Increasing Bone Sclerosis During Bortezomib Therapy in Multiple Myeloma Patients: Results of a Reduced-Dose Whole-Body MDCT Study.
ABSTRACT OBJECTIVE. The objective of our study was to assess the frequency, location, extent, and patterns of bone sclerosis occurring in patients with multiple myeloma (MM) during bortezomib-based therapy. MATERIALS AND METHODS. From June 2003 through December 2011, 593 whole-body reduced-dose MDCT studies were performed of 79 consecutive patients receiving bortezomib. The median surveillance time was 21 months (range, 3-67 months). Baseline studies were compared with follow-up studies during therapy (follow-up 1), at the end of therapy (follow-up 2), and 12 months after cessation of bortezomib therapy (follow-up 3). We recorded any sclerotic change occurring inside or along the margins of the osteolytic lesions, in the cancellous bone, or inside preexistent medullary or extramedullary lesions. The time point of occurrence of bone sclerosis was correlated with the best hematologic response category. RESULTS. Fourteen (17.7%) patients developed focal (n = 11) or diffuse (n = 3) bone sclerosis. The time window from bortezomib initiation to radiographic detection of bone sclerosis was 8 months (SD, 7 months). Sclerosis occurred at multiple sites (n = 7) or at an isolated site (n = 7). On subsequent whole-body reduced-dose MDCT studies, sclerosis further increased in seven (50%) patients. Hematologic best response during bortezomib treatment was complete response (n = 1), very good partial response (n = 2), partial response (n = 8), and stable disease (n = 3). Radiologic response at the time of sclerosis detection was partial response (n = 8), stable disease (n = 2), and progressive disease (n = 4). CONCLUSION. Bone remineralization may occur during bortezomib-based therapy for MM in a substantial proportion of patients. The extent, location, and patterns of sclerosis differ among patients and are unpredictable. Sclerosis was documented even in patients showing suboptimal hematologic response.
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ABSTRACT: The identification of bone lesions and extramedullary disease is crucial in the diagnosis of myeloma. Whole-body X-ray (WBXR) is considered the gold standard for the detection of myeloma bone lesions. Nevertheless, the International Myeloma Working Group recently updated the disease definition and emphasised the value of magnetic resonance imaging (MRI), computed tomography (CT) alone or combined with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). The presence of more than one focal lesion with MRI or the presence of one or more lytic bone lesion with CT (including low dose CT alone or combined with FDG PET) is considered as myeloma defining events (if 5 mm or more in size). Due to its higher sensitivity to detect bone lesions (in comparison with WBXR), MRI of spine and pelvis is mandatory for patients with solitary plasmacytoma as additional bone lesions can be detected in approximately one-third of cases. MRI is also recommended in patients with smouldering myeloma and may be considered for the staging of multiple myeloma (MM). Moreover, accurate imaging of MM and related plasma cell disorders using MRI and/or FDG PET/CT may provide information on tumour burden, aggressiveness and tumour heterogeneity. Nonetheless, inclusion of MRI and FDG PET/CT for MM patient stratification and therapeutic decisions remains to define.04/2015; 3(2):95-109. DOI:10.1007/s40336-015-0119-x
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ABSTRACT: To investigate the performance of a new CT software generating rib unfolded images for improved detection of rib osteolyses in patients with multiple myeloma. One hundred sixteen patients who underwent whole-body reduced-dose multidetector computed tomography (WBRD-MDCT) for multiple myeloma diagnosis and during follow-up were retrospectively evaluated. Nonenhanced CT scans with 5- and 1-mm slice thickness were interpreted by two readers with focus on detection of rib involvement (location, number, fracture). Image analysis of "unfolded," 1-mm-based CT rib images was subsequently undertaken. We classified the number of lytic bone lesions into 0, 1, 2, <5, <10 and ≥10. For all three data sets the reading time was registered. An approximated sum of 6,727 myeloma-related rib lesions was found. On a patient-based analysis, CT (5 mm), CT (1 mm) and CT (1 mm "unfolded rib") yielded a sensitivity, specificity and accuracy of 79.7/94.7/87.1, 88.1/93/90.5 and 98.3/96.5/97.4, respectively. In a lesion-based analysis, the sensitivity, specificity and accuracy of the three evaluations were 69.7/87.2/70.5, 79.8/55.9/78 and 96.5/89.7/96.1. Mean reading time for 5 mm/1 mm axial images and unfolded images was 178.7/215.1/90.8 s, respectively. The generation of "unfolded rib" images improves detection of rib involvement in patients with multiple myeloma and significantly reduces reading time.Skeletal Radiology 04/2015; 44(7). DOI:10.1007/s00256-015-2131-7 · 1.74 Impact Factor