Appearance of monoclonal plasma cell diseases in whole-body MRI and correlation with parameters of disease activity
International Journal of Cancer (Impact Factor: 5.09). 11/2014; 135(10). DOI: 10.1002/ijc.28877
The aim of this study was to assess in which way different infiltration patterns of monoclonal plasma cell diseases in whole-body (wb) MRI are associated with clinical stages, plasma cell content in bone marrow samples, and established serum markers of disease activity. Institutional review board approval was obtained. We performed wb-MRI in 547 consecutive, unselected and untreated patients with monoclonal gammopathy of undetermined significance (MGUS, n=138), smoldering myeloma (SMM, n=157) and multiple myeloma (MM, n=252) on two 1.5 Tesla MRI-scanners with body array coils. The studies were evaluated in consensus by two experienced radiologists blinded to the diagnosis. We observed focal lesions in 23.9% (MGUS), 34.4% (SMM) and 81.3% (MM), respectively. A diffuse infiltration pattern was detected in 38.4%, 45.9%, and 71%, respectively. The differences between all infiltration patterns were significant (p<0.0001). The presence of focal lesions and the presence of a diffuse bone marrow infiltration was associated with an increased plasma cell percentage in bone marrow samples (median 22% vs. 14%, 26% vs. 10%, both p<0.0001) and monoclonal protein concentration (median 18 g/dl vs. 13 g/dl, p=0.003, 20g/dl vs. 11 g/dl, p < 0.0001). Further categorization of the diffuse infiltration patterns in wb-MRI into “salt-and-pepper", moderate, and severe identified significant associations with M-protein (median g/dl for S+P/moderate/severe 23/18/25, p=0.04), plasma cell percentage in the bone marrow (median 25%/24%/40%, p=0.02), and age (median years 67/60/57, p<0.0001). Bone marrow infiltration in wb-MRI is significantly different between the various stages of plasma cell disease and correlates well with established markers of disease activity. © 2014 Wiley Periodicals, Inc.
- [Show abstract] [Hide abstract]
ABSTRACT: Detection of lytic bone lesions is a crucial in the work up for multiple myeloma and very often dictates the decision to start treatment. Conventional radiography, despite decades of use, is often insufficient for detection of bone disease in multiple myeloma. Modern imaging techniques such as magnetic resonance imaging (MRI), positron-emission tomography, and computed tomography offer superior detection of myeloma bone disease and extramedullary manifestations of plasma cell dyscrasias. Novel whole-body low-dose computed tomography (WBLDCT) protocols allow for collection of superior image detail of the skeleton at doses of radiation similar to that of conventional planar radiography. Several studies have shown that WBLDCT has a superior detection rate for lytic bone lesions compared to whole body X-ray (WBXR), potentially leading to restaging and changes in therapy. MRI and PET provide imaging data important for assessing disease activity and prognostication. Due to several advantages over WBXR, WBLDCT is already the standard imaging technique for use in multiple myeloma patients in many European institutions. However, the radiographic skeletal survey or WBXR is still initial study of choice used to screen for myeloma bone disease in many institutions. In this review, we aim to explore the changing landscape of imaging for myeloma bone disease through use of modern imaging techniques.Clinical Cancer Research 10/2014; 20(23). DOI:10.1158/1078-0432.CCR-14-1692 · 8.72 Impact Factor
- Journal of Clinical Oncology 01/2015; 33(6). DOI:10.1200/JCO.2014.59.5066 · 18.43 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.