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Rossi A, Cattabriga A, Bezzi D. Symptomatic Myeloma: PET, Whole-Body MR Imaging with Diffusion-Weighted Imaging or Both. PET Clin 2024; 19:525-534. [PMID: 38969566 DOI: 10.1016/j.cpet.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
According to international guidelines, patients with suspected myeloma should primarily undergo low-dose whole-body computed tomography (CT) for diagnostic purposes. To optimize sensitivity and specificity and enable treatment response assessment, whole-body MR (WB-MR) imaging should include diffusion-weighted imaging with apparent diffusion coefficient maps and T1-weighted Dixon sequences with bone marrow Fat Fraction Quantification. At baseline WB-MR imaging shows greater sensitivity for the detecting focal lesions and diffuse bone marrow infiltration pattern than 18F-fluorodeoxyglucose PET-CT, which is considered of choice for evaluating response to treatment and minimal residual disease and imaging of extramedullary disease.
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Affiliation(s)
- Alice Rossi
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Arrigo Cattabriga
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Dipartimento di Scienze Mediche e Chirurgiche, Via Massarenti 9, 40138 Bologna, Italy
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Gao Y, Wang Q, Zhang L, Li S, Liu D, Wang S, Zhu J, Zhang H, Xie S, Xia S, Huang W, Xue H, Li J. Treatment Response Assessment in Multiple Myeloma: Histogram Analysis of Total Tumor Apparent Diffusion Coefficient based on Whole-body Diffusion-weighted MR Imaging. J Magn Reson Imaging 2024; 60:1051-1060. [PMID: 38088500 DOI: 10.1002/jmri.29155] [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: 09/06/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The International Myeloma Working Group (IMWG) consensus criteria for response assessment in multiple myeloma (MM) has methodological limitations. Whole-body diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) histogram analysis may be complementary to response assessment of MM. PURPOSE To explore the role of histogram analysis of the ADC based on the total tumor volume (ttADC) in response assessment in patients with newly diagnosed MM (NDMM). STUDY TYPE Retrospective. POPULATION Thirty-six patients with NDMM. FIELD STRENGTH/SEQUENCE 3.0T/single-shot DWI echo planar imaging (EPI) sequence with an integrated slice-by-slice shimming (iShim) technique. ASSESSMENT Baseline (median: 1 day before treatment) and post-treatment (median: five cycles of therapy) whole-body DWI were analyzed. A region of interest (ROI) containing lesions on every section of baseline image was drawn to derive the per-patient total tumor data. Post-treatment image analysis was based on the same ROI as the corresponding baseline. Histogram metrics were extracted from both ROIs. Patients were categorized into the very good partial response or better (VGPR+) group and the less than VGPR group per the IMWG response criteria for response assessment. Progression-free survival (PFS) was also calculated. STATISTICAL TESTS Mann-Whitney test and Fisher's exact or Chi-squared tests, Receiver operating characteristic (ROC) analysis and DeLong test, Kaplan-Meier analysis and Cox proportional hazards model. A two-tailed P-value <0.05 was considered statistically significant. RESULTS Thirty patients were categorized into the VGPR+ group and six into the less than VGPR group. The ttADC histogram changes between post-treatment and baseline metrics (ΔttADC) revealed significant differences in all percentile values between the VGPR+ and less than VGPR groups. For distinguishing VGPR+, ΔttADC_5th percentile had the largest area under the curve (AUC) (0.950, 95% CI 0.821-0.995). Patients with lower ΔttADC_5th percentile values (cutoff point, 188.193) showed significantly longer PFS (HR = 34.911, 95% CI 6.392-190.677). DATA CONCLUSION ttADC histogram may facilitate response assessment in patients with NDMM. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Yuhan Gao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qin Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lu Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuo Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dong Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shitian Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinxia Zhu
- MR Research Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Haibo Zhang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Sheng Xie
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Wenyang Huang
- Department of Lymphoma, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Boutry S, Laurent S, Burtea C. Editorial for: "Treatment Response Assessment in Multiple Myeloma: Histogram Analysis of Total Tumor Apparent Diffusion Coefficient based on Whole-body Diffusion-weighted MR Imaging". J Magn Reson Imaging 2024; 60:1061-1062. [PMID: 38091345 DOI: 10.1002/jmri.29158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 08/02/2024] Open
