) sequences. The MRI presentation was used to determine MM infiltration patterns and calculate apparent diffusion coefficient (ADC) and a fat fraction (FF). The one-way ANOVA and Kruskal-Wallis test were used to compare the differences of these values between DS, ISS, and R-ISS stages in different MM infiltration patterns. Spearman correlation test was used for correlation analysis of ADC and FF against prognostic biomarkers, and two independent sample t-test was used to evaluate the differences of ADC and FF in different free light-chain ratio groups. Results The MRI presentation was classified into normal pattern (36 patients; 37.9%), diffuse (27 patients; 28.4%), and focal (32 patients; 33.7%) infiltration patterns. Statistically significant ADC and FF differences between different DS, ISS, and R-ISS stages were observed in normal/diffuse infiltration patterns but not in focal infiltration patterns. The ADC and FF of the normal/diffuse infiltration pattern showed correlations with hemoglobin, β2-microglobulin, bone marrow plasma cells, flow cytometry of bone marrow cells, and serum monoclonal protein. In contrast, ADC in focal infiltration patterns was negatively correlated with β2-microglobulin and C-reactive protein. The FF of patients with a normal/diffuse infiltration pattern was higher in the low free light-chain ratio group than that in the high free light-chain ratio group (P=0.023). Conclusions Our observations indicate that quantitative whole-body functional MRI examination may serve as an effective complement to imaging diagnosis based on morphology and provide further information on the tumor burden of patients with MM.
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Affiliation(s)
- Mengtian Sun
- Department of Magnetic Resonance, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cuiping Ren
- Department of Magnetic Resonance, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yinhua Li
- Department of Magnetic Resonance, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Li
- Department of Magnetic Resonance, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Suping Zhang
- Department of Hematology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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34
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Updates and Ongoing Challenges in Imaging of Multiple Myeloma: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 217:775-785. [PMID: 33978464 DOI: 10.2214/ajr.21.25878] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Advances in the understanding and treatment of multiple myeloma have led to the need for more sensitive and accurate imaging of intramedullary and extramedullary disease. This role of imaging is underscored by recently revised imaging recommendations of the International Myeloma Working Group (IMWG). This narrative review discusses these recommendations from the IMWG for different disease stages, focusing on advanced whole-body modalities, and addresses related challenges and controversies. In the recommendations, whole-body low-dose CT is central in initial patient assessment, replacing the conventional skeletal survey. Although the recommendations favor MRI for diagnosis because of its superior sensitivity and utility in identifying myeloma-defining events, FDG PET/CT is recommended as the modality of choice for assessing treatment response. Consensus opinions are offered regarding the role of imaging in multiple myeloma for characterization of disease distribution, determination of prognosis, and response evaluation.
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Brandelik SC, Skornitzke S, Mokry T, Sauer S, Stiller W, Nattenmüller J, Kauczor HU, Weber TF, Do TD. Quantitative and qualitative assessment of plasma cell dyscrasias in dual-layer spectral CT. Eur Radiol 2021; 31:7664-7673. [PMID: 33783572 PMCID: PMC8452563 DOI: 10.1007/s00330-021-07821-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/19/2021] [Indexed: 01/01/2023]
Abstract
Objectives Virtual non-calcium (VNCa) images could improve assessment of plasma cell dyscrasias by enhancing visibility of bone marrow. Thus, VNCa images from dual-layer spectral CT (DLCT) were evaluated at different calcium suppression (CaSupp) indices, correlating results with apparent diffusion coefficient (ADC) values from MRI. Methods Thirty-two patients with initial clinical diagnosis of a plasma cell dyscrasia before any chemotherapeutic treatment, who had undergone whole-body low-dose DLCT and MRI within 2 months, were retrospectively enrolled. VNCa images with CaSupp indices ranging from 25 to 95 in steps of 10, conventional CT images, and ADC maps were quantitatively analyzed using region-of-interests in the vertebral bodies C7, T12, L1-L5, and the iliac bone. Independent two-sample t-test, Wilcoxon-signed-rank test, Pearson’s correlation, and ROC analysis were performed. Results Eighteen patients had a non-diffuse, 14 a diffuse infiltration in conventional MRI. A significant difference between diffuse and non-diffuse infiltration was shown for VNCa-CT with CaSupp indices from 55 to 95, for conventional CT, and for ADC (each p < 0.0001). Significant quantitative correlation between VNCa-CT and MRI could be found with strongest correlation at CaSupp index 65 for L3 (r = 0.68, p < 0.0001) and averaged L1-L5 (r = 0.66, p < 0.0001). The optimum CT number cut-off point for differentiation between diffuse and non-diffuse infiltration at CaSupp index 65 for averaged L1-L5 was −1.6 HU (sensitivity 78.6%, specificity 75.0%). Conclusion Measurements in VNCa-CT showed the highest correlation with ADC at CaSupp index 65. VNCa technique may prove useful for evaluation of bone marrow infiltration if MRI is not feasible. Key Points • VNCa-CT images can support the evaluation of bone marrow infiltration in plasma cell dyscrasias. • VNCa measurements of vertebral bodies show significant correlation with ADC in MRI. • Averaging L1-L5 at CaSupp index 65 allowed quantitative detection of infiltration comparable to MRI ADC.
