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Kaiser M, Goh V, Stern S, Spencer N, Rabin N, Ramasamy K, Lawless S, Soutar R, Ashcroft J, Pratt G, Messiou C, Bygrave C. Advanced imaging for earlier diagnosis and morbidity prevention in multiple myeloma: A British Society of Haematology and UK Myeloma Society Good Practice Paper. Br J Haematol 2024. [PMID: 39248274 DOI: 10.1111/bjh.19716] [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: 06/11/2024] [Accepted: 08/08/2024] [Indexed: 09/10/2024]
Abstract
This Good Practice Paper provides recommendations for the use of advanced imaging for earlier diagnosis and morbidity prevention in multiple myeloma. It describes how advanced imaging contributes to optimal healthcare resource utilisation by in newly diagnosed and relapsed myeloma, and provides a perspective on future directions of myeloma imaging, including machine learning assisted reporting.
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Affiliation(s)
- Martin Kaiser
- Department of Haematology, The Royal Marsden Hospital, London, UK
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Vicky Goh
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Radiology, Guy's & St Thomas' Hospitals, London, UK
| | - Simon Stern
- Epsom and St Helier University Hospitals NHS Trust, Epsom, UK
| | - Nicholas Spencer
- Department of Radiology, Mid Yorkshire Teaching NHS Trust, Wakefield, UK
| | - Neil Rabin
- University College Hospitals, London, UK
| | - Karthik Ramasamy
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Richard Soutar
- Department of Haematology, Gartnavel General Hospital/Beatson Oncology Centre, Glasgow, UK
| | - John Ashcroft
- Department of Haematology, Mid-Yorkshire Teaching Hospitals Trust, Wakefield, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christina Messiou
- Department of Radiology, The Royal Marsden Hospital and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Ceri Bygrave
- Department of Haematology, University Hospital of Wales, Cardiff, UK
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Lecouvet FE, Chabot C, Taihi L, Kirchgesner T, Triqueneaux P, Malghem J. Present and future of whole-body MRI in metastatic disease and myeloma: how and why you will do it. Skeletal Radiol 2024; 53:1815-1831. [PMID: 39007948 PMCID: PMC11303436 DOI: 10.1007/s00256-024-04723-2] [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: 05/20/2024] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 07/16/2024]
Abstract
Metastatic disease and myeloma present unique diagnostic challenges due to their multifocal nature. Accurate detection and staging are critical for determining appropriate treatment. Bone scintigraphy, skeletal radiographs and CT have long been the mainstay for the assessment of these diseases, but have limitations, including reduced sensitivity and radiation exposure. Whole-body MRI has emerged as a highly sensitive and radiation-free alternative imaging modality. Initially developed for skeletal screening, it has extended tumor screening to all organs, providing morphological and physiological information on tumor tissue. Along with PET/CT, whole-body MRI is now accepted for staging and response assessment in many malignancies. It is the first choice in an ever increasing number of cancers (such as myeloma, lobular breast cancer, advanced prostate cancer, myxoid liposarcoma, bone sarcoma, …). It has also been validated as the method of choice for cancer screening in patients with a predisposition to cancer and for staging cancers observed during pregnancy. The current and future challenges for WB-MRI are its availability facing this number of indications, and its acceptance by patients, radiologists and health authorities. Guidelines have been developed to optimize image acquisition and reading, assessment of lesion response to treatment, and to adapt examination designs to specific cancers. The implementation of 3D acquisition, Dixon method, and deep learning-based image optimization further improve the diagnostic performance of the technique and reduce examination durations. Whole-body MRI screening is feasible in less than 30 min. This article reviews validated indications, recent developments, growing acceptance, and future perspectives of whole-body MRI.
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Affiliation(s)
- Frederic E Lecouvet
- Department of Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, B-1200, Brussels, Belgium.
