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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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Morè S, Corvatta L, Manieri VM, Morsia E, Offidani M. The Challenging Approach to Multiple Myeloma: From Disease Diagnosis and Monitoring to Complications Management. Cancers (Basel) 2024; 16:2263. [PMID: 38927968 PMCID: PMC11202048 DOI: 10.3390/cancers16122263] [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: 05/16/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
The outcome of multiple myeloma (MM) has significantly improved in the last few decades due to several factors such as new biological discoveries allowing to better stratify disease risk, development of more effective therapies and better management of side effects related to them. However, handling all these aspects requires an interdisciplinary approach involving multiple knowledge and collaboration of different specialists. The hematologist, faced with a patient with MM, must not only choose a treatment according to patient and disease characteristics but must also know when therapy needs to be started and how to monitor it during and after treatment. Moreover, he must deal not only with organ issues related to MM such as bone disease, renal failure or neurological disease but also with adverse events, often very serious, related to novel therapies, particularly new generation immunotherapies such as CAR T cell therapy and bispecific antibodies. In this review, we provide an overview on the newer MM diagnostic and monitoring strategies and on the main side effects of MM therapies, focusing on adverse events occurring during treatment with CAR T cells and bispecific antibodies.
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Affiliation(s)
- Sonia Morè
- Clinica di Ematologia Azienda Ospedaliero, Universitaria delle Marche, 60126 Ancona, Italy; (S.M.); (V.M.M.); (E.M.)
| | - Laura Corvatta
- U.O.C. Medicina, Ospedale Profili, 60044 Fabriano, Italy;
| | - Valentina Maria Manieri
- Clinica di Ematologia Azienda Ospedaliero, Universitaria delle Marche, 60126 Ancona, Italy; (S.M.); (V.M.M.); (E.M.)
| | - Erika Morsia
- Clinica di Ematologia Azienda Ospedaliero, Universitaria delle Marche, 60126 Ancona, Italy; (S.M.); (V.M.M.); (E.M.)
| | - Massimo Offidani
- Clinica di Ematologia Azienda Ospedaliero, Universitaria delle Marche, 60126 Ancona, Italy; (S.M.); (V.M.M.); (E.M.)
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Cui S, Guo Y, Li J, Bian W, Wu W, Zhang W, Zheng Q, Guan H, Wang J, Niu J. Development of a whole spinal MRI-based tumor burden scoring method in participants with multiple myeloma: a pilot study of prognostic significance. Ann Hematol 2024; 103:1665-1673. [PMID: 38326481 DOI: 10.1007/s00277-024-05642-x] [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: 11/01/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024]
Abstract
The aim of the study was to develop a new whole spinal MRI-based tumor burden scoring method in participants with newly diagnosed multiple myeloma (MM) and to explore its prognostic significance. We prospectively recruited participants with newly diagnosed MM; performed whole spinal MRI (sagittal FSE T1WI, sagittal IDEAL T2WI, and axial FLAIR T2WI) on them; and collected their clinical data, early treatment response, progression-free survival (PFS), and overall survival (OS). We developed a new tumor burden scoring method according to the extent of bone marrow infiltration in five MRI patterns. All participants were divided into good response and poor response groups after four treatment cycles. Univariate, multivariate analyses, and ROC were used to determine the performance of independent predictors. Thresholds for PFS and OS were calculated using X-tile, and their prognostic significance were assessed by Kaplan-Meier. The Kruskal-Wallis H test was used to compare the differences of tumor burden score between the revised International Staging System (R-ISS) stages. The new tumor burden scoring method was used in 62 participants (median score, 12; range, 0-18). The tumor burden score (OR 1.266, p = 0.002) was an independent predictor of poor response and the AUC was 0.838. Higher tumor burden scores were associated with shorter PFS (p = 0.002) and OS (p = 0.011). The tumor burden score was higher in R-ISS-III than in R-ISS-I and R-ISS-II (p = 0.016 and p = 0.006, respectively). The tumor burden score was an excellent predictor of prognosis and may serve as a supplemental marker for R-ISS.
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Affiliation(s)
- Sha Cui
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Radiology, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China
| | - Yinnan Guo
- Department of Pain, Fifth Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jianting Li
- Department of Radiology, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China
| | - Wenjin Bian
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wenqi Wu
- Department of Radiology, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China
| | - Wenjia Zhang
- Department of Radiology, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China
| | - Qian Zheng
- Department of Radiology, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China
| | - Haonan Guan
- GE Healthcare, MR Research China, Beijing, China
| | - Jun Wang
- Department of Radiology, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China
| | - Jinliang Niu
- Department of Radiology, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, 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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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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Wijnands C, Noori S, Donk NWCJVD, VanDuijn MM, Jacobs JFM. Advances in minimal residual disease monitoring in multiple myeloma. Crit Rev Clin Lab Sci 2023; 60:518-534. [PMID: 37232394 DOI: 10.1080/10408363.2023.2209652] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023]
Abstract
Multiple myeloma (MM) is characterized by the clonal expansion of plasma cells and the excretion of a monoclonal immunoglobulin (M-protein), or fragments thereof. This biomarker plays a key role in the diagnosis and monitoring of MM. Although there is currently no cure for MM, novel treatment modalities such as bispecific antibodies and CAR T-cell therapies have led to substantial improvement in survival. With the introduction of several classes of effective drugs, an increasing percentage of patients achieve a complete response. This poses new challenges to traditional electrophoretic and immunochemical M-protein diagnostics because these methods lack sensitivity to monitor minimal residual disease (MRD). In 2016, the International Myeloma Working Group (IMWG) expanded their disease response criteria with bone marrow-based MRD assessment using flow cytometry or next-generation sequencing in combination with imaging-based disease monitoring of extramedullary disease. MRD status is an important independent prognostic marker and its potential as a surrogate endpoint for progression-free survival is currently being studied. In addition, numerous clinical trials are investigating the added clinical value of MRD-guided therapy decisions in individual patients. Because of these novel clinical applications, repeated MRD evaluation is becoming common practice in clinical trials as well as in the management of patients outside clinical trials. In response to this, novel mass spectrometric methods that have been developed for blood-based MRD monitoring represent attractive minimally invasive alternatives to bone marrow-based MRD evaluation. This paves the way for dynamic MRD monitoring to allow the detection of early disease relapse, which may prove to be a crucial factor in facilitating future clinical implementation of MRD-guided therapy. This review provides an overview of state-of-the-art of MRD monitoring, describes new developments and applications of blood-based MRD monitoring, and suggests future directions for its successful integration into the clinical management of MM patients.
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Affiliation(s)
- Charissa Wijnands
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Somayya Noori
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | | | - Martijn M VanDuijn
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Joannes F M Jacobs
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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Kim DK, Jung JY, Kim H, Lee S, Lee SY, Lee S, Park SS, Min CK. Development of a Semiquantitative Whole-Body MRI Scoring System for Multiple Myeloma. Radiology 2023; 308:e230667. [PMID: 37668524 DOI: 10.1148/radiol.230667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Background In patients with multiple myeloma (MM), the serum marker β2-microglobulin does not always accurately reflect tumor load. In contrast, whole-body (WB) MRI has shown high sensitivity for detecting bone lesions. Purpose To develop and validate a semiquantitative WB MRI scoring system for newly diagnosed MM and to compare it with the International Staging System (ISS) and Revised ISS (R-ISS). Materials and Methods This study included two retrospective groups (group 1, July 2015 to September 2021; group 2, February 2020 to September 2021) and one prospective group (group 3, October 2021 to February 2022) of patients with newly diagnosed MM. A new scoring system for MM was developed using spine MRI scans in group 1 and WB MRI scans in group 2 that integrated three features: (a) background marrow pattern, (b) number of focal bone lesions, and (c) presence of extramedullary or paramedullary lesions. The summed total score ranged from zero to nine. The interobserver agreement for each feature was assessed using Fleiss or Cohen weighted κ. WB MRI total scores in group 3 were compared across ISS and R-ISS stages using two-way analysis of variance. Results Groups 1, 2, and 3 included 103 patients (mean age, 62.1 years ± 9.1 [SD]; 60 men), 36 patients (mean age 65.4 years ± 11.3 [SD]; 19 women), and 39 participants (mean age, 62.0 years ± 11.7 [SD]; 20 men), respectively. The interobserver agreements for the three features composing the scoring system were substantial (κ range, 0.69-0.80). WB MRI total score increased with increasing ISS stage (mean score for ISS 1, 2, and 3 was 2.2, 4.2, and 5.8, respectively; P = .009) and R-ISS stage (mean score for R-ISS 1, 2, and 3 was 2.1, 3.8, and 5.9, respectively; P = .005). Conclusion The developed WB MRI scoring system for MM demonstrated substantial observer agreement and corresponded well with ISS and R-ISS stages. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Dragan and Messiou in this issue.