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Affiliation(s)
- S C Brandelik
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - S Skornitzke
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - T Mokry
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - S Sauer
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - W Stiller
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - J Nattenmüller
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - H U Kauczor
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - T F Weber
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - T D Do
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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Takasu M, Tanitame K, Baba Y, Akiyama Y, Tamura T, Kondo S, Maeda S, Sakai A, Awai K. Does chemical shift imaging offer a biomarker for the diagnosis and assessment of disease severity in multiple myeloma?: A cross-sectional study. Medicine (Baltimore) 2021; 100:e24358. [PMID: 33578532 PMCID: PMC7886478 DOI: 10.1097/md.0000000000024358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/22/2020] [Indexed: 01/05/2023] Open
Abstract
To investigate whether chemical shift imaging (CSI) is useful for differentiating myelomatous infiltration from hematopoietic bone marrow (BM) and for quantitatively assessing disease severity.In this retrospective study, spinal MRI, including a sagittal iterative decomposition of water and fat with echo asymmetry and least-squares estimation T2 fast spin-echo sequence, was performed on 76 myeloma patients (45 men, 67.0 ± 11.4 years; 31 women, 66.5 ± 11.0 years) and 30 control subjects (20 men, 67.0 ± 8.4 years; 10 women, 67.0 ± 9.2 years). The fat-signal fraction (FF) and mean signal dropout ratio (DR) were calculated from lumbar BM that contained no focal lesions. The BM plasma cell percentage (BMPC%) and serological data were obtained. As DR is highest when FF = 50%, the patients were divided into 2 groups: a water-dominant group (FF < 50%) and a fat-dominant group (FF > 50%).Serum monoclonal protein (M protein), β2-microglobulin, and BMPC% were significantly higher in the water-dominant group than in the fat-dominant group. In the water-dominant group, DR correlated significantly with BMPC% and M protein, whereas in the control group, DR showed a weak correlation with age but no correlation with other clinical factors. No significant differences in any clinical data were seen between high and low DR.CSI proved ineffective for differentiating myelomatous infiltration from hematopoietic BM. For myeloma patients with relatively high BM cellularity, a small signal drop on opposed-phase images indicated a higher tumor burden. For BM with relatively low cellularity, disease severity was not reflected by CSI.
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Affiliation(s)
- Miyuki Takasu
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University
| | - Keizo Tanitame
- Department of Radiology, Hiroshima Prefectural Hospital, Hiroshima
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University
| | - Yuji Akiyama
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University
| | - Takayuki Tamura
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University
| | - Shota Kondo
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University
| | - Shogo Maeda
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University
| | - Akira Sakai
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University
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Whole-Body Low-Dose CT in Multiple Myeloma: Diagnostic Value of Appendicular Medullary Patterns of Attenuation. AJR Am J Roentgenol 2021; 216:742-751. [PMID: 33439048 DOI: 10.2214/ajr.20.23204] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE. The purpose of this article is to analyze whole-body low-dose CT-detected appendicular medullary patterns of attenuation in patients with newly diagnosed multiple myeloma and to determine the diagnostic performance of whole-body low-dose CT in detecting diffuse marrow infiltration. MATERIALS AND METHODS. A total of 76 patients with myeloma who underwent whole-body low-dose CT and spinal MRI at initial assessment were retrospectively analyzed. The medullary cavities of femurs and humeri were evaluated qualitatively and quantitatively on CT. Medullary attenuation and SD-to-mean attenuation ratio were recorded for each long bone. The pattern of marrow involvement on spinal MRI was used as reference. The chi-square test was used to evaluate the relationship between the CT-based appendicular medullary cavity pattern and the MRI pattern, and ROC analysis was performed to assess the diagnostic accuracy of CT attenuation measurements for the differentiation between diffuse and mixed CT-based appendicular medullary cavity patterns. RESULTS. Medullary attenuation differed significantly among mixed, nodular, and diffuse CT-based appendicular medullary cavity patterns in the femurs (mean, 34.23 HU and range, 15-61 HU; mean, 66.26 HU and range, 26-104 HU; mean, 92.80 HU and range, 53-127 HU, respectively) and humeri (mean, 22.18 HU and range, 9-41; mean, 61.18 HU and range, 23-93 HU; mean, 77.50 and range, 25-105 HU, respectively). To discriminate between diffuse and mixed CT-based appendicular medullary cavity patterns, optimal cutoff attenuation values were 63 HU (sensitivity, 97.7%; specificity, 100.0%) for the femurs, and 52 HU (sensitivity, 97.4%; specificity, 100.0%) for the humeri. A total of 24 of 30 (80.0%) patients with a diffuse MRI pattern showed a diffuse CT-based appendicular medullary cavity pattern on whole-body low-dose CT, and all patients with a diffuse CT-based appendicular medullary cavity pattern also showed a diffuse pattern on MRI. CONCLUSION. According to analysis of peripheral medullary patterns of attenuation, whole-body low-dose CT can identify patients with multiple myeloma with diffuse marrow involvement.
