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Bauer F, Sauer S, Weinhold N, Delorme S, Wennmann M. (Smoldering) multiple myeloma: mismatch between tumor load estimated from bone marrow biopsy at iliac crest and tumor load shown by MRI. Skeletal Radiol 2023; 52:2513-2518. [PMID: 37300710 PMCID: PMC10582145 DOI: 10.1007/s00256-023-04383-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
In multiple myeloma and its precursor stages, precise quantification of tumor load is of high importance for diagnosis, risk assessment, and therapy response evaluation. Both whole-body MRI, which allows to investigate the complete bone marrow of a patient, and bone marrow biopsy, which is commonly used to assess the histologic and genetic status, are relevant methods for tumor load assessment in multiple myeloma. We report on a series of striking mismatches between the plasma cell infiltration estimating the tumor load from unguided biopsies of the bone marrow at the posterior iliac crest and the tumor load assessment from whole-body MRI.
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Affiliation(s)
- Fabian Bauer
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Sandra Sauer
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Niels Weinhold
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Stefan Delorme
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Markus Wennmann
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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Hildenbrand N, Klein A, Maier-Hein K, Wennmann M, Delorme S, Goldschmidt H, Hillengass J. Identification of focal lesion characteristics in MRI which indicate presence of corresponding osteolytic lesion in CT in patients with multiple myeloma. Bone 2023; 175:116857. [PMID: 37487861 DOI: 10.1016/j.bone.2023.116857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE The presence of bone marrow focal lesions and osteolytic lesions in patients with multiple myeloma (MM) is of high prognostic significance for their individual outcome. It is not known yet why some focal lesions seen in MRI, reflecting localized bone marrow infiltration of myeloma cells, remain non-lytic, whereas others are associated with destruction of mineralized bone. In this study, we analyzed MRI characteristics of manually segmented focal lesions in MM patients to identify possible features that might discriminate lytic and non-lytic lesions. METHOD The initial cohort included a total of 140 patients with different stages of MM who had undergone both whole-body MRI and whole-body low-dose CT within 30 days, and of which 29 satisfied the inclusion criteria for this study. Focal lesions in MRI and corresponding osteolytic areas in CT were segmented manually. Analysis of the lesions included volume, location and first order texture features analysis. RESULTS There were significantly more lytic lesions in the axial skeleton than in the appendicular skeleton (p = 0.037). Out of 926 focal lesions in the axial skeleton seen on MRI, 544 (59.3 %) were osteolytic. Analysis of volume and first order texture features showed differences in texture and volume between focal lesions in MRI with and without local bone destruction in CT, but these findings were not statistically significant. CONCLUSIONS Neither morphological imaging characteristics like size and location nor first order texture features could predict whether focal lesions seen in MRI would exhibit corresponding bone destruction in CT. Studies performing biopsies of such lesions are ongoing.
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Affiliation(s)
- Nina Hildenbrand
- Department of Orthopedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - André Klein
- Information Technology, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA.
| | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg, Germany; Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Markus Wennmann
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg, Germany.
| | - Stefan Delorme
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg, Germany.
| | - Hartmut Goldschmidt
- Internal Medicine V and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.
| | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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Wennmann M, Klein A, Bauer F, Chmelik J, Grözinger M, Uhlenbrock C, Lochner J, Nonnenmacher T, Rotkopf LT, Sauer S, Hielscher T, Götz M, Floca RO, Neher P, Bonekamp D, Hillengass J, Kleesiek J, Weinhold N, Weber TF, Goldschmidt H, Delorme S, Maier-Hein K, Schlemmer HP. Combining Deep Learning and Radiomics for Automated, Objective, Comprehensive Bone Marrow Characterization From Whole-Body MRI: A Multicentric Feasibility Study. Invest Radiol 2022; 57:752-763. [PMID: 35640004 DOI: 10.1097/rli.0000000000000891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Disseminated bone marrow (BM) involvement is frequent in multiple myeloma (MM). Whole-body magnetic resonance imaging (wb-MRI) enables to evaluate the whole BM. Reading of such whole-body scans is time-consuming, and yet radiologists can transfer only a small fraction of the information of the imaging data set to the report. This limits the influence that imaging can have on clinical decision-making and in research toward precision oncology. The objective of this feasibility study was to implement a concept for automatic, comprehensive characterization of the BM from wb-MRI, by automatic BM segmentation and subsequent radiomics analysis of 30 different BM spaces (BMS). MATERIALS AND METHODS This retrospective multicentric pilot study used a total of 106 wb-MRI from 102 patients with (smoldering) MM from 8 centers. Fifty wb-MRI from center 1 were used for training of segmentation algorithms (nnU-Nets) and radiomics algorithms. Fifty-six wb-MRI from 8 centers, acquired with a variety of different MRI scanners and protocols, were used for independent testing. Manual segmentations of 2700 BMS from 90 wb-MRI were performed for training and testing of the segmentation algorithms. For each BMS, 296 radiomics features were calculated individually. Dice score was used to assess similarity between automatic segmentations and manual reference segmentations. RESULTS The "multilabel nnU-Net" segmentation algorithm, which performs segmentation of 30 BMS and labels them individually, reached mean dice scores of 0.88 ± 0.06/0.87 ± 0.06/0.83 ± 0.11 in independent test sets from center 1/center 2/center 3-8 (interrater variability between radiologists, 0.88 ± 0.01). The subset from the multicenter, multivendor test set (center 3-8) that was of high imaging quality was segmented with high precision (mean dice score, 0.87), comparable to the internal test data from center 1. The radiomic BM phenotype consisting of 8880 descriptive parameters per patient, which result from calculation of 296 radiomics features for each of the 30 BMS, was calculated for all patients. Exemplary cases demonstrated connections between typical BM patterns in MM and radiomic signatures of the respective BMS. In plausibility tests, predicted size and weight based on radiomics models of the radiomic BM phenotype significantly correlated with patients' actual size and weight ( P = 0.002 and P = 0.003, respectively). CONCLUSIONS This pilot study demonstrates the feasibility of automatic, objective, comprehensive BM characterization from wb-MRI in multicentric data sets. This concept allows the extraction of high-dimensional phenotypes to capture the complexity of disseminated BM disorders from imaging. Further studies need to assess the clinical potential of this method for automatic staging, therapy response assessment, or prediction of biopsy results.
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Affiliation(s)
| | - André Klein
- Medical Image Computing, German Cancer Research Center
| | | | | | | | | | | | - Tobias Nonnenmacher
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg
| | | | - Sandra Sauer
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center, Heidelberg
| | | | | | - Peter Neher
- Medical Image Computing, German Cancer Research Center
| | | | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY
| | | | - Niels Weinhold
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg
| | - Tim Frederik Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg
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Gertz M. Smoldering multiple myeloma: Reviewing the rationale for intervention. Leuk Lymphoma 2022; 63:2033-2040. [PMID: 35532298 PMCID: PMC9719610 DOI: 10.1080/10428194.2022.2068008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/09/2022] [Indexed: 10/18/2022]
Abstract
Smoldering multiple myeloma has been recognized for over 40 years and represents a pre-symptomatic phase of the 2nd most common hematologic malignancy. 1/3 of patients will remain asymptomatic at 10 years. There is an identifiable subset of patients that will develop CRAB within 2 years of recognition and these patients are considered for therapeutic intervention before the development of potentially irreversible complications. Obstacles to widespread implementation of therapeutic guidelines are limited by the variable definitions associated with this high-risk group as well as the poor concordance between classification schemes. Analysis of clinical trial outcomes as well as uniform eligibility helps determine whether a given patient should be considered for therapeutic intervention outside of a clinical trial.
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Affiliation(s)
- Morie Gertz
- Mayo Clinic Rochester Minnesota, Rochester, USA
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Weber MA, Bazzocchi A, Nöbauer-Huhmann IM. Tumors of the Spine: When Can Biopsy Be Avoided? Semin Musculoskelet Radiol 2022; 26:453-468. [PMID: 36103887 DOI: 10.1055/s-0042-1753506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Regarding osseous tumors of the spine, characteristic morphology is encountered in hemangioma of the vertebral body, osteoid osteoma (OO), osteochondroma, Paget's disease, and bone islands. In these cases, radiologic imaging can make a specific diagnosis and thereby avoid biopsy, especially when the radiologist has chosen the correct imaging modality to establish the diagnosis, such as thin-slice computed tomography in suspected OO. A benign lesion is suggested by a high amount of fat within the lesion, the lack of uptake of the contrast agent, and a homogeneous aspect without solid parts in a cystic tumor. Suspicion of malignancy should be raised in spinal lesions with a heterogeneous disordered matrix, distinct signal decrease in T1-weighted magnetic resonance imaging, blurred border, perilesional edema, cortex erosion, and a large soft tissue component. Biopsy is mandatory in presumed malignancy, such as any Lodwick grade II or III osteolytic lesion in the vertebral column. The radiologist plays a crucial role in determining the clinical pathway by choosing the imaging approach wisely, by narrowing the differential diagnosis list, and, when characteristic morphology is encountered, by avoiding unnecessary biopsies.