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Affiliation(s)
- Dong Kyun Kim
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Joon-Yong Jung
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Hyeonseon Kim
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Sungwon Lee
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - So-Yeon Lee
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Seungeun Lee
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Sung-Soo Park
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Chang-Ki Min
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
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Hillengass J, Martin T, Puig N, Paiva B, Usmani S, Kumar S, San-Miguel J. Disease Monitoring In Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:244-248. [PMID: 36774297 DOI: 10.1016/j.clml.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/29/2022] [Accepted: 01/11/2023] [Indexed: 01/16/2023]
Affiliation(s)
| | - Tom Martin
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Noemi Puig
- Department of Hematology Salamanca, Salamanca, Spain
| | - Bruno Paiva
- Clínica Universidad de Navarra, CCUN, CIMA, CIBERONC, IDISNA, Pamplona, Spain
| | - Saad Usmani
- Levine Cancer Institute-Atrium Health, Charlotte, NC
| | - Shaji Kumar
- Department of Hematology, Mayo Clinic, Rochester, MN
| | - Jesus San-Miguel
- Clínica Universidad de Navarra, CCUN, CIMA, CIBERONC, IDISNA, Pamplona, Spain.
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Shi L, Chen B, Liu T, Li L, Hu B, Li C, Jia B, Wang F. 99mTc-CD3813: A Nanobody-Based Single Photon Emission Computed Tomography Radiotracer with Clinical Potential for Myeloma Imaging and Evaluation of CD38 Expression. Mol Pharm 2022; 19:2583-2594. [PMID: 35696536 DOI: 10.1021/acs.molpharmaceut.2c00279] [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] [Indexed: 12/24/2022]
Abstract
Daratumumab (DARA) is an anti-CD38 monoclonal antibody for the treatment of multiple myeloma (MM). The tumor CD38 expression level is one of the important factors in determining the efficacy of DARA treatment. Therefore, there is an urgent clinical need for a noninvasive tool to evaluate the CD38 levels in cancer patients before, during, and after DARA treatment. In this study, we prepared a new molecular imaging probe 99mTc-CD3813, the 99mTc-labeled nanobody CD3813, for noninvasive imaging of CD38 expression by single photon emission computed tomography (SPECT). We evaluated 99mTc-CD3813 for its CD38 affinity and specificity and its capacity to image the CD38 expression in the MM and lymphoma xenografts models. 99mTc-CD3813 SPECT/CT is able to visualize subcutaneous/orthotopic myeloma lesions in animal models and has advantages over 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography. Excess DARA has less impact on its tumor uptake (3.14 ± 0.83 vs 2.29 ± 0.91 %ID/g, n.s.), strongly suggesting that there is no competition between 99mTc-CD3813 and DARA in binding to CD38. 99mTc-CD3813 SPECT/CT revealed significant reduction in CD38 expression in the Ramos-bearing mice under DARA treatment, as evidenced by their reduced tumor uptake (3.04 ± 0.70 vs 1.07 ± 0.28 %ID/cc, P < 0.001). 99mTc-CD3813 SPECT/CT was also able to detect the increased tumor uptake (0.79 ± 0.29 vs 2.12 ± 0.12 %ID/cc, P < 0.001) due to the upregulation of CD38 levels caused by all-trans retinoic acid infection. 99mTc-CD3813 is a promising SPECT radiotracer for imaging the CD38-positive tumors and has clinical potential as a molecular imaging tool for evaluation of the CD38 expression level in patients before, during, and after DARA treatment.
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Affiliation(s)
- Linqing Shi
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China
| | - Bo Chen
- Chengdu NBbiolab Co., Ltd., Chengdu 611130, China
| | - Tianyu Liu
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China
| | - Liqiang Li
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China
| | - Biao Hu
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China
| | - Chenzhen Li
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China
| | - Bing Jia
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China.,Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China
| | - Fan Wang
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China.,Key Laboratory of Protein and Peptide Pharmaceuticals, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China.,Guangzhou Laboratory, Guangzhou 510005, China
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11
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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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12
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Gu R, Amlani A, Haberland U, Hodson D, Streetly M, Antonelli M, Dregely I, Goh V. Correlation between Whole Skeleton Dual Energy CT Calcium-Subtracted Attenuation and Bone Marrow Infiltration in Multiple Myeloma. Eur J Radiol 2022; 149:110223. [PMID: 35240412 PMCID: PMC9026281 DOI: 10.1016/j.ejrad.2022.110223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/19/2022] [Accepted: 02/12/2022] [Indexed: 11/30/2022]
Abstract
Quantification of whole skeleton calcium-subtracted attenuation with dual energy CT is feasible. Whole skeleton calcium-subtracted attenuation correlates with the degree of marrow infiltration by plasma cells on bone marrow biopsy. Whole skeleton calcium-subtracted attenuation provides complementary information to the detection of osteolytic bone lesions.
Objectives Objective evaluation of the extent of skeletal marrow involvement in multiple myeloma remains a clinical gap for CT. We aimed to develop a quantitative segmentation pipeline for dual energy CT and to assess whether quantified whole skeleton calcium-subtracted attenuation values correlate with biopsy-derived bone marrow infiltration in multiple myeloma. Methods Consecutive prospective patients with suspected/established myeloma underwent dual source CT from the skull vertex to proximal tibia. Whole skeleton segmentation was performed for 120 kVp-equivalent images as follows: following Hounsfield unit (HU) thresholding, a Chan-Vese morphological operation was implemented to generate a whole skeleton segmentation mask. This mask was then applied to corresponding whole skeleton material decomposition calcium-subtracted maps, generating whole skeleton HU values. Associations with biopsy-derived bone marrow plasma cell infiltration percentage were assessed with Spearman’s rank correlation; significance was at 5%. Results 21 patients (12 females; median (IQR) 67 (61, 73) years) were included; 16 patients had osteolytic bone lesions; 15 patients underwent bone marrow biopsy. Segmentation and quantification were feasible in all patients. Median (IQR) of the average skeletal calcium-subtracted attenuation was −59.9 HU (-66.3, −51.8HU). There was a positive correlation with bone marrow plasma cell infiltration percentage (Spearman’s rho: + 0.79, p < 0.001). Conclusion Whole skeleton calcium-subtracted attenuation is associated with the degree of bone marrow infiltration by plasma cells, providing an objective measure of marrow involvement with the potential to allow earlier detection of disease.
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Affiliation(s)
- Renyang Gu
- Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7TH, United Kingdom
| | - Ashik Amlani
- Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7TH, United Kingdom; Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7TH, United Kingdom
| | - Ulrike Haberland
- Siemens Healthineers, Siemensstrasse 1, 91301 Forchheim, Germany
| | - Dan Hodson
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7TH, United Kingdom
| | - Matthew Streetly
- Department of Haematology and Oncology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, United Kingdom
| | - Michela Antonelli
- Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7TH London, United Kingdom
| | - Isabel Dregely
- Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7TH London, United Kingdom
| | - Vicky Goh
- Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7TH, United Kingdom; Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7TH, United Kingdom.
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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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14
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Treitl KM, Ricke J, Baur-Melnyk A. Whole-body magnetic resonance imaging (WBMRI) versus whole-body computed tomography (WBCT) for myeloma imaging and staging. Skeletal Radiol 2022; 51:43-58. [PMID: 34031705 PMCID: PMC8626374 DOI: 10.1007/s00256-021-03799-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 02/02/2023]
Abstract
Myeloma-associated bone disease (MBD) develops in about 80-90% of patients and severely affects their quality of life, as it accounts for the majority of mortality and morbidity. Imaging in multiple myeloma (MM) and MBD is of utmost importance in order to detect bone and bone marrow lesions as well as extraosseous soft-tissue masses and complications before the initiation of treatment. It is required for determination of the stage of disease and aids in the assessment of treatment response. Whole-body low-dose computed tomography (WBLDCT) is the key modality to establish the initial diagnosis of MM and is now recommended as reference standard procedure for the detection of lytic destruction in MBD. In contrast, whole-body magnetic resonance imaging (WBMRI) has higher sensitivity for the detection of focal and diffuse plasma cell infiltration patterns of the bone marrow and identifies them prior to osteolytic destruction. It is recommended for the evaluation of spinal and vertebral lesions, while functional, diffusion-weighted MRI (DWI-MRI) is a promising tool for the assessment of treatment response. This review addresses the current improvements and limitations of WBCT and WBMRI for diagnosis and staging in MM, underlining the fact that both modalities offer complementary information. It further summarizes the corresponding radiological findings and novel technological aspects of both modalities.