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Hu C, Zhang Y, Xiong X, Meng Q, Yao F, Ye A, Hao Z. Quantitative evaluation of bone marrow infiltration using dual-energy spectral computed tomography in patients with multiple myeloma. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:463-475. [PMID: 33720868 DOI: 10.3233/xst-200811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the potential value of quantitative parameters derived from dual-energy spectral computed tomography (DESCT) as comparing to the parameters derived from magnetic resonance imaging (MRI) in detecting bone marrow (BM) infiltration and distinguishing different patterns of BM infiltration in patients diagnosed with Multiple myeloma (MM). METHODS This study involved 35MM patients and 15 healthy control subjects who had undergone spinal DESCT and MRI. Pattern assignment was based on visual assessment of MR images, and the regions of interest were defined on both DESCT and apparent diffusion coefficient maps. Quantitative values of DESCT parameters were measured and compared between infiltrated and healthy bone marrow. Receiver operating characteristic (ROC) analysis was performed to determine potential utility of DESCT parameters in identifying BM infiltration and different patterns defined by MRI. Sensitivity and specificity under the optimal thresholds determined by the Youden Index were also calculated. RSULTS Statistical differences were observed between the DESCT parameters including Ca(Water), Water(Ca), HAP(Fat), Fat(HAP) and Effective atomic number (Eff-Z) but not for the 70-keV CT value between the infiltrated and healthy BM (all P < 0.001). The 70keV CT value and Ca(Water), HAP(Fat) and Eff-Z values were also found to be statistically different in comparing different infiltration patterns (all P < 0.05). Performance of the model-based parameter Ca/Water was superior in differentiating between infiltrated and healthy BM in which the area under ROC curve, AUC = 0.856 [95% CI, 81.4-89.1%] with sensitivity = 0.841 and specificity = 0.768, as well as between MM patients and control subjects (AUC = 0.910 [95% CI, 79.5-97.3%], sensitivity = 0.829 and specificity = 1.000). CONCLUSIONS Analysis of DESCT offers potential as a quantitative method to detect infiltrated BM and evaluate infiltration patterns of BM in patients diagnosed with MM.
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Affiliation(s)
- Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Medical Imaging, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, Jiangsu, China
| | - Yu Zhang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Medical Imaging, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, Jiangsu, China
| | - Xing Xiong
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qian Meng
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Feirong Yao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Aihua Ye
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhengmei Hao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Isaac A, Lecouvet F, Dalili D, Fayad L, Pasoglou V, Papakonstantinou O, Ahlawat S, Messiou C, Weber MA, Padhani AR. Detection and Characterization of Musculoskeletal Cancer Using Whole-Body Magnetic Resonance Imaging. Semin Musculoskelet Radiol 2020; 24:726-750. [PMID: 33307587 DOI: 10.1055/s-0040-1719018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Whole-body magnetic resonance imaging (WB-MRI) is gradually being integrated into clinical pathways for the detection, characterization, and staging of malignant tumors including those arising in the musculoskeletal (MSK) system. Although further developments and research are needed, it is now recognized that WB-MRI enables reliable, sensitive, and specific detection and quantification of disease burden, with clinical applications for a variety of disease types and a particular application for skeletal involvement. Advances in imaging techniques now allow the reliable incorporation of WB-MRI into clinical pathways, and guidelines recommending its use are emerging. This review assesses the benefits, clinical applications, limitations, and future capabilities of WB-MRI in the context of other next-generation imaging modalities, as a qualitative and quantitative tool for the detection and characterization of skeletal and soft tissue MSK malignancies.
