Value of whole body MRI and dynamic contrast enhanced MRI in the diagnosis,follow-up and evaluation of disease activity and extent in multiple myeloma |
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Authors: | Julie C. Dutoit Matthias A. Vanderkerken Koenraad L. Verstraete |
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Affiliation: | Department of Radiology, MR-1K12, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium |
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Abstract: | PurposeTo evaluate the significance of dynamic contrast enhanced MRI (DCE-MRI) and whole body MRI (WB-MRI) in the diagnosis, prognosis and assessment of therapy for patients with monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM).Materials and methodsThe retrospective study includes 219 patients providing 463 WB-MRI and DCE-MRI investigations for the subgroups MGUS (n = 70), MM active disease (n = 126; this includes 70 patients with new diagnosis of MM, according to the International Staging System (ISS): 41.4% ISS stage I, 20.0% ISS stage II, 7.1% ISS stage III, 31.4% insufficient for staging; and 56 patients with ‘(re-)active disease’: 16.07% relapse, 32.14% progressive disease and 51.79% stable disease) and MM remission (n = 23; 60.87% complete remission, 17.39% very good partial remission and 21.74% partial remission). Investigations of patients with hereditary multiple exostoses (n = 5), neurofibromatosis (n = 7) and healthy persons (n = 9) were added as control subjects (n = 21). WB-MRI evaluation was done by evaluating thirteen skeletal regions, providing a ‘skeletal score’. DCE-MRI images of the spine, were analyzed with regions-of-interest and time-intensity-curves (TIC).ResultsAll TIC parameters can significantly differentiate between the predefined subgroups (p < 0.001). One hundred days after autologous stem cell transplantation a 75% decrease of the slope wash-in value (p < 0.001) can be seen. A cubic regression trend between ‘skeletal score’ and slope wash-in (adj.R2 = 0.412) could demonstrate a significant increase bone marrow perfusion if MM affects more than 10 skeletal regions (p < 0.001), associated with a poorer prognosis (p < 0.001).ConclusionDCE-MRI evaluation of the spine is useful for diagnosis of MM, follow-up after stem cell transplantation and evaluation of disease activity. A combined evaluation with WB-MRI and DCE-MRI provides additional micro-vascular information on the morphologic lesions and could help categorize patients with MM in two different groups to offer useful therapeutic and prognostic advise. |
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Keywords: | ASCT, autologous stem cell transplantation a.U., arbitrary units A, artery CR, complete response DCE-MRI, dynamic contrast enhanced MRI IMWG, International Myeloma Working Group ISS, international staging system MPNST, malignant peripheral nerve sheath tumor MRI, magnetic resonance imaging MVD, micro vascular density MGUS, monoclonal gammopathy of undetermined significance MM, multiple myeloma M, muscle NF, neurofibromatosis PR, partial response PET, positron-emission tomography PD, progressive disease ROC, receiver operating characteristics ROI, region of interest SI, signal intensity sMM, smouldering multiple myeloma SD, stable disease T, time TIC, time-intensity curve TVA, total vascular area V, vertebra VGPR, very good partial response WI, wash-in WO, wash-out WB-MRI, whole body-MRI |
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