Affiliation(s)
- Sebastien Boutry
- Unit of General, Organic and Biomedical Chemistry, University of Mons (UMONS), Mons, Belgium
- Center for Microscopy and Molecular Imaging, Charleroi, Belgium
| | - Sophie Laurent
- Unit of General, Organic and Biomedical Chemistry, University of Mons (UMONS), Mons, Belgium
- Center for Microscopy and Molecular Imaging, Charleroi, Belgium
| | - Carmen Burtea
- Unit of General, Organic and Biomedical Chemistry, University of Mons (UMONS), Mons, Belgium
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Perillo T, Giorgio C, Fico A, Perrotta M, Serino A, Cuocolo R, Manto A. Review of whole-body magnetic resonance imaging in multiple myeloma. Jpn J Radiol 2024:10.1007/s11604-024-01635-y. [PMID: 39088009 DOI: 10.1007/s11604-024-01635-y] [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: 02/19/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
Multiple Myeloma (MM) is a hematological malignancy affecting bone marrow, most frequently in elderly men. Imaging has a crucial role in this disease. Recently, whole-body MRI has been introduced and it has gained growing interest due to is high sensitivity and specificity in evaluating bone marrow involvement in MM. Diffusion-weighted sequences (DWI) with apparent diffusion coefficient (ADC) maps have emerged as the most sensitive technique to evaluate patients with MM, both in the pre- and post-treatment setting. Aim of this review is to provide an overview of the role and main imaging findings of whole-body MRI in MM.
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Affiliation(s)
- Teresa Perillo
- Neuroradiology Unit, Umberto I" Hospital, Nocera Inferiore, Italy.
| | - Claudia Giorgio
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Fisciano, Italy
| | - Arianna Fico
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Fisciano, Italy
| | | | | | - Renato Cuocolo
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Fisciano, Italy
| | - Andrea Manto
- Neuroradiology Unit, Umberto I" Hospital, Nocera Inferiore, Italy
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Ghosh A, Li H, Towbin AJ, Turpin BK, Trout AT. Histogram Analysis of Apparent Diffusion Coefficient Maps Provides Genotypic and Pretreatment Phenotypic Information in Pediatric and Young Adult Rhabdomyosarcoma. Acad Radiol 2024; 31:2550-2561. [PMID: 38296742 DOI: 10.1016/j.acra.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION We evaluate the role of apparent diffusion coefficient (ADC) histogram metrics in stratifying pediatric and young adult rhabdomyosarcomas. METHODS We retrospectively evaluated baseline diffusion-weighted imaging (DWI) from 38 patients with rhabdomyosarcomas (Not otherwise specified: 2; Embryonal: 21; Spindle Cell: 2; Alveolar: 13, mean ± std dev age: 8.1 ± 7.76 years). The diffusion images were obtained on a wide range of 1.5 T and 3 T scanners at multiple sites. FOXO1 fusion status was available for 35 patients, nine of whom harbored the fusion. 13 patients were TNM stage 1, eight had stage 2 disease, nine were stage 3, and eight had stage 4 disease. 23 patients belonged to Clinical Group III and seven to Group IV, while two and five were CG I and II, respectively. Nine patients were classified as low risk, while 21 and five were classified as intermediate and high risk respectively. Histogram parameters of the apparent diffusion coefficient (ADC) map from the entire tumor were obtained based on manual tumor contouring. A two-tailed Mann-Whitney U test was used for all two-group, and the Kruskal-Wallis's test was used for multiple-group comparisons. Bootstrapped receiver operating characteristic (ROC) curves and areas under the curve (AUC) were generated for the statistically significant histogram parameters to differentiate genotypic and phenotypic parameters. RESULTS Alveolar rhabdomyosarcomas had a statistically significant lower 10th Percentile (586.54 ± 164.52, mean ± std dev, values are in ×10-6mm2/s) than embryonal rhabdomyosarcomas (966.51 ± 481.33) with an AUC of 0.85 (95%CI. 0.73-0.95) for differentiating the two. The 10th percentile was also significantly different between FOXO1 fusion-positive (553.87 ± 187.64) and negative (898.07 ± 449.38) rhabdomyosarcomas with an AUC of 0.83 (95% CI 0.71-0.94). Alveolar rhabdomyosarcomas also had statistically significant lower Mean, Median, and Root Mean Squared ADC histogram values than embryonal rhabdomyosarcomas. Four, five, and seven of the 18 histogram parameters evaluated demonstrated a statistically significant increase with higher TNM stage, clinical group, assignment, and pretreatment risk stratification, respectively. For example, Entropy had an AUC of 0.8 (95% CI. 0.67-0.92) for differentiating TNM stage 1 from ≥ stage 2 and 0.9 (95% CI. 0.8-0.98) for differentiating low from intermediate or high-risk stratification. CONCLUSION Our findings demonstrate the potential of ADC histogram metrics to predict clinically relevant variables for rhabdomyosarcoma, including FOXO1 fusion status, histopathology, Clinical Group, TNM staging, and risk stratification.