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Affiliation(s)
- Amanda Isaac
- School of Biomedical Engineering & Imaging Sciences, Kings College London, United Kingdom.,Guy's & St Thomas' Hospitals, London, United Kingdom
| | - Frederic Lecouvet
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Danoob Dalili
- School of Biomedical Engineering & Imaging Sciences, Kings College London, United Kingdom.,Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Laura Fayad
- The Russell H. Morgan Department of Radiology and Radiological Science, John's Hopkins School of Medicine, Baltimore, Maryland
| | - Vasiliki Pasoglou
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Olympia Papakonstantinou
- 2nd Department of Radiology, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology and Radiological Science, John's Hopkins School of Medicine, Baltimore, Maryland
| | - Christina Messiou
- The Royal Marsden Hospital, London, United Kingdom.,The Institute of Cancer Research, London, United Kingdom
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Anwar R Padhani
- The Institute of Cancer Research, London, United Kingdom.,Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom
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40
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Paternain A, García-Velloso MJ, Rosales JJ, Ezponda A, Soriano I, Elorz M, Rodríguez-Otero P, Aquerreta JD. The utility of ADC value in diffusion-weighted whole-body MRI in the follow-up of patients with multiple myeloma. Correlation study with 18F-FDG PET-CT. Eur J Radiol 2020; 133:109403. [PMID: 33202373 DOI: 10.1016/j.ejrad.2020.109403] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To analyze the feasibility of DWI-MRI and ADC to evaluate treatment response in patients with multiple myeloma (MM). To correlate the variations of ADC and SUVmax in 18F-FDG PET-CT. METHODS 27 patients with MM that had a whole-body MRI and 18F-FDG PET-CT performed at baseline and after treatment were retrospectively recruited between February 2018 and May 2020. Three target bone lesions were selected for each patient and their ADC, SUVmax and Deauville score were measured in every study. Correlation between ADC and SUVmax of the lesions was evaluated, as well as changes in mean ADC, SUVmax, and Deauville score between studies. Patients were classified as responder or non-responder according to the IMWG, MRI (MY-RADS) and PET-CT (IMPeTUs) response criteria. Agreement between the MRI and PET-CT criteria with the IMWG criteria was evaluated. RESULTS The correlation between the ADC and SUVmax of all the target lesions was strong, negative and significant (r=-0.603; p < 0.001). After treatment, mean ADC in lesions from responders was significantly higher than in non-responders (1585.51 × 10-6 mm2/s vs 698.17 × 10-6 mm2/s; p < 0.001). SUVmax of the same lesions was significantly lower in responders than in non-responders (2.05 vs 5.33; p < 0.001). There was a very strong or strong agreement of the IMWG response criteria with both MRI (κ = 0.852; p < 0.001) and PET (κ = 0.767; p < 0.001) criteria. CONCLUSION DWI-MRI and ADC may be used to assess treatment response in MM patients, showing a good correlation with 18F-FDG PET-CT and the IMWG response criteria.
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Affiliation(s)
- Alberto Paternain
- Clínica Universidad de Navarra, Avenida Pío XII, 36., Pamplona, Spain.
| | | | - Juan José Rosales
- Clínica Universidad de Navarra, Avenida Pío XII, 36., Pamplona, Spain
| | - Ana Ezponda
- Clínica Universidad de Navarra, Avenida Pío XII, 36., Pamplona, Spain
| | - Ignacio Soriano
- Clínica Universidad de Navarra, Avenida Pío XII, 36., Pamplona, Spain
| | - Mariana Elorz
- Clínica Universidad de Navarra, Avenida Pío XII, 36., Pamplona, Spain
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Hameed M, Sandhu A, Soneji N, Amiras D, Rockall A, Messiou C, Wallitt K, Barwick TD. Pictorial review of whole body MRI in myeloma: emphasis on diffusion-weighted imaging. Br J Radiol 2020; 93:20200312. [PMID: 32667830 DOI: 10.1259/bjr.20200312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There have been major advances in myeloma imaging over the past few years with focal lesions on imaging now forming part of the disease defining criteria. Whole body diffusion-weighted MRI (WB-MRI) is considered the most sensitive technique for the detection of focal active lesions. This pictorial review will focus on imaging the spectrum of myelomatous disorders on WB-MRI including diffusion and Dixon sequences. The typical imaging patterns of disease are demonstrated including in the contexts of staging, presumed solitary plasmacytoma, smouldering myeloma and examples of paramedullary and extramedullary disease. The utility of diffusion-weighted imaging in response assessment is a major advantage and this will be exemplified here.
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Affiliation(s)
- Maira Hameed
- Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Neil Soneji
- Imperial College Healthcare NHS Trust, London, UK.,The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | | | - Andrea Rockall
- Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Christina Messiou
- The Royal Marsden Hospital NHS Foundation Trust, London, UK.,The Institute of Cancer Research, London, UK
| | | | - Tara D Barwick
- Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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Zamagni E, Tacchetti P, Barbato S, Cavo M. Role of Imaging in the Evaluation of Minimal Residual Disease in Multiple Myeloma Patients. J Clin Med 2020; 9:jcm9113519. [PMID: 33142671 PMCID: PMC7692446 DOI: 10.3390/jcm9113519] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 01/13/2023] Open
Abstract
The International Myeloma Working Group (IMWG) recently introduced the evaluation of minimal residual disease (MRD) within the multiple myeloma (MM) response criteria, and MRD negativity assessed inside and outside the bone marrow is currently considered the most powerful predictor of favorable long-term outcomes. However, MRD evaluation has thus far relied on flow-cytometry or molecular-based methods, despite the limitations associated with the patchy infiltration of bone marrow (BM) plasma cells and the presence of extra-medullary (EMD). On the contrary, imaging-based sensitive response assessment through the use of functional rather than morphological whole-body (WB) imaging techniques, such as positron emission tomography with computed tomography (PET/CT) and magnetic resonance imaging (MRI), likely is a promising strategy to overcome these limitations in evaluating response to therapy and in the assessment of the MRD status in MM patients. However, despite the significant advances in the development and availability of novel functional imaging techniques for MRD evaluation, a worldwide standardization of imaging criteria for acquisition, interpretation, and reporting is yet to be determined and will be object of future investigations.