| | - Caroline Chabot
- Department of Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, B-1200, Brussels, Belgium
| | - Lokmane Taihi
- Department of Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, B-1200, Brussels, Belgium
| | - Thomas Kirchgesner
- Department of Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, B-1200, Brussels, Belgium
| | - Perrine Triqueneaux
- Department of Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, B-1200, Brussels, Belgium
| | - Jacques Malghem
- Department of Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, B-1200, Brussels, Belgium
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Quinn SCM, Goh V, Westerland OA, Pratt G. National myeloma patient survey shows continuing inappropriate imaging and geographical inequalities. Br J Radiol 2024; 97:1443-1449. [PMID: 38833672 PMCID: PMC11256933 DOI: 10.1093/bjr/tqae110] [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: 07/03/2023] [Revised: 05/20/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE To evaluate the provision of imaging at diagnosis of myeloma from the service user perspective with a specific focus on how the experiences of patients align with the National Institute for Health and Care Excellence (NICE) guidelines (NG35, 2016) on first-line imaging practice for myeloma in the United Kingdom. METHODS A national survey was performed to evaluate access to imaging from the patient's perspective. Patients with myeloma who received their diagnosis between 2017 and March 2022 were invited to participate. Data were collected using an online survey from 895 patients and carers between 4 and 14 March 2022. RESULTS Most patients had more than one imaging test. First-line MRI was used in 69.2% of respondents. First-line skeletal survey (SS, whole body X-rays) remained common (48.7% of respondents). 18F-fluorodexyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was used least often (23.1% of respondents). SS was used more often in East England (57.9%) and Scotland (61.2%) than in South East England (36.3%). CONCLUSIONS Despite NICE recommendations, first-line MRI was not used in a third of patients surveyed, with geographical variation in imaging practice. Patients are still undergoing multiple imaging tests at diagnosis. Healthcare professionals should continue to emphasize the superiority of MRI compared to SS to drive for improvements in care. ADVANCES IN KNOWLEDGE Current recommendations on first-line imaging for myeloma are not provided consistently across the United Kingdom. There is a need to drive change and support healthcare professionals to deliver guidance-based recommendations to improve experience and outcomes for patients.
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Affiliation(s)
- Sandra C M Quinn
- Research and Advocacy Directorate, Myeloma UK, Edinburgh EH7 4HG, United Kingdom
| | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, WC2R 2LS, United Kingdom
| | - Olwen A Westerland
- Clinical Imaging and Medical Physics, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 9RT, United Kingdom
| | - Guy Pratt
- Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2WB, United Kingdom
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Dwyer A, Korlaet M, Callary SA, Robertson T, Smitham P, Solomon LB. Impact of computed tomography metal artifact reduction protocol on periprosthetic tissue characterization after total hip arthroplasty: A cadaveric study. J Orthop Res 2023; 41:657-662. [PMID: 35652835 DOI: 10.1002/jor.25391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/19/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023]
Abstract
Metal artifact reduction (MAR) has improved computed tomography (CT) imaging of total hip arthroplasty (THA) but the assessment of osteolysis and implant to bone contact relies on the accurate depiction of bone defects, cancellous bone, and cement. This study evaluates the impact of available single and dual-energy protocols on periprosthetic tissue characterization in a cadaveric phantom. Bilateral THA was performed on a fresh frozen cadaveric pelvis with simulated osteolytic cavities. CT acquisitions with projection-based MAR and noise equivalence were performed using single energy 140 kVp, single energy 150 kVp with 0.6 mm tin filtration, and dual-energy at 100/150 kVp with 0.6 mm tin filtration, from which simulated energies were extracted. Image subtraction, segmentation, region of interest histograms, and line profiles were used to characterize tissue density and separation. Tissue densities were heavily dependent on the energy profile of the protocol. Cancellous bone ranged from 182 to 45 HU and cement from 1012 to 131 HU using 140 kVp compared to dual-energy with weighted high energy tube, respectively. Spectral separation between cancellous bone, osteolytic defect, and cement was reduced for all protocols compared with 140 kVp. Spectral overlap was most severe using dual-energy with heavily weighted high-energy tubes. Dual-energy algorithms reduced trabecular contrast within the cancellous bone and cortical edge response. Although the dual-energy acquisition has been proposed as an additive to projection-based MAR techniques in THA, reduced density and contrast in clinically relevant periprosthetic tissue compared to 140 kVp single energy may limit its use in characterizing periprosthetic tissues.