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Affiliation(s)
- Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, The Rizzoli Orthopedic Institute, Bologna, Italy
| | - Iris-M Nöbauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
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Wennmann M, Goldschmidt H, Mosebach J, Hielscher T, Bäuerle T, Komljenovic D, McCarthy PL, Merz M, Schlemmer HP, Raab MS, Sauer S, Delorme S, Hillengass J. Whole-body magnetic resonance imaging plus serological follow-up for early identification of progression in smouldering myeloma patients to prevent development of end-organ damage. Br J Haematol 2022; 199:65-75. [PMID: 35608264 DOI: 10.1111/bjh.18232] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/26/2022]
Abstract
The definition of multiple myeloma (MM) was updated in 2014, with the intent to enable earlier treatment and thereby avoid appearance of end-organ damage at progression from smouldering multiple myeloma (SMM) to MM. The purpose of this study was to investigate to which extent the development of end-organ damage at progression to MM was reduced under the updated guidelines. In this prospective observational cohort study (ClinicalTrials.gov Identifier: NCT01374412), between 2014 and 2020, 96 SMM patients prospectively underwent whole-body magnetic resonance imaging (wb-MRI) and serological follow-up at baseline and every 6 months thereafter. A total of 22 patients progressed into MM during follow-up, of which seven (32%) showed SLiM-criteria only but no end-organ damage. Four (57%) of the seven patients who progressed by SLiM-criteria only progressed with >1 focal lesion (FL) or a growing FL, and three (43%) due to serum free light-chain-ratio ≥100. Fifteen (68%) out of 22 patients who progressed still suffered from end-organ damage at progression. The updated disease definition reduced the proportion of SMM patients suffering from end-organ damage at progression to MM by one third. wb-MRI is an important tool for detection of SMM patients who progress to MM without end-organ damage.
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Affiliation(s)
- Markus Wennmann
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hartmut Goldschmidt
- Multiple Myeloma Section, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Jennifer Mosebach
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tobias Bäuerle
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) and University Hospital Erlangen, Erlangen, Germany
| | - Dorde Komljenovic
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philip L McCarthy
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Maximilian Merz
- Multiple Myeloma Section, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.,Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | | | - Marc-Steffen Raab
- Multiple Myeloma Section, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Sandra Sauer
- Multiple Myeloma Section, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Delorme
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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[Potential of radiomics and artificial intelligence in myeloma imaging : Development of automatic, comprehensive, objective skeletal analyses from whole-body imaging data]. Radiologe 2021; 62:44-50. [PMID: 34889968 DOI: 10.1007/s00117-021-00940-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
CLINICAL/METHODICAL ISSUE Multiple myeloma can affect the complete skeleton, which makes whole-body imaging necessary. With the current assessment of these complex datasets by radiologists, only a small part of the accessible information is assessed and reported. STANDARD RADIOLOGICAL METHODS Depending on the question and availability, computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) is performed and the results are then visually examined by radiologists. METHODOLOGICAL INNOVATIONS A combination of automatic skeletal segmentation using artificial intelligence and subsequent radiomics analysis of each individual bone have the potential to provide automatic, comprehensive, and objective skeletal analyses. PERFORMANCE A few automatic skeletal segmentation algorithms for CT already show promising results. In addition, first studies indicate correlations between radiomics features of bone and bone marrow with established disease markers and therapy response. ACHIEVEMENTS Artificial intelligence (AI) and radiomics algorithms for automatic skeletal analysis from whole-body imaging are currently in an early phase of development.
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