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Affiliation(s)
- Karla M. Treitl
- grid.5252.00000 0004 1936 973XDepartment of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Jens Ricke
- grid.5252.00000 0004 1936 973XDepartment of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Andrea Baur-Melnyk
- grid.5252.00000 0004 1936 973XDepartment of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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15
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Comparative Performance of Whole Body MRI and 18F-FDG PET/CT in Evaluation of Response to Treatment of Multiple Myeloma: Meta-analysis and Systematic Review. AJR Am J Roentgenol 2021; 218:602-613. [PMID: 34704461 DOI: 10.2214/ajr.21.26381] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Traditional approaches for evaluating multiple myeloma (MM) treatment response have low sensitivity for residual disease. Recent studies highlight utility of whole-body MRI or FDG PET/CT in evaluating treatment response, with increasing emphasis on DWI. Objective: This systematic review was conducted to assess the diagnostic accuracy of whole-body MRI and FDG PET/CT for treatment response assessment in MM. Evidence Acquisition: Studies using whole-body MRI or FDG PET/CT to evaluate MM treatment response were identified through search of PubMed and EMBASE databases through June 30, 2021. Pooled sensitivity and specificity for detecting response were calculated by bivariate modeling. Diagnostic performance of whole-body MRI and FDG PET/CT were compared. Subgroup analyses assessed studies comparing both modalities and studies in which whole-body MRI included DWI. Evidence Synthesis: Twelve studies comprising 373 patients were included: six evaluated both modalities, four evaluated whole-body MRI only, and two evaluated FDG PET/CT only; of studies with MRI, five used DWI. Pooled sensitivity and specificity were 87% (95% CI, 75%-93%) and 57% (95% CI, 37%-76%) for whole-body MRI, versus 64% (95% CI, 45%-79%) and 82% (95% CI, 75%-88%) for FDG PET/CT (sensitivity: p = .29; specificity: p = .01). For studies directly comparing the modalities, pooled sensitivity and specificity were 90% (95% CI, 80%-100%) and 56% (95% CI, 44%-68%) for whole-body MRI, versus 66% (95% CI, 47%-85%) and 81% (95% CI, 72%-90%) for FDG PET/CT (sensitivity: p = .18; specificity: p < .001). Sensitivity and specificity were 93% (95% CI, 75%-98%) and 57% (95% CI, 21%-87%) for DWI, versus 74% (95% CI, 60%-85%) and 56% (95% CI, 38%-73%) for whole-body MRI without DWI (sensitivity: p = .27; specificity: p = .99). AUC was 0.84 for whole-body MRI, 0.83 for FDG PET/CT, and 0.92 for DWI. Conclusion: FDG PET/CT had significantly higher specificity, whereas whole-body MRI had higher sensitivity (though non-significant). DWI may contribute to the high sensitivity of whole-body MRI. Clinical Impact: This meta-analysis suggests potential complementary roles of whole-body MRI and FDG PET/CT in MM treatment response assessment. Future studies should explore their combination through PET/MRI.
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Ippolito D, Giandola T, Maino C, Gandola D, Ragusi M, Brambilla P, Bonaffini PA, Sironi S. Diagnostic Value of Whole-Body MRI Short Protocols in Bone Lesion Detection in Multiple Myeloma Patients. Diagnostics (Basel) 2021; 11:diagnostics11061053. [PMID: 34201122 PMCID: PMC8226715 DOI: 10.3390/diagnostics11061053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/29/2021] [Accepted: 06/04/2021] [Indexed: 02/05/2023] Open
Abstract
The aim of the study is to evaluate the effectiveness of short whole-body magnetic resonance imaging (WBMRI) protocols for the overall assessment of bone marrow involvement in patients with multiple myeloma (MM), in comparison with standard whole-body MRI protocol. Patients with biopsy-proven MM, who underwent a WBMRI with full-body coverage (from vertex to feet) were retrospectively enrolled. WBMRI images were independently evaluated by two expert radiologists, in terms of infiltration patterns (normal, focal, diffuse, and combined), according to location (the whole skeleton was divided into six anatomic districts: skull, spine, sternum and ribs, upper limbs, pelvis and proximal two-thirds of the femur, remaining parts of lower limbs) and lytic lesions number (<5, 5-20, and >20). The majority of patients showed focal and combined infiltration patterns with bone lesions predominantly distributed in the spine and pelvis. As skull and lower limbs are less frequently involved by focal bone lesions, excluding them from the standard MRI protocol allows to obtain a shorter protocol, maintaining a good diagnostic value.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Correspondence:
| | - Teresa Giandola
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Cesare Maino
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Davide Gandola
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Maria Ragusi
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Paolo Brambilla
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy;
| | - Pietro Andrea Bonaffini
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy;
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy;
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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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18
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Ippolito D, Giandola T, Maino C, Gandola D, Ragusi M, Bonaffini PA, Sironi S. Whole Body Low Dose Computed Tomography (WBLDCT) Can Be Comparable to Whole-Body Magnetic Resonance Imaging (WBMRI) in the Assessment of Multiple Myeloma. Diagnostics (Basel) 2021; 11:diagnostics11050857. [PMID: 34064594 PMCID: PMC8150749 DOI: 10.3390/diagnostics11050857] [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: 04/11/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 02/07/2023] Open
Abstract
Aim of the study is to compare the agreement between whole-body low-dose computed tomography (WBLDCT) and magnetic resonance imaging (WBMRI) in the evaluation of bone marrow involvement in patients with multiple myeloma (MM). Patients with biopsy-proven MM, who underwent both WBLDCT and WBMRI were retrospectively enrolled. After identifying the presence of focal bone involvement (focal infiltration pattern), the whole skeleton was divided into five anatomic districts (skull, spine, sternum and ribs, pelvis, and limbs). Patients were grouped according to the number and location of the lytic lesions (<5, 5-20, and >20) and Durie and Salmon staging system. The agreement between CT and MRI regarding focal pattern, staging, lesion number, and distribution was assessed using the Cohen Kappa statistics. The majority of patients showed focal involvement. According to the distribution of the focal lesions and Durie Salmon staging, the agreement between CT and MRI was substantial or almost perfect (all κ > 0.60). The agreement increased proportionally with the number of lesions in the pelvis and spine (κ = 0.373 to κ = 0.564, and κ = 0.469-0.624), while for the skull the agreement proportionally decreased without reaching a statistically significant difference (p > 0.05). In conclusion, WBLDCT showed an almost perfect agreement in the evaluation of focal involvement, staging, lesion number, and distribution of bone involvement in comparison with WBMRI.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Correspondence:
| | - Teresa Giandola
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Cesare Maino
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Davide Gandola
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Maria Ragusi
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Pietro Andrea Bonaffini
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy
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Comparison of [ 18F]FDG PET/CT and MRI for Treatment Response Assessment in Multiple Myeloma: A Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11040706. [PMID: 33920809 PMCID: PMC8071116 DOI: 10.3390/diagnostics11040706] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
The present study was designed to assess the additional value of 2-deoxy-2[18F]fluoro-D-glucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) to magnetic resonance imaging (MRI) in the treatment response assessment of multiple myeloma (MM). We performed a meta-analysis of all available studies to compare the detectability of treatment response of [18F]FDG PET/CT and MRI in treated MM. We defined detecting a good therapeutic effect as positive, and residual disease as negative. We determined the sensitivities and specificities across studies, calculated the positive and negative likelihood ratios (LR), and made summary receiver operating characteristic curves (SROC) using hierarchical regression models. The pooled analysis included six studies that comprised 278 patients. The respective performance characteristics (95% confidence interval (CI)) of [18F]FDG PET/CT and MRI were as follows: sensitivity of 80% (56% to 94%) and 25% (19% to 31%); specificity of 58% (44% to 71%) and 83% (71% to 91%); diagnostic odds ratio (DOR) of 6.0 (3.0-12.0) and 1.7 (0.7-2.7); positive LR of 1.8 (1.3-2.4) and 1.4 (0.7-2.7); and negative LR of 0.33 (0.21-0.53) and 0.81 (0.62-1.1). In the respective SROC curves, the area under the curve was 0.77 (SE, 0.038) and 0.59 (SE, 0.079) and the Q* index was 0.71 and 0.57. Compared with MRI, [18F]FDG PET/CT had higher sensitivity and better DOR and SROC curves. Compared with MRI, [18F]FDG PET/CT had greater ability to detect the treatment assessment of MM.
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Diamond BT, Rustad E, Maclachlan K, Thoren K, Ho C, Roshal M, Ulaner GA, Landgren CO. Defining the undetectable: The current landscape of minimal residual disease assessment in multiple myeloma and goals for future clarity. Blood Rev 2021; 46:100732. [PMID: 32771227 PMCID: PMC9928431 DOI: 10.1016/j.blre.2020.100732] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/05/2020] [Accepted: 07/06/2020] [Indexed: 01/19/2023]
Abstract
Multiple Myeloma, the second most prevalent hematologic malignancy, yet lacks an established curative therapy. However, overall response rate to modern four-drug regimens approaches 100%. Major efforts have thus focused on the measurement of minute quantities of residual disease (minimal residual disease or MRD) for prognostic metrics and therapeutic response evaluation. Currently, MRD is assessed by flow cytometry or by next generation sequencing to track tumor-specific immunoglobulin V(D)J rearrangements. These bone marrow-based methods can reach sensitivity thresholds of the identification of one neoplastic cell in 1,000,000 (10-6). New technologies are being developed to be used alone or in conjunction with established methods, including peripheral blood-based assays, mass spectrometry, and targeted imaging. Data is also building for MRD as a surrogate endpoint for overall survival. Here, we will address the currently utilized MRD assays, challenges in validation across labs and clinical trials, techniques in development, and future directions for successful clinical application of MRD in multiple myeloma.