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Affiliation(s)
- Adarsh Ghosh
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
| | - Hailong Li
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brian K Turpin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Vulasala SS, Virarkar M, Karbasian N, Calimano-Ramirez LF, Daoud T, Amini B, Bhosale P, Javadi S. Whole-body MRI in oncology: A comprehensive review. Clin Imaging 2024; 108:110099. [PMID: 38401295 DOI: 10.1016/j.clinimag.2024.110099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/26/2024]
Abstract
Whole-Body Magnetic Resonance Imaging (WB-MRI) has cemented its position as a pivotal tool in oncological diagnostics. It offers unparalleled soft tissue contrast resolution and the advantage of sidestepping ionizing radiation. This review explores the diverse applications of WB-MRI in oncology. We discuss its transformative role in detecting and diagnosing a spectrum of cancers, emphasizing conditions like multiple myeloma and cancers with a proclivity for bone metastases. WB-MRI's capability to encompass the entire body in a singular scan has ushered in novel paradigms in cancer screening, especially for individuals harboring hereditary cancer syndromes or at heightened risk for metastatic disease. Additionally, its contribution to the clinical landscape, aiding in the holistic management of multifocal and systemic malignancies, is explored. The article accentuates the technical strides achieved in WB-MRI, its myriad clinical utilities, and the challenges in integration into standard oncological care. In essence, this review underscores the transformative potential of WB-MRI, emphasizing its promise as a cornerstone modality in shaping the future trajectory of cancer diagnostics and treatment.
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Affiliation(s)
- Sai Swarupa Vulasala
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, United States.
| | - Mayur Virarkar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Niloofar Karbasian
- Department of Radiology, McGovern Medical School at University of Texas Health Houston, Houston, TX, United States
| | - Luis F Calimano-Ramirez
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Taher Daoud
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Behrang Amini
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Priya Bhosale
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sanaz Javadi
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Xiong X, Hong R, Fan X, Hao Z, Zhang X, Zhang Y, Hu C. Quantitative assessment of bone marrow infiltration and characterization of tumor burden using dual-layer spectral CT in patients with multiple myeloma. Radiol Oncol 2024; 58:43-50. [PMID: 38183278 PMCID: PMC10878765 DOI: 10.2478/raon-2024-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/31/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The aim of the study was to evaluate whether virtual calcium subtraction (VNCa) image extracted from dual-layer spectral CT could estimate bone marrow (BM) infiltration with MRI as the reference standard and characterize tumor burden in patients with multiple myeloma (MM). PATIENTS AND METHODS Forty-seven patients with newly diagnosed MM were retrospectively enrolled. They had undergone whole-body low-dose dual-layer spectral CT (DLCT) and whole-body MRI within one week. VNCa images with calcium-suppressed (CaSupp) indices ranging from 25 to 95 at an interval of 10 and apparent diffusion coefficient (ADC) maps were quantitatively analyzed on vertebral bodies L1-L5 at the central slice of images. The optimal combination was selected by correlation analysis between CT numbers and ADC values. Then, it was used to characterize tumor burden by correlation analysis and receiver operating characteristic (ROC) curves analysis, including plasma cell infiltration rate (PCIR), high serum-free light chains (SFLC) ratio and the high-risk cytogenetic (HRC) status. RESULTS The most significant quantitative correlation between CT numbers of VNCa images and ADC values could be found at CaSupp index 85 for averaged L1-L5 (r = 0.612, p < 0.001). It allowed quantitative evaluation of PCIR (r = 0.835, p < 0.001). It could also anticipate high SFLC ratio and the HRC status with area under the curve (AUC) of 0.876 and 0.760, respectively. CONCLUSIONS The VNCa measurements of averaged L1-L5 showed the highest correlation with ADC at CaSupp index 85. It could therefore be used as additional imaging biomarker for non-invasive assessment of tumor burden if ADC is not feasible.