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Affiliation(s)
- Elena Zamagni
- Correspondence: ; Tel.: +39-051-2143831; Fax: +39-051-6364037
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Mulé S, Reizine E, Blanc-Durand P, Baranes L, Zerbib P, Burns R, Nouri R, Itti E, Luciani A. Whole-Body Functional MRI and PET/MRI in Multiple Myeloma. Cancers (Basel) 2020; 12:cancers12113155. [PMID: 33121132 PMCID: PMC7693006 DOI: 10.3390/cancers12113155] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Whole-body magnetic resonance imaging (MRI) is recognized as the most sensitive imaging technique for the detection of bone marrow infiltration, and was therefore, recently included in the new diagnostic myeloma criteria, as proposed by the International Myeloma Working Group. The use of diffusion-weighted MRI further improved the performances of whole-body MRI in the setting of multiple myeloma, and its systematic implementation in general clinical practice is now recommended. Whole-body, dynamic, contrast-enhanced MRI might provide further information on lesions vascularity and might help evaluate response to treatment. Hybrid PET/MRI might act as the optimal imaging modality, owing to the association of the best techniques for both detecting bone marrow involvement and evaluating treatment response, providing one-stop-shop imaging in a whole-body scale. This review provides an overview on the value of whole-body MRI, including diffusion-weighted and dynamic contrast-enhanced MRI and whole-body 18F-FDG PET/MRI in diagnosis, staging, and response evaluation in multiple myeloma. Abstract Bone disease is one of the major features of multiple myeloma (MM), and imaging has a pivotal role in both diagnosis and follow-up. Whole-body magnetic resonance imaging (MRI) is recognized as the gold standard for the detection of bone marrow involvement, owing to its high sensitivity. The use of functional MRI sequences further improved the performances of whole-body MRI in the setting of MM. Whole-body diffusion-weighted (DW) MRI is the most attractive functional technique and its systematic implementation in general clinical practice is now recommended by the International Myeloma Working Group. Whole-body dynamic contrast-enhanced (DCE) MRI might provide further information on lesions vascularity and help evaluate response to treatment. Whole Body PET/MRI is an emerging hybrid imaging technique that offers the opportunity to combine information on morphology, fat content of bone marrow, bone marrow cellularity and vascularization, and metabolic activity. Whole-body PET/MRI allows a one-stop-shop examination, including the most sensitive technique for detecting bone marrow involvement, and the most recognized technique for treatment response evaluation. This review aims at providing an overview on the value of whole-body MRI, including DW and DCE MRI, and combined whole-body 18F-FDG PET/MRI in diagnosis, staging, and response evaluation in patients with MM.
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Affiliation(s)
- Sébastien Mulé
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Department of Medical Imaging, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
- Université Paris-Est Créteil, 94010 Créteil, France
- Correspondence:
| | - Edouard Reizine
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Department of Medical Imaging, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Paul Blanc-Durand
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Université Paris-Est Créteil, 94010 Créteil, France
- Department of Nuclear Medicine, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Laurence Baranes
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Department of Medical Imaging, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Pierre Zerbib
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Department of Medical Imaging, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Robert Burns
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Department of Medical Imaging, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Refaat Nouri
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Department of Medical Imaging, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Emmanuel Itti
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Université Paris-Est Créteil, 94010 Créteil, France
- Department of Nuclear Medicine, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Alain Luciani
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; (E.R.); (P.B.-D.); (L.B.); (P.Z.); (R.B.); (R.N.); (E.I.); (A.L.)
- Department of Medical Imaging, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
- Université Paris-Est Créteil, 94010 Créteil, France
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Perl RM, Gronbach F, Fritz J, Horger MS, Hepp T. Longitudinal monitoring of apparent diffusion coefficient (ADC) in myeloma patients with lower M-gradient levels undergoing systemic treatment and whole-body MRI monitoring. Eur J Radiol 2020; 132:109306. [PMID: 33038578 DOI: 10.1016/j.ejrad.2020.109306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/19/2020] [Accepted: 09/20/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Longitudinal assessment of changes in apparent diffusion coefficient (ADC)-values in multiple myeloma (MM) patients and their potential role for classifying disease activity. METHODS Retrospective analysis of whole-body-MRI data in 73 stage III MM patients undergoing systemic treatment. Bone marrow involvement was evaluated using a standardized unenhanced 4-sequences whole-body-MRI protocol. We measured ADC-values in focal lesions (FL) and diffusely involved bone marrow (DIBM) areas. Response to treatment was based on the course of hematologic parameters. The time points of MRI-examinations were baseline, 1st (mean, 3 months), 2nd (mean, 10 months), and 3rd (mean, 18 months) follow up (FU). RESULTS Mean IgG and IgA serum values at baseline were 2.1 mg/dl and 1.8 mg/dl, respectively. Patients were classified into responders (n = 59) and non-responders (n = 34). Some patients were re-enrolled for new treatment regimens as they became therapy-refractory. Patterns of medullary involvement were focal (n = 44), diffuse (n = 61) and mixed (n = 30). In FL, a subgroup of myeloma patients undergoing short-term 1st FU experienced a significant increase in ADC in responders (p = 0.001), but not in non-responders (p = 0.9). In the further course of the study, ADC levels decreased continuously in responders (p = 0.02) and increased slightly in non-responders (p = 0.8). In patients with DIBM, ADC values decreased in the responders (p < 0.001) and in the non-responders (p = 0.78). An ADC cut-off value of 0.5-0.6 × 10-3 mm2/s for diagnosing inactive disease at follow-up proved unreliable. CONCLUSIONS In myeloma-patients with lower tumor burden, the longitudinal course of ADC-values is predictable only for FL whereas for DIBM ADC-changes considerably overlap between responders and non-responders and are not indicative for assessment of the disease activity.