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Affiliation(s)
| | | | | | | | - Caleb Ho
- Memorial Sloan Kettering Cancer Center, USA
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F-18 FDG PET/CT and F-18 FLT PET/CT as predictors of outcome in patients with multiple myeloma. A pilot study. Eur J Radiol 2021; 136:109564. [PMID: 33517249 DOI: 10.1016/j.ejrad.2021.109564] [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: 11/18/2020] [Revised: 12/28/2020] [Accepted: 01/19/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We evaluated the prognostic significance of the combined use of F-18 FDG (FDG) and F-18 FLT (FLT) PET/CT (PET/CT) in patients (pts) with multiple myeloma (MM) suspected relapse after a first line chemotherapy. METHODS twenty-eight patients (57 ± 12 years) underwent both PET/CT scans over 2-4 weeks. Patients were grouped according to imaging results (FDG+/-; FLT+/-) and the findings compared to the event free survival (EFS). RESULTS five pts had FDG+; FLT+, 8 showed FDG+;FLT-, two had FDG-;FLT + and 13 presented FDG-;FLT-, mostly (87 %) of FDG+;FLT- pts had destructive lytic bone lesions. At Cox regression analysis the FDG PET/CT (HR 4.4, 95 % CI 1.3-15.4, p < 0.05) and FLT PET/CT (HR 5.8, 95 % CI 1.7-19.3, p < 0.01) were predictive of worst prognosis. The Kaplan-Meier analysis showed that FDG and FLT PET/CT independently influenced the survival. FDG-;FLT-patients had better EFS as compared to FDG+; FLT + pts and FDG-;FLT + pts, those of FDG+;FLT- group also had worsened EFS. CONCLUSIONS results from the aggregate use of PET/CT FDG and FLT in MM represent a valuable prognostic indicator for identifying patients at higher risk of undue events and may help to correctly stratify the patients with suspected relapse.
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Maccora D, Caldarella C, Taralli S, Scolozzi V, Lorusso M, Cocciolillo F, Calcagni ML. Diagnostic role of 11C-methionine PET/CT in patients with multiple myeloma and other plasma cell malignancy: a literature review. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-020-00400-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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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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Di Giuliano F, Picchi E, Muto M, Calcagni A, Ferrazzoli V, Da Ros V, Minosse S, Chiaravalloti A, Garaci F, Floris R, Muto M. Radiological imaging in multiple myeloma: review of the state-of-the-art. Neuroradiology 2020; 62:905-923. [DOI: 10.1007/s00234-020-02417-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/26/2020] [Indexed: 12/16/2022]
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Ulaner GA, Sobol NB, O'Donoghue JA, Kirov AS, Riedl CC, Min R, Smith E, Carter LM, Lyashchenko SK, Lewis JS, Landgren CO. CD38-targeted Immuno-PET of Multiple Myeloma: From Xenograft Models to First-in-Human Imaging. Radiology 2020; 295:606-615. [PMID: 32255416 DOI: 10.1148/radiol.2020192621] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Current measurements of multiple myeloma disease burden are suboptimal. Daratumumab is a monoclonal antibody that targets CD38, an antigen expressed on nearly all myeloma cells. Purpose To demonstrate preclinical and first-in-human application of an antibody composed of the native daratumumab labeled with the positron-emitting radionuclide zirconium 89 (89Zr) through the chelator deferoxamine (DFO), or 89Zr-DFO-daratumumab, for immunologic PET imaging of multiple myeloma. Materials and Methods 89Zr-DFO-daratumumab was synthesized by conjugating 89Zr to daratumumab with DFO. A murine xenograft model using CD38-positive OPM2 multiple myeloma cells was used to evaluate CD38-specificity of 89Zr-DFO-daratumumab. Following successful preclinical imaging, a prospective phase I study of 10 patients with multiple myeloma was performed. Study participants received 74 MBq (2 mCi) of intravenous 89Zr-DFO-daratumumab. Each participant underwent four PET/CT scans over the next 8 days, as well as blood chemistry and whole-body counts, to determine safety, tracer biodistribution, pharmacokinetics, and radiation dosimetry. Because 89Zr has a half-life of 78 hours, only a single administration of tracer was needed to obtain all four PET/CT scans. Results 89Zr-DFO-daratumumab was synthesized with radiochemical purity greater than 99%. In the murine model, substantial bone marrow uptake was seen in OPM2 mice but not in healthy mice, consistent with CD38-targeted imaging of OPM2 multiple myeloma cells. In humans, 89Zr-DFO-daratumumab was safe and demonstrated acceptable dosimetry. 89Zr-DFO-daratumumab uptake was visualized at PET in sites of osseous myeloma. Conclusion These data demonstrate successful CD38-targeted immunologic PET imaging of multiple myeloma in a murine model and in humans. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Gary A Ulaner
- From the Department of Radiology (G.A.U., N.B.S., C.C.R., R.M., L.M.C., S.K.L., J.S.L.), Department of Medical Physics (J.A.O., A.S.K.), Myeloma Service, Department of Medicine (E.S., C.O.L.), and Molecular Pharmacology Program (J.S.L.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Radiology, Weill Cornell Medical College, New York, NY (G.A.U., C.C.R., J.S.L.)
| | - Nicholas B Sobol
- From the Department of Radiology (G.A.U., N.B.S., C.C.R., R.M., L.M.C., S.K.L., J.S.L.), Department of Medical Physics (J.A.O., A.S.K.), Myeloma Service, Department of Medicine (E.S., C.O.L.), and Molecular Pharmacology Program (J.S.L.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Radiology, Weill Cornell Medical College, New York, NY (G.A.U., C.C.R., J.S.L.)
| | - Joseph A O'Donoghue
- From the Department of Radiology (G.A.U., N.B.S., C.C.R., R.M., L.M.C., S.K.L., J.S.L.), Department of Medical Physics (J.A.O., A.S.K.), Myeloma Service, Department of Medicine (E.S., C.O.L.), and Molecular Pharmacology Program (J.S.L.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Radiology, Weill Cornell Medical College, New York, NY (G.A.U., C.C.R., J.S.L.)
| | - Assen S Kirov
- From the Department of Radiology (G.A.U., N.B.S., C.C.R., R.M., L.M.C., S.K.L., J.S.L.), Department of Medical Physics (J.A.O., A.S.K.), Myeloma Service, Department of Medicine (E.S., C.O.L.), and Molecular Pharmacology Program (J.S.L.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Radiology, Weill Cornell Medical College, New York, NY (G.A.U., C.C.R., J.S.L.)
| | - Christopher C Riedl
- From the Department of Radiology (G.A.U., N.B.S., C.C.R., R.M., L.M.C., S.K.L., J.S.L.), Department of Medical Physics (J.A.O., A.S.K.), Myeloma Service, Department of Medicine (E.S., C.O.L.), and Molecular Pharmacology Program (J.S.L.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Radiology, Weill Cornell Medical College, New York, NY (G.A.U., C.C.R., J.S.L.)
| | - Ryan Min
- From the Department of Radiology (G.A.U., N.B.S., C.C.R., R.M., L.M.C., S.K.L., J.S.L.), Department of Medical Physics (J.A.O., A.S.K.), Myeloma Service, Department of Medicine (E.S., C.O.L.), and Molecular Pharmacology Program (J.S.L.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Radiology, Weill Cornell Medical College, New York, NY (G.A.U., C.C.R., J.S.L.)
| | - Eric Smith
- From the Department of Radiology (G.A.U., N.B.S., C.C.R., R.M., L.M.C., S.K.L., J.S.L.), Department of Medical Physics (J.A.O., A.S.K.), Myeloma Service, Department of Medicine (E.S., C.O.L.), and Molecular Pharmacology Program (J.S.L.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Radiology, Weill Cornell Medical College, New York, NY (G.A.U., C.C.R., J.S.L.)
| | - Lukas M Carter
- From the Department of Radiology (G.A.U., N.B.S., C.C.R., R.M., L.M.C., S.K.L., J.S.L.), Department of Medical Physics (J.A.O., A.S.K.), Myeloma Service, Department of Medicine (E.S., C.O.L.), and Molecular Pharmacology Program (J.S.L.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Radiology, Weill Cornell Medical College, New York, NY (G.A.U., C.C.R., J.S.L.)
| | - Serge K Lyashchenko
- From the Department of Radiology (G.A.U., N.B.S., C.C.R., R.M., L.M.C., S.K.L., J.S.L.), Department of Medical Physics (J.A.O., A.S.K.), Myeloma Service, Department of Medicine (E.S., C.O.L.), and Molecular Pharmacology Program (J.S.L.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Radiology, Weill Cornell Medical College, New York, NY (G.A.U., C.C.R., J.S.L.)
| | - Jason S Lewis
- From the Department of Radiology (G.A.U., N.B.S., C.C.R., R.M., L.M.C., S.K.L., J.S.L.), Department of Medical Physics (J.A.O., A.S.K.), Myeloma Service, Department of Medicine (E.S., C.O.L.), and Molecular Pharmacology Program (J.S.L.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Radiology, Weill Cornell Medical College, New York, NY (G.A.U., C.C.R., J.S.L.)
| | - C Ola Landgren
- From the Department of Radiology (G.A.U., N.B.S., C.C.R., R.M., L.M.C., S.K.L., J.S.L.), Department of Medical Physics (J.A.O., A.S.K.), Myeloma Service, Department of Medicine (E.S., C.O.L.), and Molecular Pharmacology Program (J.S.L.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Radiology, Weill Cornell Medical College, New York, NY (G.A.U., C.C.R., J.S.L.)