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Affiliation(s)
- Xing Xiong
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Rong Hong
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xu Fan
- 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
| | - Xiaohui Zhang
- Department of Clinical Science, Philips Healthcare Greater China, Shanghai, China
| | - Yu Zhang
- Department of Radiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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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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Hou M, Huang Y, Yan J, Fan G. Quantitative Dixon and intravoxel incoherent motion diffusion magnetic resonance imaging parameters in lumbar vertebrae for differentiating aplastic anemia and acute myeloid leukemia. Front Oncol 2023; 13:1277978. [PMID: 38111525 PMCID: PMC10725906 DOI: 10.3389/fonc.2023.1277978] [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: 08/15/2023] [Accepted: 11/07/2023] [Indexed: 12/20/2023] Open
Abstract
Objective We sought to evaluate the use of quantitative Dixon (Q-Dixon) and intravoxel incoherent motion diffusion imaging (IVIM) for the differential diagnosis of aplastic anemia (AA) and acute myeloid leukemia (AML). Methods Between August 2021 and October 2023, we enrolled 68 diagnosed patients, including 36 patients with AA and 32 patients with AML, as well as 26 normal controls. All patients underwent 3-Tesla magnetic resonance imaging, which included IVIM and T2*-corrected Q-Dixon imaging at the L2-4 level. The iliac crest biopsy's pathology was used as the diagnostic criterion. The interobserver measurement repeatability was evaluated using the intraclass correlation coefficient (ICC). One-way analysis of variance, Spearman analysis, and receiver operating characteristic curve analysis were used. Results The fat fraction (FF) and perfusion fraction (f) values were statistically significantly different between the three groups (p < 0.001 and p = 0.007). The FF and f values in the AA group were higher than those in the AML group. The true apparent diffusion coefficient (D) value was substantially negatively correlated to the FF and R2* values (r = -0.601, p < 0.001; r = -0.336, p = 0.002). The f value was positively correlated with both FF and pseudo-apparent diffusion coefficient (D*) values (r = 0.376, p < 0.001; r = 0.263, p = 0.017) and negatively correlated with the D value (r = -0.320, p = 0.003). The FF and f values were negatively correlated with the degree of myelodysplasia (r = -0.597, p < 0.001; r = -0.454, p = 0.004), and the D value was positively correlated with the degree of myelodysplasia (r = 0.395, p = 0.001). For the differential diagnosis of AA and AML, the Q-Dixon model's sensitivity (93.75%) and specificity (84%) confirmed that it outperformed the IVIM model. Conclusion Q-Dixon parameters have the potential to be used as new biomarkers to differentiate AA from AML.