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Affiliation(s)
- Regine Mariette Perl
- Department of Diagnostic and Interventional Radiology University-Hospital of Tuebingen, Germany.
| | - Felix Gronbach
- Department of Diagnostic and Interventional Radiology University-Hospital of Tuebingen, Germany
| | - Jan Fritz
- New York University Langone HealthGrossman School of Medicine, Department of Radiology, New York, USA
| | - Marius Stefan Horger
- Department of Diagnostic and Interventional Radiology University-Hospital of Tuebingen, Germany
| | - Tobias Hepp
- Department of Diagnostic and Interventional Radiology University-Hospital of Tuebingen, Germany; Max Planck Institute for Intelligent Systems, Tuebingen, Germany
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Zhang L, Wang Q, Wu X, Zhao A, Feng J, Zhang H, Cao X, Li S, Cai H, Sun Z, Duan M, Zhu T, Zhang W, Jin Z, Zhou D, Xue H, Li J. Baseline bone marrow ADC value of diffusion-weighted MRI: a potential independent predictor for progression and death in patients with newly diagnosed multiple myeloma. Eur Radiol 2020; 31:1843-1852. [PMID: 32965573 DOI: 10.1007/s00330-020-07295-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/07/2020] [Accepted: 09/15/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To illuminate the prognostic value of ADC (apparent diffusion coefficient), an important quantitative parameter of diffusion-weighted MRI, for multiple myeloma (MM). METHODS A prospective single-center study which enrolled 114 consecutive newly diagnosed MM patients with baseline whole-body diffusion-weighted MRI (WB DW-MRI) results was conducted. Baseline clinical and MRI parameters were analyzed with univariate and multivariate approaches to identify independent risk factors for progression-free survival (PFS) and overall survival (OS). RESULTS Five different DW-MRI patterns were seen, and the mean ADC value of the representative background bone marrow was 0.4662 ± 0.1939 × 10-3 mm2/s. After a mean follow-up of 50.2 months (range, 15.7-75.8 months), twenty-four patients died and seven were lost to follow-up. The mean ADC value of the representative background bone marrow was showed to be an independent risk factor for both PFS (HR 4.664; 95% confidence interval (CI) 1.138-19.121; p = 0.032) and OS (HR 14.130; 95% CI 1.544-129.299; p = 0.019). Normal/salt-and-pepper pattern on DW-MRI was associated with PFS using univariate analysis (p = 0.035) but lost the significance with multivariate Cox regression. CONCLUSIONS Mean ADC value of the representative background bone marrow predicts both PFS and OS which suggests the role of baseline DW-MRI for risk stratification in newly diagnosed MM patients. KEY POINTS • Whole-body diffusion-weighted MRI (WB DW-MRI) might be helpful to improve the current risk stratification systems for newly diagnosed multiple myeloma (MM). • Morphological parameters as MRI pattern and focal lesion-associated parameters have been reported to be related to survival. However, important functional parameters such as apparent diffusion coefficient (ADC) values were not incorporated into the current risk stratification model. • This study is one of the first endeavors to delineate the correlation of baseline ADC values and survival in MM patients. It is revealed that the mean ADC value of the representative background bone marrow (L3-S1 and iliac bone) was an independent risk factor for both PFS and OS.
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Affiliation(s)
- Lu Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Qin Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xia Wu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Ailin Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jun Feng
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Haibo Zhang
- Department of Radiology, China-Japan Friendship Hospital, Yinghua East Road 2#, Heping Street, Chaoyang District, Beijing, 100029, China
| | - Xinxin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Shuo Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Huacong Cai
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Zhaoyong Sun
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Minghui Duan
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Tienan Zhu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Berardo S, Sukhovei L, Andorno S, Carriero A, Stecco A. Quantitative bone marrow magnetic resonance imaging through apparent diffusion coefficient and fat fraction in multiple myeloma patients. Radiol Med 2020; 126:445-452. [PMID: 32812173 DOI: 10.1007/s11547-020-01258-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 08/10/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Quantitative bone marrow (BM) MR sequences, as DWI and CSI, were used to evaluate BM water-fat composition. The aim of the study was to assess the potential usefulness of fat fraction (FF) and ADC, calculated by CSI or DWI, in diagnosing and classifying myeloma (MM) patients according to their different BM infiltration patterns. METHODS The study group included 43 MM patients (19F; 24M; mean age 64 years), 15 asymptomatic, 15 symptomatic with diffuse BM infiltration and 13 symptomatic with focal lesions (FLs). The control group was made up of 15 healthy subjects (7F; 8M; mean age 64 years). MRI examinations consisted of sagittal T1w TSE on the spinal column, axial DWI (b 50-400-800 mm2/s) and coronal T2 Dixon, on the whole body. Mean ADC and FF were calculated placing 1 ROI on 6 vertebras and 2 ROIs on either the pelvis or FL. RESULTS ANOVA with Bonferroni's correction showed a significant difference in ADC values among the different groups of MM patients (P < 0.05), while FF was only significantly different between patients with diffuse infiltration and patients with FL (P = 0.002). ADC allowed distinguishing MM patients from normal BM patients with diffuse BM infiltration (cutoff value: 0.491 × 10-3 mm2/s; sensitivity 73%, specificity 80%). FF helped better discriminate healthy controls from normal BM patients (cutoff = 0.33, sensitivity 73%, specificity 92%) and patients with diffuse BM infiltration from those with FL (cutoff = 0.16, sensitivity 82%, specificity 92%). CONCLUSION ADC and FF are potentially useful parameter for the quantitative evaluation of BM infiltration in MM patients.