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Kothari S, Hillengass J, McCarthy PL, Holstein SA. Determination of Minimal Residual Disease in Multiple Myeloma: Does It Matter? Curr Hematol Malig Rep 2020; 14:39-46. [PMID: 30671912 DOI: 10.1007/s11899-019-0497-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The ability to detect minimal residual disease (MRD) in myeloma has improved due to advances in flow cytometry and sequencing methodologies. Here, we evaluate recent clinical trial data and explore the current and future roles of MRD assessment in the context of clinical trial design and clinical practice. RECENT FINDINGS A review of recent phase III studies reveals that achievement of MRD negativity is associated with improved progression-free survival (PFS) and/or overall survival (OS). Treatment arms that are more effective from a PFS or overall response rate perspective are also associated with superior MRD negativity rates. The current standard MRD methodologies are limited by requiring bone marrow samples and refinement of methodologies that can detect disease outside of the bone marrow is needed. Currently, MRD is a prognostic biomarker and further efforts are required to determine whether it can serve as a surrogate endpoint. The use of MRD status to guide treatment decisions is currently not recommended outside the confines of a clinical trial.
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Affiliation(s)
- Shalin Kothari
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Philip L McCarthy
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Sarah A Holstein
- Department of Internal Medicine, University of Nebraska Medical Center, 986840 Nebraska Medical Center, Omaha, NE, 68198, USA.
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Pfahler V, D'Anastasi M, Dürr HR, Schinner R, Ricke J, Baur-Melnyk A. Tumor load in patients with multiple myeloma: β₂-microglobulin levels versus low-dose whole-body CT. Eur J Haematol 2020; 104:383-389. [PMID: 31762076 DOI: 10.1111/ejh.13356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Beta-2-microglobulin is a serum marker of tumor burden in multiple myeloma (MM). Our aim was to correlate serum β₂-microglobulin levels in patients with MM to tumor burden determined by low-dose whole-body CT (LDWBCT). MATERIALS AND METHODS A total of 52 patients with newly diagnosed, untreated MM who underwent LDWBCT were included. LDWBCT scans were assessed by two musculoskeletal radiologists in consensus for focal lesions. The Durie and Salmon PLUS staging system was used for staging patients in stages I-III. β₂-microglobulin was also subdivided into stages I-III on the basis of the multiple myeloma International Staging System (ISS). RESULTS Using the Durie and Salmon PLUS staging system criteria for image evaluation, we were able to identify stage I MM in 17 patients, stage II MM in nine patients, and stage III MM in 26 patients. Eight of nine patients with stage II MM and 16 of 26 patients with stage III MM had normal β₂-microglobulin levels. Thus, 24 of 35 patients (68.6%) had 5 or more focal lesions and false-negative β₂-microglobulin levels. CONCLUSION Serum β₂-microglobulin levels alone may not indicate the full extent of tumor burden in a significant subset of myeloma patients.
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Affiliation(s)
- Vanessa Pfahler
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Hans-Roland Dürr
- Department of Orthopedic Surgery, University Hospitals Munich - Campus Grosshadern, Munich, Germany
| | - Regina Schinner
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andrea Baur-Melnyk
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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Oliva S, D'Agostino M, Boccadoro M, Larocca A. Clinical Applications and Future Directions of Minimal Residual Disease Testing in Multiple Myeloma. Front Oncol 2020; 10:1. [PMID: 32076595 PMCID: PMC7006453 DOI: 10.3389/fonc.2020.00001] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/02/2020] [Indexed: 12/20/2022] Open
Abstract
In the last years, the life expectancy of multiple myeloma (MM) patients has substantially improved thanks to the availability of many new drugs. Our ability to induce deep responses has improved as well, and the treatment goal in patients tolerating treatment moved from the delay of progression to the induction of the deepest possible response. As a result of these advances, a great scientific effort has been made to redefine response monitoring, resulting in the development and validation of high-sensitivity techniques to detect minimal residual disease (MRD). In 2016, the International Myeloma Working Group (IMWG) updated MM response categories defining MRD-negative responses both in the bone marrow (assessed by next-generation flow cytometry or next-generation sequencing) and outside the bone marrow. MRD is an important factor independently predicting prognosis during MM treatment. Moreover, using novel combination therapies, MRD-negative status can be achieved in a fairly high percentage of patients. However, many questions regarding the clinical use of MRD status remain unanswered. MRD monitoring can guide treatment intensity, although well-designed clinical trials are needed to demonstrate this potential. This mini-review will focus on currently available techniques and data on MRD testing and their potential future applications.
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Affiliation(s)
- Stefania Oliva
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Cittá Della Salute e Della Scienza di Torino, Turin, Italy
| | - Mattia D'Agostino
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Cittá Della Salute e Della Scienza di Torino, Turin, Italy
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Cittá Della Salute e Della Scienza di Torino, Turin, Italy
| | - Alessandra Larocca
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Cittá Della Salute e Della Scienza di Torino, Turin, Italy
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Ulaner GA, Landgren CO. Current and potential applications of positron emission tomography for multiple myeloma and plasma cell disorders. Best Pract Res Clin Haematol 2020; 33:101148. [PMID: 32139013 DOI: 10.1016/j.beha.2020.101148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 11/19/2022]
Abstract
Fluorine-18 (18F)-fluorodeoxyglucose (FDG) positron emission tomography (PET) allows evaluation of elevated glucose metabolism in malignancies. There has been increasing interest in FDG PET/CT for plasma cell disorders since the International Myeloma Working Group outlined multiple applications of this imaging modality, including distinguishing smoldering myeloma from active multiple myeloma, confirmation of solitary plasmacytoma, and multiple indications in patients with known multiple myeloma, including determining extent of initial disease, monitoring therapy response, and detection of residual disease following therapy. The field of molecular imaging is now shifting focus from evaluation of metabolism to targeted evaluation of specific tumor markers. Targeted PET imaging targeted of CXCR4 and CD38 has advanced into translational clinical trials, bringing us closer to powerful imaging options for myeloma. In this review we discuss the current applications of FDG PET/CT in plasma cell disorders, as well as advances in targeted PET imaging.
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Affiliation(s)
- Gary A Ulaner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA; Weill Cornell Medical College, New York, NY, 10065, USA.
| | - C Ola Landgren
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA; Weill Cornell Medical College, New York, NY, 10065, USA.
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Detappe A, Reidy M, Yu Y, Mathieu C, Nguyen HVT, Coroller TP, Lam F, Jarolim P, Harvey P, Protti A, Nguyen QD, Johnson JA, Cremillieux Y, Tillement O, Ghobrial IM, Ghoroghchian PP. Antibody-targeting of ultra-small nanoparticles enhances imaging sensitivity and enables longitudinal tracking of multiple myeloma. NANOSCALE 2019; 11:20485-20496. [PMID: 31650133 DOI: 10.1039/c9nr06512a] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Monitoring malignant progression and disease recurrence post-therapy are central challenges to improving the outcomes of patients with multiple myeloma (MM). Whereas current detection methods that rely upon bone marrow examination allow for precise monitoring of minimal residual disease and can help to elucidate clonal evolution, they do not take into account the spatial heterogeneity of the tumor microenvironment. As such, they are uninformative as to the localization of malignant plasma cells and may lead to false negative results. With respect to the latter challenge, clinically-available imaging agents are neither sufficiently sensitive nor specific enough to detect minute plasma cell populations. Here, we sought to explore methods by which to improve detection of MM cells within their natural bone marrow environment, using whole-animal magnetic resonance imaging to longitudinally monitor early-stage disease as well as to enhance tumor detection after systemic therapy. We conducted a proof-of-concept study to demonstrate that ultra-small (<5 nm) gadolinium-containing nanoparticles bound to full-length antibodies against the B-cell maturation antigen (BCMA) exhibit rapid tumor uptake followed by renal clearance, improving the signal-to-noise ratio for MM detection beyond levels that are currently afforded by other FDA-approved clinical imaging modalities. We anticipate that when combined with bone marrow or blood biopsy, such imaging constructs could help to augment the effective management of patients with MM.