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Affiliation(s)
- Meidan Hou
- Department of Radiology, The First Hospital of China Medical University, Dalian, China
- Department of Radiology, The Second Hospital of Dalian Medical University, Shenyang, China
| | - Yanan Huang
- Department of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jinsong Yan
- Department of Hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Guoguang Fan
- Department of Radiology, The First Hospital of China Medical University, Dalian, China
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Castagnoli F, Donners R, Tunariu N, Messiou C, Koh DM. Relative fat fraction of malignant bone lesions from breast cancer, prostate cancer and myeloma are significantly lower than normal bone marrow and shows excellent interobserver agreement. Br J Radiol 2023; 96:20230240. [PMID: 37750943 PMCID: PMC10646620 DOI: 10.1259/bjr.20230240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES To compare relative fat fraction (rFF) of active bone lesions from breast, prostate and myeloma malignancies and normal bone marrow; to assess its inter-reader agreement. METHODS Patients with breast (n = 26), myeloma (n = 32) and prostate cancer (n = 52) were retrospectively evaluated. 110 baseline rFF maps from whole-body MRI were reviewed by two radiologists. Regions of interest for up to four focal active lesions in each patient were drawn on rFF maps, one each at the cervicothoracic spine, lumbosacral spine, pelvis and extremity. The mean and standard deviation of rFF were recorded. The rFF of normal marrow was measured in the pelvis for patients without diffuse bone disease (n = 88). We compared the rFF of malignant bone lesions and normal marrow using Mann-Whitney test. Interobserver agreement was assessed by interclass correlation coefficient. RESULTS Malignant bone lesions showed significantly lower median rFF (13.87%) compared with normal marrow (89.76%) with little overlap (p < 0.0001). There was no significant difference in the median rFF of malignant lesions from breast (14.46%), myeloma (13.12%) and prostate cancer (13.67%) (p > 0.017, Bonferroni correction) and in the median rFF of bone disease according to their anatomical locations (p > 0.008, Bonferroni correction). There was excellent interobserver agreement (0.95). CONCLUSION The low rFF of active bone lesions in breast, prostate and myeloma malignancies provides high image contrast relative to normal marrow that may be used to detect bone metastases. ADVANCES IN KNOWLEDGE This study shows the importance of rFF towards detecting bone metastases.
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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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13
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Carrino JA. Advances in Musculoskeletal Imaging: It is Tough to Make Predictions, Especially About the Future, But Here Goes. Radiology 2023; 308:e230642. [PMID: 37642567 DOI: 10.1148/radiol.230642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- John A Carrino
- From the Department of Radiology and Imaging, Weill Medicine, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
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14
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Rossi A, Prochowski Iamurri A, Diano D, Oboldi D, Sintuzzi E, Maurizio L, Andalò A, Cavallucci M, Ferroni F, Amadori E, Barone D, Petralia G. Patient centered radiology: investigating 3 Tesla whole body MRI acceptance in cancer patients. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01665-y. [PMID: 37395842 DOI: 10.1007/s11547-023-01665-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Whole body magnetic resonance imaging (WB-MRI) is a promising emerging imaging technology for detecting bone and soft tissue pathology, especially in the onco-hematological field. This study aims to evaluate cancer patients' experience of WB-MRI performed on a 3T scanner compared to other diagnostic total body examinations. MATERIAL AND METHOD In this prospective committee-approved study, patients completed a questionnaire in person (n = 134) after undergoing a WB-MRI scan to collect data on their physical and psychological reactions during the scan, the global satisfaction level, and preference for other types of MRI or computed tomography (CT), or positron emission tomography (PET/CT). Of all patients who had performed a CT or PET/CT the previous year, 61.9% had already undergone an MRI. The most common symptoms reported were: 38.1% perceived a localized increase in temperature and 34.4% numbness and tingling of the limbs. The scan time averaged 45 min and was well tolerated by most patients (112, 85.5%). Overall, WB-MRI was appreciated by the majority (121/134-90.3%) of patients who said they would probably undergo the procedure again. Patients preferred the WB-MRI in 68.7% of cases (92/134), followed by CT in 15.7% of cases (21/134) and by PET/CT in 7.4% (10/134), with 8.4% (11/134) of patients without any preference. The preference for imaging modalities was age-dependent (p = 0.011), while (p > 0.05) was independent of sex and a primary cancer site. CONCLUSION These results demonstrate a high degree of WB-MRI acceptance from a patient's point of view.