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Affiliation(s)
- Sara Berardo
- Department of Radiology, AOU Maggiore della Carità, Novara, Italy.
| | - Lidiia Sukhovei
- Department of Radiology, AOU Maggiore della Carità, Novara, Italy
| | - Silvano Andorno
- Department of Biomedical Statistics, AOU Maggiore della Carità, Novara, Italy
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Baffour FI, Glazebrook KN, Kumar SK, Broski SM. Role of imaging in multiple myeloma. Am J Hematol 2020; 95:966-977. [PMID: 32350883 DOI: 10.1002/ajh.25846] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 12/17/2022]
Abstract
With rapid advancements in the diagnosis and treatment of multiple myeloma (MM), imaging has become instrumental in detection of intramedullary and extramedullary disease, providing prognostic information, and assessing therapeutic efficacy. Whole-body low dose computed tomography (WBLDCT) has emerged as the study of choice to detect osteolytic bone disease. Positron emission tomography/computed tomography (PET/CT) combines functional and morphologic information to identify MM disease activity and assess treatment response. Magnetic resonance imaging (MRI) has excellent soft-tissue contrast and is the modality of choice for bone marrow evaluation. This review focuses on the imaging modalities available for MM patient management, highlighting advantages, disadvantages, and applications of each.
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Affiliation(s)
| | | | - Shaji K. Kumar
- Department of Internal Medicine, Division of HematologyMayo Clinic Rochester Minnesota USA
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Accuracy of diffusion-weighted imaging in discriminating atypical vertebral haemangiomas from malignant masses in patients with vertebral lesions: a cross-sectional study. Pol J Radiol 2020; 85:e340-e347. [PMID: 32817766 PMCID: PMC7425224 DOI: 10.5114/pjr.2020.97602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/28/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose Vertebral haemangiomas are incidental findings in imaging modalities. Atypical haemangiomas are haeman-giomas rich in vascular tissue, and they are found to be hypointense in T1 sequences and hyperintense in T2 sequences, mimicking the findings of metastatic lesions. In the present study we aim to evaluate the ability of diffusion- weighted imaging to differentiate these two groups of vertebral lesions. Material and methods In the present cross-sectional study, a total of 23 lesions were included, including 10 haemangiomas and 13 malignant lesions. Diffusion-weighted imaging was used to compare atypical haemangiomas and metastatic lesions. The apparent diffusion co-efficient was determined for each lesion, and then the mean of each group was calculated. The means were then compared. Receiver operating characteristic analysis was used to determine a cut-off ADC value to differentiate these lesions. Results The difference between the mean age of the two groups was not significant. The mean ADC value for atypical haemangiomas was 1884 ± 74 × 10-6 mm2/s and 1008 ± 81 × 10-6 mm2/s for the malignant lesions. The difference between the two groups was statistically significant (p < 10-3). ROC curve analysis determined an ADC value of 958 × 10-6 mm2/s to be able to differentiate between atypical haemangiomas and malignant lesions. Conclusions Diffusion-weighted MRI could be used to differentiate between atypical haemangiomas and malignant metastatic lesions.