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Affiliation(s)
- Alexandre Detappe
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA. and Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA. and Centre Paul Strauss, 3 rue de la porte de l'hôpital, 67000 Strasbourg, France
| | - Mairead Reidy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA. and Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Yingjie Yu
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA.
| | - Clelia Mathieu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA. and Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Hung V-T Nguyen
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Thibaud P Coroller
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA and Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Fred Lam
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA. and Clinical Scholar Program, Division of Neurosurgery, McMaster University, 237 Barton St East, Hamilton General Hospital, Hamilton ON, L8L 2X2, Canada
| | - Petr Jarolim
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA and Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - Peter Harvey
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Andrea Protti
- Lurie Family Imaging Center, Department of Radiology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Quang-De Nguyen
- Lurie Family Imaging Center, Department of Radiology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Jeremiah A Johnson
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Yannick Cremillieux
- Institut des Sciences Moléculaires, Université de Bordeaux, UMR CNRS 5255, 33076 Bordeaux, France
| | - Olivier Tillement
- Institut Lumière Matière, UMR 5306 Université Lyon1-CNRS, Université de Lyon, 69622 Villeurbanne Cedex, France
| | - Irene M Ghobrial
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA. and Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - P Peter Ghoroghchian
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA. and Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA.
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Solovev MV, Mendeleeva LP, Firsova MV, Aslanidi IP, Mukhortova OV, Savchenko VG. [PET/CT with 18F-fluorodeoxyglucose and 11C-methionine after autologous stem cell transplantation in multiple myeloma patients]. TERAPEVT ARKH 2019; 91:75-82. [PMID: 32598739 DOI: 10.26442/00403660.2019.07.000328] [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: 04/16/2020] [Indexed: 11/22/2022]
Abstract
AIM to compare the results of tumor visualization when using 18F-FDG and 11C-methionine PET/CT after auto-HSCT in MM patients. MATERIALS AND METHODS A prospective study included 27 MM patients subjected to 18F-FDG and 11C-methionine PET/CT on day 100 after auto-HSCT. Obtained images were visually and semi - quantitatively analyzed. Focal areas of increased uptake for every radiopharmaceutical agent (hypermetabolic foci) not associated with its physiological distribution were registered. Maximum Standardized Uptake Values (SUVmax) in pathological foci were automatically calculated for every radiopharmaceutical agent separately. PET/CT findings were compared to antitumor response achieved after auto-HSCT according to International MM Working Group criteria. RESULTS After auto-HSCT, the majority of patients (16/60%) achieved a complete response. Abnormal 18F-FDG uptake was registered in 37% (n=10) of patients, negative PET findings were obtained in 63% (n=17) of patients. 11C-methionine PET/CT revealed hypermetabolic foci in 67% (n=18) of patients, and there was no 11C-methionine uptake in 33% (n=9). Pathological foci of radiopharmaceutical agent uptake were 1.8 times more frequently revealed using PET/CT with 11C-methionine (p.
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Affiliation(s)
| | | | | | - I P Aslanidi
- Bakoulev Scientific Center for Cardiovascular Surgery
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Ormond Filho AG, Carneiro BC, Pastore D, Silva IP, Yamashita SR, Consolo FD, Hungria VTM, Sandes AF, Rizzatti EG, Nico MAC. Whole-Body Imaging of Multiple Myeloma: Diagnostic Criteria. Radiographics 2019; 39:1077-1097. [DOI: 10.1148/rg.2019180096] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders. Lancet Oncol 2019; 20:e302-e312. [DOI: 10.1016/s1470-2045(19)30309-2] [Citation(s) in RCA: 211] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 02/08/2023]
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Messiou C, Hillengass J, Delorme S, Lecouvet FE, Moulopoulos LA, Collins DJ, Blackledge MD, Abildgaard N, Østergaard B, Schlemmer HP, Landgren O, Asmussen JT, Kaiser MF, Padhani A. Guidelines for Acquisition, Interpretation, and Reporting of Whole-Body MRI in Myeloma: Myeloma Response Assessment and Diagnosis System (MY-RADS). Radiology 2019; 291:5-13. [PMID: 30806604 DOI: 10.1148/radiol.2019181949] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acknowledging the increasingly important role of whole-body MRI for directing patient care in myeloma, a multidisciplinary, international, and expert panel of radiologists, medical physicists, and hematologists with specific expertise in whole-body MRI in myeloma convened to discuss the technical performance standards, merits, and limitations of currently available imaging methods. Following guidance from the International Myeloma Working Group and the National Institute for Clinical Excellence in the United Kingdom, the Myeloma Response Assessment and Diagnosis System (or MY-RADS) imaging recommendations are designed to promote standardization and diminish variations in the acquisition, interpretation, and reporting of whole-body MRI in myeloma and allow response assessment. This consensus proposes a core clinical protocol for whole-body MRI and an extended protocol for advanced assessments. Published under a CC BY 4.0 license. Online supplemental material is available for this article.
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Affiliation(s)
- Christina Messiou
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Jens Hillengass
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Stefan Delorme
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Frédéric E Lecouvet
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Lia A Moulopoulos
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - David J Collins
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Matthew D Blackledge
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Niels Abildgaard
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Brian Østergaard
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Heinz-Peter Schlemmer
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Ola Landgren
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Jon Thor Asmussen
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Martin F Kaiser
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Anwar Padhani
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
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Wu C, Huang J, Xu WB, Guan YJ, Ling HW, Mi JQ, Yan H. Discriminating Depth of Response to Therapy in Multiple Myeloma Using Whole-body Diffusion-weighted MRI with Apparent Diffusion Coefficient: Preliminary Results From a Single-center Study. Acad Radiol 2018; 25:904-914. [PMID: 29373210 DOI: 10.1016/j.acra.2017.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to measure apparent diffusion coefficient (ADC) in Chinese patients with newly diagnosed multiple myeloma by whole-body diffusion-weighted magnetic resonance imaging (WB-DWI MRI) and assess the diagnostic accuracy of ADC in the discrimination of deep response to induction chemotherapy. MATERIALS AND METHODS Seventeen patients underwent WB-DWI MRI before and after induction chemotherapy (week 20). DWI images and ADC maps were produced and 89 regions of interest were chosen. ADC percent changes were compared between deep (complete response or very good partial response) and non-deep responders (partial response, minimal response, stable disease, or progressive disease) as International Myeloma Working Group criteria. Diagnostic accuracy of ADC was calculated using specific cut offs. Predictive positive value of ADC was calculated to predict deep response to consolidation therapy. RESULTS Lesions reduced in size and number and signal intensity decreased in follow-up DWI, which did not differ between deep and non-deep responders. ADC percent changes were significantly higher in deep responders (36.79%) than in non-deep responders (11.50%) after induction therapy (P = .02) in per lesion analysis. ADC percent increases by 46.96%, 78.0% yielded specificity at 81.4%, 90.7% in discriminating deep response to induction therapy. Predictive positive value predicting deep response to consolidation therapy was 60.5% by using ADC cutoff >1.00 × 10-3 mm2/s at week 20. CONCLUSIONS ADC from WB-DWI MRI increased remarkably in patients who achieved deep response at the end of induction chemotherapy, which represented a confirmatory diagnostic tool to discriminate deep response to induction therapy for patients with multiple myeloma. ADC may have a potential to predict deep response to consolidation therapy.
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Stecco A, Buemi F, Iannessi A, Carriero A, Gallamini A. Current concepts in tumor imaging with whole-body MRI with diffusion imaging (WB-MRI-DWI) in multiple myeloma and lymphoma. Leuk Lymphoma 2018; 59:2546-2556. [PMID: 29431555 DOI: 10.1080/10428194.2018.1434881] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Whole-body MRI (WB-MRI) with diffusion-weighted imaging (DWI) can now be used to stage and restage multiple myeloma (MM) and lymphoma. Magnetic resonance imaging (MRI) is the standard tool to detect BM involvement (BMI). The 2016 diagnostic criteria of the International Myeloma Working Group identify WB-MRI and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) as the most sensitive imaging techniques for detecting skeletal and extra-skeletal MM invasion, respectively. Preliminary findings have also shown that WB-MRI is better than CT and equal to PET/CT in staging aggressive lymphoma and Hodgkin lymphoma, whereas MRI is better for diagnosing BMI in patients with low-grade lymphoma. Signal intensity (SI) and the apparent diffusion coefficient (ADC) are useful metrics to quantify the chemotherapy response in WB-MRI.