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Affiliation(s)
- Andrew Dwyer
- Clinical & Research Imaging Centre, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
| | - Mishelle Korlaet
- Clinical & Research Imaging Centre, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
| | - Stuart A Callary
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas Robertson
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Smitham
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lucian B Solomon
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
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Floccinaucinihilipilification: is there a continuing role for the radiographic skeletal survey? Skeletal Radiol 2022; 51:5-9. [PMID: 33893515 DOI: 10.1007/s00256-021-03780-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 02/02/2023]
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Westerland O, Drinkwater KJ, Parikh J, Streetly M, Pratt G, Goh V, Howlett DC. Imaging in myeloma: a Royal College of Radiologists national survey of current imaging practice. Clin Radiol 2021; 76:820-828. [PMID: 34187681 DOI: 10.1016/j.crad.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 05/20/2021] [Indexed: 11/24/2022]
Abstract
AIMS To evaluate current national imaging practice in myeloma with reference to National Institute for Health and Care Excellence (NICE) guidelines (NG35, 2016) and compare results with an initial survey conducted in 2017 (61 participating sites). MATERIALS AND METHODS All UK radiology departments treating myeloma patients and with a Royal College of Radiologists (RCR) Audit Lead were invited to participate. Data were collected using an online questionnaire. Descriptive statistics were performed. RESULTS One hundred and fourteen hospitals supplied data (54% return rate). Skeletal survey (SS) remains the most-commonly performed first-line imaging test for suspected/confirmed myeloma or plasmacytoma (39%, 45/114 hospitals), followed by whole-body magnetic resonance imaging (WBMRI) (27%, 31/114) and whole-body computed tomography (WBCT) (19%, 22/114). Integrated positron-emission tomography/CT (PET/CT) was first-line in 14% (16/114). The NICE recommended initial investigation, WBMRI, is currently offered in 27% of surveyed hospitals (<10% in 2017). Ongoing challenges to implementing WBMRI include scanner availability, financial constraints, reporting time, and radiologist training. CONCLUSION Despite NICE recommendations regarding WBMRI in diagnosis/follow-up of myeloma, SS (poor sensitivity and specificity) remains the most commonly performed first-line test. Radiologists, haematologists, and patients should continue to emphasise the superiority and benefit of modern and more accurate imaging, such that they are prioritised in clinical service planning.
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Affiliation(s)
- O Westerland
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Clinical Imaging and Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K J Drinkwater
- Directorate of Professional Practice, Royal College of Radiologists, London, UK.
| | - J Parikh
- Clinical Imaging and Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Streetly
- Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G Pratt
- Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - V Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Clinical Imaging and Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Winfield JM, Blackledge MD, Tunariu N, Koh DM, Messiou C. Whole-body MRI: a practical guide for imaging patients with malignant bone disease. Clin Radiol 2021; 76:715-727. [PMID: 33934876 DOI: 10.1016/j.crad.2021.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/08/2021] [Indexed: 01/09/2023]
Abstract
Whole-body magnetic resonance imaging (MRI) is now a crucial tool for the assessment of the extent of systemic malignant bone disease and response to treatment, and forms part of national and international recommendations for imaging patients with myeloma or metastatic prostate cancer. Recent developments in scanners have enabled acquisition of good-quality whole-body MRI data within 45 minutes on modern MRI systems from all main manufacturers. This provides complimentary morphological and functional whole-body imaging; however, lack of prior experience and acquisition times required can act as a barrier to adoption in busy radiology departments. This article aims to tackle the former by reviewing the indications and providing guidance for technical delivery and clinical interpretation of whole-body MRI for patients with malignant bone disease.
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Affiliation(s)
- J M Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK; MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - M D Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK; MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - N Tunariu
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK; MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - D-M Koh
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK; MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - C Messiou
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK; MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
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Kaiser MF, Boyd K, Koh D, Rata M, Blackledge M, Messiou C. Improving real-world myeloma patient access to whole body MRI through "open-access" knowledge sharing: The UK experience. EJHAEM 2020; 1:361-363. [PMID: 35847719 PMCID: PMC9176055 DOI: 10.1002/jha2.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Martin F Kaiser
- Division of Molecular PathologyThe Institute of Cancer ResearchLondonUK
- Department of HaematologyThe Royal Marsden HospitalLondonUK
| | - Kevin Boyd
- Department of HaematologyThe Royal Marsden HospitalLondonUK
| | - Dow‐Mu Koh
- Department of RadiologyRoyal Marsden Hospital and Institute of Cancer ResearchLondonUK
| | - Mihaela Rata
- Department of RadiologyRoyal Marsden Hospital and Institute of Cancer ResearchLondonUK
| | | | - Christina Messiou
- Department of RadiologyRoyal Marsden Hospital and Institute of Cancer ResearchLondonUK
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