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Takasu M, Kondo S, Akiyama Y, Takahashi Y, Maeda S, Baba Y, Kawase T, Ichinohe T, Awai K. Assessment of early treatment response on MRI in multiple myeloma: Comparative study of whole-body diffusion-weighted and lumbar spinal MRI. PLoS One 2020; 15:e0229607. [PMID: 32106239 PMCID: PMC7046272 DOI: 10.1371/journal.pone.0229607] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/10/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives To compare remission status at completion of chemotherapy for multiple myeloma (MM) with changes in total diffusion volume (tDV) calculated from whole-body diffusion-weighted imaging (WB-DWI) and fat fraction (FF) of lumbar bone marrow (BM) by modified Dixon Quant (mDixon Quant) soon after induction of chemotherapy, and to assess the predictive value of MRI. Methods Fifty patients (mean age, 66.9 ± 10.5 years) with symptomatic myeloma were examined before and after two cycles of chemotherapy. From WB-DWI data, tDV was obtained with the threshold for positive BM involvement. Mean FF was calculated from lumbar BM using the mDixon Quant sequence. At the completion of chemotherapy, patients were categorized into a CR/very good PR (VGPR) group (n = 15; mean age, 67.6 ± 10.3 years) and a PR, SD or PD group (n = 35; mean age, 69.1 ± 8.6 years). ROC curves were plotted to assess performance in predicting achievement of CR/VGPR. Results At second examination, serum M protein, β2-microglobulin, and tDV were significantly decreased and hemoglobin, mean ADC, and FF were significantly increased in the CR/VGPR group and serum M protein was significantly increased in the PR/SD/PD group. The general linear model demonstrated that percentage changes in FF and M protein contributed significantly to achieving CR/VGPR (P = 0.02, P = 0.04, respectively). AUCs of ROC curves were 0.964 for FF and 0.847 for M protein. Conclusions Early change in FF of lumbar BM and serum M protein soon after induction of chemotherapy contributed significantly to prediction of CR/VGPR.
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Affiliation(s)
- Miyuki Takasu
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
- * E-mail:
| | - Shota Kondo
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Akiyama
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Takahashi
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Maeda
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Takakazu Kawase
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Almeida SD, Santinha J, Oliveira FPM, Ip J, Lisitskaya M, Lourenço J, Uysal A, Matos C, João C, Papanikolaou N. Quantification of tumor burden in multiple myeloma by atlas-based semi-automatic segmentation of WB-DWI. Cancer Imaging 2020; 20:6. [PMID: 31931880 PMCID: PMC6958755 DOI: 10.1186/s40644-020-0286-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 01/06/2020] [Indexed: 12/31/2022] Open
Abstract
Background Whole-body diffusion weighted imaging (WB-DWI) has proven value to detect multiple myeloma (MM) lesions. However, the large volume of imaging data and the presence of numerous lesions makes the reading process challenging. The aim of the current study was to develop a semi-automatic lesion segmentation algorithm for WB-DWI images in MM patients and to evaluate this smart-algorithm (SA) performance by comparing it to the manual segmentations performed by radiologists. Methods An atlas-based segmentation was developed to remove the high-signal intensity normal tissues on WB-DWI and to restrict the lesion area to the skeleton. Then, an outlier threshold-based segmentation was applied to WB-DWI images, and the segmented area’s signal intensity was compared to the average signal intensity of a low-fat muscle on T1-weighted images. This method was validated in 22 whole-body DWI images of patients diagnosed with MM. Dice similarity coefficient (DSC), sensitivity and positive predictive value (PPV) were computed to evaluate the SA performance against the gold standard (GS) and to compare with the radiologists. A non-parametric Wilcoxon test was also performed. Apparent diffusion coefficient (ADC) histogram metrics and lesion volume were extracted for the GS segmentation and for the correctly identified lesions by SA and their correlation was assessed. Results The mean inter-radiologists DSC was 0.323 ± 0.268. The SA vs GS achieved a DSC of 0.274 ± 0.227, sensitivity of 0.764 ± 0.276 and PPV 0.217 ± 0.207. Its distribution was not significantly different from the mean DSC of inter-radiologist segmentation (p = 0.108, Wilcoxon test). ADC and lesion volume intraclass correlation coefficient (ICC) of the GS and of the correctly identified lesions by the SA was 0.996 for the median and 0.894 for the lesion volume (p < 0.001). The duration of the lesion volume segmentation by the SA was, on average, 10.22 ± 0.86 min, per patient. Conclusions The SA provides equally reproducible segmentation results when compared to the manual segmentation of radiologists. Thus, the proposed method offers robust and efficient segmentation of MM lesions on WB-DWI. This method may aid accurate assessment of tumor burden and therefore provide insights to treatment response assessment.
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Affiliation(s)
- Sílvia D Almeida
- Computational Clinical Imaging Group, Champalimaud Foundation, Centre for the Unknown, Av. Brasília, Doca de Pedrouços, 1400-038, Lisbon, Portugal
| | - João Santinha
- Computational Clinical Imaging Group, Champalimaud Foundation, Centre for the Unknown, Av. Brasília, Doca de Pedrouços, 1400-038, Lisbon, Portugal
| | - Francisco P M Oliveira
- Radiopharmacology, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Joana Ip
- Radiology Department, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Maria Lisitskaya
- Radiology Department, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038, Lisbon, Portugal
| | - João Lourenço
- Radiology Department, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Aycan Uysal
- Radiology Department, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Celso Matos
- Radiology Department, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Cristina João
- Hematology Department, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038, Lisbon, Portugal.,Immunology Department, Nova Medical School, Nova University of Lisbon, 1169-056, Lisbon, Portugal
| | - Nikolaos Papanikolaou
- Computational Clinical Imaging Group, Champalimaud Foundation, Centre for the Unknown, Av. Brasília, Doca de Pedrouços, 1400-038, Lisbon, Portugal.
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