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Affiliation(s)
- Alessandro Stecco
- a Services Diagnosis and Therapies Department - Radiology , Azienda Ospedaliero-Universitaria Maggiore della Carita , Novara , Italy
| | - Francesco Buemi
- b Radiologic Department , L'Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte , Messina , Italy
| | - Antoine Iannessi
- c Radiology Department , Centre Antoine-Lacassagne , Nice , France
| | - Alessandro Carriero
- a Services Diagnosis and Therapies Department - Radiology , Azienda Ospedaliero-Universitaria Maggiore della Carita , Novara , Italy
| | - Andrea Gallamini
- d Research, Innovation and Statistics Department , Centre Antoine-Lacassagne , Nice , France
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Hillengass J, Merz M, Delorme S. Minimal residual disease in multiple myeloma: use of magnetic resonance imaging. Semin Hematol 2018; 55:19-21. [PMID: 29759148 DOI: 10.1053/j.seminhematol.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/06/2018] [Indexed: 12/25/2022]
Abstract
The increasing percentage of patients achieving deep responses in multiple myeloma has led to the need for more sophisticated instruments to measure residual disease as a potential source of relapse. As minimal residual disease assessment is mostly performed on a bone marrow specimen from a certain area of the body, such samples have the limitation that they might not really represent the actual tumor burden, because focal accumulations of malignant cells might be either hit or missed. Magnetic resonance imaging is a highly sensitive technique for the assessment of tumor burden and can be performed as whole-body protocol, overcoming the problem of sampling error for minimal residual disease assessment. Despite its high sensitivity, however, magnetic resonance imaging cannot differentiate between vital and necrotic lesions after therapy. Therefore, new fusion and functional techniques are currently under investigation, and image-guided biopsies are performed to combine the strengths of all available methods.
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Affiliation(s)
- Jens Hillengass
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY; Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Maximilian Merz
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Stefan Delorme
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
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GroΔ JP, Nattenmüller J, Hemmer S, Tichy D, Krzykalla J, Goldschmidt H, Bertsch U, Delorme S, Kauczor HU, Hillengass J, Merz M. Body fat composition as predictive factor for treatment response in patients with newly diagnosed multiple myeloma - subgroup analysis of the prospective GMMG MM5 trial. Oncotarget 2017; 8:68460-68471. [PMID: 28978130 PMCID: PMC5620270 DOI: 10.18632/oncotarget.19536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 06/03/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION/BACKGROUND Obesity is a well-known risk factor for malignant tumors and increased body mass index (BMI) is correlated to the risk of developing multiple myeloma (MM). The correlation of body fat composition with disease activity, adverse events and treatment response of MM patients has not been investigated yet. PATIENTS AND METHODS A subgroup of 108 patients from a single institution enrolled in the prospective GMMG-MM5 trial, who received a whole-body low-dose computed tomography (WBLDCT) before induction therapy, were included in this study. Body fat composition was measured in WBLDCT for each patient, divided in the compartments abdomen, pelvis, thigh and further categorized in subcutaneous (SAT) and visceral adipose tissue (VAT). The correlation of these parameters with disease activity (M protein, plasma cell count, LDH, CRAB-criteria), adverse cytogenetics, adverse events and treatment response were evaluated. RESULTS Significant reciprocal correlation was found between adverse cytogenetics and VAT of the abdomen and pelvis, respectively (gain 1q21: p=0.009 and p=0.021; t(4;14): p=0.038 and p=0.042). No correlation of VAT or SAT with adverse events was observed. Significant reciprocal correlation was observed between abdominal (p=0.03) and pelvic (p=0.035) VAT and treatment response. Abdominal VAT remains significant (p=0.034) independently of revised ISS stage and treatment. The BMI did not show a significant correlation with treatment response or investigated cytogenetics. CONCLUSION Based on the clinically relevant difference in treatment outcome depending on VAT and SAT, excessive body fat of abdomen and pelvis might be a predictive factor for poor treatment response. Further influences in this context should be considered as well, e.g. chemotherapy dosing and body fat metabolism. Further studies are necessary to investigate this hypothesis.
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Affiliation(s)
- Jonathan P GroΔ
- University of Heidelberg, Department of Internal Medicine V, Heidelberg, Germany
| | - Johanna Nattenmüller
- University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany
| | - Stefan Hemmer
- University of Heidelberg, Department of Orthopedics and Trauma Surgery, Heidelberg, Germany
| | - Diana Tichy
- German Cancer Research Centre, Department of Biostatistics, Heidelberg, Germany
| | - Julia Krzykalla
- German Cancer Research Centre, Department of Biostatistics, Heidelberg, Germany
| | - Hartmut Goldschmidt
- University of Heidelberg, Department of Internal Medicine V, Heidelberg, Germany
| | - Uta Bertsch
- University of Heidelberg, Department of Internal Medicine V, Heidelberg, Germany
| | - Stefan Delorme
- German Cancer Research Centre, Department of Radiology, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany
| | - Jens Hillengass
- University of Heidelberg, Department of Internal Medicine V, Heidelberg, Germany.,German Cancer Research Centre, Department of Radiology, Heidelberg, Germany
| | - Maximilian Merz
- University of Heidelberg, Department of Internal Medicine V, Heidelberg, Germany.,German Cancer Research Centre, Department of Radiology, Heidelberg, Germany
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Kumar S, Paiva B, Anderson KC, Durie B, Landgren O, Moreau P, Munshi N, Lonial S, Bladé J, Mateos MV, Dimopoulos M, Kastritis E, Boccadoro M, Orlowski R, Goldschmidt H, Spencer A, Hou J, Chng WJ, Usmani SZ, Zamagni E, Shimizu K, Jagannath S, Johnsen HE, Terpos E, Reiman A, Kyle RA, Sonneveld P, Richardson PG, McCarthy P, Ludwig H, Chen W, Cavo M, Harousseau JL, Lentzsch S, Hillengass J, Palumbo A, Orfao A, Rajkumar SV, Miguel JS, Avet-Loiseau H. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol 2017; 17:e328-e346. [PMID: 27511158 DOI: 10.1016/s1470-2045(16)30206-6] [Citation(s) in RCA: 1733] [Impact Index Per Article: 247.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/21/2016] [Accepted: 05/24/2016] [Indexed: 12/16/2022]
Abstract
Treatment of multiple myeloma has substantially changed over the past decade with the introduction of several classes of new effective drugs that have greatly improved the rates and depth of response. Response criteria in multiple myeloma were developed to use serum and urine assessment of monoclonal proteins and bone marrow assessment (which is relatively insensitive). Given the high rates of complete response seen in patients with multiple myeloma with new treatment approaches, new response categories need to be defined that can identify responses that are deeper than those conventionally defined as complete response. Recent attempts have focused on the identification of residual tumour cells in the bone marrow using flow cytometry or gene sequencing. Furthermore, sensitive imaging techniques can be used to detect the presence of residual disease outside of the bone marrow. Combining these new methods, the International Myeloma Working Group has defined new response categories of minimal residual disease negativity, with or without imaging-based absence of extramedullary disease, to allow uniform reporting within and outside clinical trials. In this Review, we clarify several aspects of disease response assessment, along with endpoints for clinical trials, and highlight future directions for disease response assessments.
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Affiliation(s)
- Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
| | - Bruno Paiva
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain
| | | | - Brian Durie
- Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Ola Landgren
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Meletios Dimopoulos
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Torino, Italy; Mount Sinai Cancer Institute, New York, NY, USA
| | | | - Hartmut Goldschmidt
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | | | - Jian Hou
- Chang Zheng Hospital, Shanghai, China
| | | | - Saad Z Usmani
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - Elena Zamagni
- Seragnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | | | | | - Hans E Johnsen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Evangelos Terpos
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece
| | - Anthony Reiman
- Dalhousie University Medical School, Dalhousie, Nova Scotia, Canada
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Heinz Ludwig
- Wilhelminenspital Der Stat Wien, Vienna, Austria
| | | | - Michele Cavo
- Seragnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | | | | | - Jens Hillengass
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Alberto Orfao
- University Hospital of Salamanca/IBSAL, Salamanca, Spain
| | | | - Jesus San Miguel
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain
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Karampinos DC, Ruschke S, Dieckmeyer M, Diefenbach M, Franz D, Gersing AS, Krug R, Baum T. Quantitative MRI and spectroscopy of bone marrow. J Magn Reson Imaging 2017; 47:332-353. [PMID: 28570033 PMCID: PMC5811907 DOI: 10.1002/jmri.25769] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
Abstract
Bone marrow is one of the largest organs in the human body, enclosing adipocytes, hematopoietic stem cells, which are responsible for blood cell production, and mesenchymal stem cells, which are responsible for the production of adipocytes and bone cells. Magnetic resonance imaging (MRI) is the ideal imaging modality to monitor bone marrow changes in healthy and pathological states, thanks to its inherent rich soft‐tissue contrast. Quantitative bone marrow MRI and magnetic resonance spectroscopy (MRS) techniques have been also developed in order to quantify changes in bone marrow water–fat composition, cellularity and perfusion in different pathologies, and to assist in understanding the role of bone marrow in the pathophysiology of systemic diseases (e.g. osteoporosis). The present review summarizes a large selection of studies published until March 2017 in proton‐based quantitative MRI and MRS of bone marrow. Some basic knowledge about bone marrow anatomy and physiology is first reviewed. The most important technical aspects of quantitative MR methods measuring bone marrow water–fat composition, fatty acid composition, perfusion, and diffusion are then described. Finally, previous MR studies are reviewed on the application of quantitative MR techniques in both healthy aging and diseased bone marrow affected by osteoporosis, fractures, metabolic diseases, multiple myeloma, and bone metastases. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:332–353.