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Affiliation(s)
- Alice Rossi
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Andrea Prochowski Iamurri
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy.
| | - Danila Diano
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Devil Oboldi
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Emanuele Sintuzzi
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Laghi Maurizio
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Alice Andalò
- Data Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Martina Cavallucci
- Data Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Fabio Ferroni
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Elena Amadori
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Domenico Barone
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Milan, Italy
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15
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Cruz IAN, Fayad LM, Ahlawat S, Lederman HM, Nico MAC, Ormond Filho AG, Guimarães JB. Whole-Body MRI in Musculoskeletal Oncology: A Comprehensive Review with Recommendations. Radiol Imaging Cancer 2023; 5:e220107. [PMID: 37144975 DOI: 10.1148/rycan.220107] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Whole-body (WB) MRI has emerged as an attractive method for oncologic evaluation, potentially replacing conventional imaging modalities and providing a one-step wide-coverage assessment of both the skeleton and soft tissues. In addition to providing anatomic information, WB MRI may also yield a functional analysis with the inclusion of diffusion-weighted imaging (DWI). DWI translates microstructural changes, resulting in an excellent alternative to fluorodeoxyglucose PET/CT. WB MRI (with DWI) offers comparable accuracy to PET/CT and has the advantage of avoiding ionizing radiation. Technological advances and the development of faster protocols have prompted greater accessibility of WB MRI, with growing applications in routine practice for the diagnosis, staging, and follow-up of cancer. This review discusses the technical considerations, clinical applications, and accuracy of WB MRI in musculoskeletal oncology. Keywords: Pediatrics, MR Imaging, Skeletal-Axial, Skeletal-Appendicular, Soft Tissues/Skin, Bone Marrow, Extremities, Oncology, Musculoskeletal Imaging © RSNA, 2023.
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Affiliation(s)
- Isabela A N Cruz
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, R. Mato Grosso 306, Higienópolis, SP, Brazil 01239-040 (I.A.N.C., M.A.C.N., A.G.O.F., J.B.G.); Department of Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil (I.A.N.C., H.M.L., J.B.G.); The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, Md (L.M.F., S.A.); and Department of Radiology, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil (H.M.L., J.B.G.)
| | - Laura M Fayad
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, R. Mato Grosso 306, Higienópolis, SP, Brazil 01239-040 (I.A.N.C., M.A.C.N., A.G.O.F., J.B.G.); Department of Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil (I.A.N.C., H.M.L., J.B.G.); The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, Md (L.M.F., S.A.); and Department of Radiology, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil (H.M.L., J.B.G.)
| | - Shivani Ahlawat
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, R. Mato Grosso 306, Higienópolis, SP, Brazil 01239-040 (I.A.N.C., M.A.C.N., A.G.O.F., J.B.G.); Department of Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil (I.A.N.C., H.M.L., J.B.G.); The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, Md (L.M.F., S.A.); and Department of Radiology, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil (H.M.L., J.B.G.)
| | - Henrique M Lederman
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, R. Mato Grosso 306, Higienópolis, SP, Brazil 01239-040 (I.A.N.C., M.A.C.N., A.G.O.F., J.B.G.); Department of Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil (I.A.N.C., H.M.L., J.B.G.); The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, Md (L.M.F., S.A.); and Department of Radiology, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil (H.M.L., J.B.G.)
| | - Marcelo A C Nico
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, R. Mato Grosso 306, Higienópolis, SP, Brazil 01239-040 (I.A.N.C., M.A.C.N., A.G.O.F., J.B.G.); Department of Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil (I.A.N.C., H.M.L., J.B.G.); The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, Md (L.M.F., S.A.); and Department of Radiology, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil (H.M.L., J.B.G.)
| | - Alípio G Ormond Filho
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, R. Mato Grosso 306, Higienópolis, SP, Brazil 01239-040 (I.A.N.C., M.A.C.N., A.G.O.F., J.B.G.); Department of Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil (I.A.N.C., H.M.L., J.B.G.); The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, Md (L.M.F., S.A.); and Department of Radiology, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil (H.M.L., J.B.G.)
| | - Júlio Brandão Guimarães
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, R. Mato Grosso 306, Higienópolis, SP, Brazil 01239-040 (I.A.N.C., M.A.C.N., A.G.O.F., J.B.G.); Department of Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil (I.A.N.C., H.M.L., J.B.G.); The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, Md (L.M.F., S.A.); and Department of Radiology, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil (H.M.L., J.B.G.)
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16
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Yan SY, Yang YW, Jiang XY, Hu S, Su YY, Yao H, Hu CH. Fat quantification: Imaging methods and clinical applications in cancer. Eur J Radiol 2023; 164:110851. [PMID: 37148843 DOI: 10.1016/j.ejrad.2023.110851] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
Recently, the study of the relationship between lipid metabolism and cancer has evolved. The characteristics of intratumoral and peritumoral fat are distinct and changeable during cancer development. Subcutaneous and visceral adipose tissue are also associated with cancer prognosis. In non-invasive imaging, fat quantification parameters such as controlled attenuation parameter, fat volume fraction, and proton density fat fraction from different imaging methods complement conventional images by providing concrete fat information. Therefore, measuring the changes of fat content for further understanding of cancer characteristics has been applied in both research and clinical settings. In this review, the authors summarize imaging advances in fat quantification and highlight their clinical applications in cancer precaution, auxiliary diagnosis and classification, therapy response monitoring, and prognosis.
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Affiliation(s)
- Suo Yu Yan
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China
| | - Yi Wen Yang
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China
| | - Xin Yu Jiang
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China
| | - Su Hu
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China
| | - Yun Yan Su
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China.
| | - Hui Yao
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China; Department of General Surgery, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China.
| | - Chun Hong Hu
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China.
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17
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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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18
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Heidemeier A, Schloetelburg W, Thurner A, Metz C, Heidemeier H, Rasche L, Martin Kortuem K, Boeckle D, Weiland E, Benkert T, Nickel D, Werner R, Buck AK, Bley TA. Multi-parametric whole-body MRI evaluation discerns vital from non-vital multiple myeloma lesions as validated by 18F-FDG and 11C-methionine PET/CT. Eur J Radiol 2022; 155:110493. [PMID: 36027759 DOI: 10.1016/j.ejrad.2022.110493] [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: 12/29/2021] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE We tested a novel multi-parametric (mp) whole body (WB)-MRI evaluation algorithm for medullary lesions in comparison to positron emission tomography (PET) radiotracers 18F-fluorodeoxyglucose (18F-FDG) and 11C-methionine (11C-MET). METHODS AND MATERIALS This retrospective single-center study included 44 MM patients, who received both 18F-FDG-PET and WB-MRI within ten days. MRI classified focal lesions as vital when showing 1) significant diffusion-restriction, 2) a fat fraction (FF) less than 20 % and 3) homogenous hypointensity on T2-weighted images. On a lesion-by-lesion level the findings were compared to 18F-FDG PET by using a 5-point scoring system (analogous to the Deauville score [DS]). In 24/44 (55 %) patients additional comparison to 11C-MET PET was available. RESULTS Among two radiologists, an excellent inter-observer reliability for mpWB-MRI in a total of 84 medullary lesions was observed (ICC = 1, k = 1, p <.01). 16/17 (94.1 %) MRI-classified vital lesions had a DS of 4 or 5 on either 18F-FDG-PET or 11C-MET-PET. MRI-rated non-vital lesions correlated with PET-based DS ≤ 3. When results of mpWB-MRI were compared to 18F-FDG, a fair inter-observer agreement was recorded (ICC = 0.52, k = 0.53, p <.01), while for 11C-MET, an excellent concordance rate was achieved (ICC = 0.81, k = 0.79, p <.01). CONCLUSION The proposed mpWB-MRI interpretation algorithm allowed to assess tumor activity of myeloma lesions with high inter-observer reproducibility. We observed a substantial concordance between the mpWB-MRI classification of lesions and PET assessment based on a semi-automatically calculated 5-point scoring system analogous to the Deauville scores.
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Affiliation(s)
- Anke Heidemeier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany.
| | - Wiebke Schloetelburg
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Annette Thurner
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Corona Metz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Heike Heidemeier
- Department of Psychology, Private University Göttingen, Weender Landstrasse 3-7, 37073 Göttingen, Germany
| | - Leo Rasche
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - K Martin Kortuem
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - David Boeckle
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Elisabeth Weiland
- Department of MR Application Predevelopment, Siemens Healthcare, 91301 Erlangen, Germany
| | - Thomas Benkert
- Department of MR Application Predevelopment, Siemens Healthcare, 91301 Erlangen, Germany
| | - Dominik Nickel
- Department of MR Application Predevelopment, Siemens Healthcare, 91301 Erlangen, Germany
| | - Rudolf Werner
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Andreas Konrad Buck
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
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