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Affiliation(s)
- Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Stefan Ruschke
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Maximilian Diefenbach
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Daniela Franz
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Alexandra S Gersing
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Thomas Baum
- Section for Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
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Whole-body MRI, dynamic contrast-enhanced MRI, and diffusion-weighted imaging for the staging of multiple myeloma. Skeletal Radiol 2017; 46:733-750. [PMID: 28289855 DOI: 10.1007/s00256-017-2609-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 02/02/2023]
Abstract
Magnetic resonance imaging (MRI) is the most sensitive imaging technique for the detection of bone marrow infiltration, and has therefore recently been included in the new diagnostic myeloma criteria, as proposed by the International Myeloma Working Group. Nevertheless, conventional MRI only provides anatomical information and is therefore only of limited use in the response assessment of patients with multiple myeloma. The additional information from functional MRI techniques, such as diffusion-weighted imaging and dynamic contrast-enhanced MRI, can improve the detection rate of bone marrow infiltration and the assessment of response. This can further enhance the sensitivity and specificity of MRI in the staging of multiple myeloma patients. This article provides an overview of the technical aspects of conventional and functional MRI techniques with practical recommendations. It reviews the diagnostic performance, prognostic value, and role in therapy assessment in multiple myeloma and its precursor stages.
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Abstract
Multiple myeloma is the most common bone malignancy. Imaging plays an important role in identifying the extent of the disease, disease process, guiding biopsies, and diagnosing associated spinal and intracranial complications. Multiple myeloma and related plasma cell proliferative disorders have a diverse set of clinicopathologic findings and on neuroimaging present unique and diverse findings from the disease and from complications of the disease and treatment, which are valuable for clinicians and radiologists.
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Affiliation(s)
- Barry Amos
- Department of Radiology, Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| | - Amit Agarwal
- Department of Neurology, Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| | - Sangam Kanekar
- Department of Radiology, Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA; Department of Neurology, Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA.
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Low expression of hexokinase-2 is associated with false-negative FDG-positron emission tomography in multiple myeloma. Blood 2017; 130:30-34. [PMID: 28432222 DOI: 10.1182/blood-2017-03-774422] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/13/2017] [Indexed: 12/15/2022] Open
Abstract
18F-Fluorodeoxyglucose (FDG)-positron emission tomography (PET) and diffusion-weighted magnetic resonance imaging with background signal suppression (DWIBS) are 2 powerful functional imaging modalities in the evaluation of malignant plasma cell (PC) disease multiple myeloma (MM). Preliminary observations have suggested that MM patients with extensive disease according to DWIBS may be reported as being disease-free on FDG-PET ("PET false-negative"). The aim of this study was to describe the proportion of PET false-negativity in a representative set of 227 newly diagnosed MM patients with simultaneous assessment of FDG-PET and DWIBS, and to identify tumor-intrinsic features associated with this pattern. We found the incidence of PET false-negativity to be 11%. Neither tumor load-associated parameters, such as degree of bone marrow PC infiltration, nor the PC proliferation rate were associated with this subset. However, the gene coding for hexokinase-2, which catalyzes the first step of glycolysis, was significantly lower expressed in PET false-negative cases (5.3-fold change, P < .001) which provides a mechanistic explanation for this feature. In conclusion, we demonstrate a relevant number of patients with FDG-PET false-negative MM and a strong association between hexokinase-2 expression and this negativity: a finding which may also be relevant for clinical imaging of other hematological cancers.
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Imaging Measurable (Minimal) Residual Disease in Multiple Myeloma. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Landgren O, Rajkumar SV. New Developments in Diagnosis, Prognosis, and Assessment of Response in Multiple Myeloma. Clin Cancer Res 2016; 22:5428-5433. [PMID: 28151710 PMCID: PMC5587183 DOI: 10.1158/1078-0432.ccr-16-0866] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 12/27/2022]
Abstract
Over the past few years, the management of multiple myeloma has changed. We have new guidelines regarding how to set the diagnosis, when to initiate therapy, and how to monitor treatment response. In 2014, the updated International Myeloma Working Group (IMWG) diagnostic criteria changed the definition of multiple myeloma from being a disease defined by symptoms to a disease defined by biomarkers. Today, modern combination therapies have reported up to 60% to 80% of patients reaching a complete response. As a logical and necessary step forward, investigators have explored strategies to detect minimal residual disease (MRD) and its correlation with clinical outcomes. Recent meta-analysis data show that MRD negativity is associated with longer progression-free survival and overall survival. In 2016, the updated IMWG response criteria include MRD as the deepest level of treatment response in multiple myeloma. Simultaneously, we are still quite behind in our understanding of the heterogeneous biology of multiple myeloma and its implications for therapy. Emerging DNA sequencing data show that newly diagnosed multiple myeloma patients have a broad range of mutations, which are distributed unevenly in multiple parallel subclones already present at diagnosis. To move beyond the ill-defined category of "high-risk multiple myeloma," which confers to approximately 25% of all newly diagnosed patients, prospective studies are needed to dissect tumor biology and define multiple myeloma subtypes, and, based on biology, seek to define rational therapies for individual subtypes. This article discusses novel insights and gives perspectives on diagnosis and MRD monitoring and future directions for prognosis and clinical management of multiple myeloma. Clin Cancer Res; 22(22); 5428-33. ©2016 AACR SEE ALL ARTICLES IN THIS CCR FOCUS SECTION, "MULTIPLE MYELOMA MULTIPLYING THERAPIES".
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Affiliation(s)
- Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
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47
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Dutoit JC, Verstraete KL. MRI in multiple myeloma: a pictorial review of diagnostic and post-treatment findings. Insights Imaging 2016; 7:553-69. [PMID: 27164915 PMCID: PMC4956620 DOI: 10.1007/s13244-016-0492-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/11/2016] [Accepted: 04/20/2016] [Indexed: 01/04/2023] Open
Abstract
Magnetic resonance imaging (MRI) is increasingly being used in the diagnostic work-up of patients with multiple myeloma. Since 2014, MRI findings are included in the new diagnostic criteria proposed by the International Myeloma Working Group. Patients with smouldering myeloma presenting with more than one unequivocal focal lesion in the bone marrow on MRI are considered having symptomatic myeloma requiring treatment, regardless of the presence of lytic bone lesions. However, bone marrow evaluation with MRI offers more than only morphological information regarding the detection of focal lesions in patients with MM. The overall performance of MRI is enhanced by applying dynamic contrast-enhanced MRI and diffusion weighted imaging sequences, providing additional functional information on bone marrow vascularization and cellularity. This pictorial review provides an overview of the most important imaging findings in patients with monoclonal gammopathy of undetermined significance, smouldering myeloma and multiple myeloma, by performing a ‘total’ MRI investigation with implications for the diagnosis, staging and response assessment. Main message • Conventional MRI diagnoses multiple myeloma by assessing the infiltration pattern. • Dynamic contrast-enhanced MRI diagnoses multiple myeloma by assessing vascularization and perfusion. • Diffusion weighted imaging evaluates bone marrow composition and cellularity in multiple myeloma. • Combined morphological and functional MRI provides optimal bone marrow assessment for staging. • Combined morphological and functional MRI is of considerable value in treatment follow-up.
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Affiliation(s)
- Julie C Dutoit
- Department of Radiology, MR -1K12, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Koenraad L Verstraete
- Department of Radiology, MR -1K12, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium
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Affiliation(s)
- Elisabet E Manasanch
- a Department of Lymphoma and Myeloma , University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Ola Landgren
- b Department of Medicine , Memorial Sloan-Kettering Cancer Center , New York , NY , USA
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Rubini G, Niccoli-Asabella A, Ferrari C, Racanelli V, Maggialetti N, Dammacco F. Myeloma bone and extra-medullary disease: Role of PET/CT and other whole-body imaging techniques. Crit Rev Oncol Hematol 2016; 101:169-83. [DOI: 10.1016/j.critrevonc.2016.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/08/2016] [Accepted: 03/03/2016] [Indexed: 01/08/2023] Open
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Mangiacavalli S, Pezzatti S, Rossini F, Doni E, Cocito F, Bolis S, Corso A. Implemented myeloma management with whole-body low-dose CT scan: a real life experience. Leuk Lymphoma 2016; 57:1539-45. [DOI: 10.3109/10428194.2015.1129535] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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