Prognostic Significance of Focal Lesions in Whole-Body Magnetic Resonance Imaging in Patients With Asymptomatic Multiple Myeloma

Department of Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany.
Journal of Clinical Oncology (Impact Factor: 18.43). 02/2010; 28(9):1606-10. DOI: 10.1200/JCO.2009.25.5356
Source: PubMed

ABSTRACT With whole-body magnetic resonance imaging (wb-MRI), almost the whole bone marrow compartment can be examined in patients with monoclonal plasma cell disease. Focal lesions (FLs) detected by spinal MRI have been of prognostic significance in symptomatic multiple myeloma (sMM). In this study, we investigated the prognostic significance of FLs in wb-MRI in patients with asymptomatic multiple myeloma (aMM).
Wb-MRI was performed in 149 patients with aMM. The prognostic significance of the presence and absence, as well as the number, of FLs for progression into sMM was analyzed.
FLs were present in 28% of patients. The presence per se of FLs and a number of greater than one FL were the strongest adverse prognostic factors for progression into sMM (P < .001) in multivariate analysis. A diffuse infiltration pattern in MRI, a monoclonal protein of 40 g/L or greater, and a plasma cell infiltration in bone marrow of 20% or greater were other adverse prognostic factors for progression-free survival in univariate analysis.
We recommend use of wb-MRI for risk stratification of patients with asymptomatic multiple myeloma.

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Available from: Stefan Delorme, Sep 26, 2015
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    • "Moulopoulos et al (1995) reported that patients with conventionally defined asymptomatic MM and abnormal MRI findings progressed to symptomatic disease more quickly than those with normal MRI. In a recent report on 149 patients with smouldering MM, the presence of FLs on WB-MRI was the strongest adverse prognostic factor for subsequent progression to symptomatic MM (Hillengass et al, 2010). In the light of such observations, (WB)-MRI should be planned in patients with smouldering MM, as it may help assess the risk of progression and lead to a better definition of symptomatic disease (Table I). "
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    ABSTRACT: Bone disease is the major feature of multiple myeloma (MM). Imaging is required for correct staging, in the follow-up after treatment and, as recently highlighted, is predictor of prognosis. In the near future, whole-body X-Ray may be replaced by more sensitive techniques, such as whole-body low-dose computerized tomography (CT). Magnetic resonance imaging (MRI) is the gold standard method for assessing bone marrow infiltration of the spine, predicting the risk of vertebral fracture and distinguishing between benign and malignant osteoporosis. Positron emission tomography (PET) with CT (PET/CT) provides important information about the extent of whole-body disease, including soft tissue masses, and is the best tool to distinguish between active or inactive disease after therapy. Both MRI and PET/CT are predictors of clinical outcome. A prospective use of these newer imaging techniques in both clinical trials and clinical practice may help optimize MM management in the near future.
    British Journal of Haematology 08/2012; 159(5). DOI:10.1111/bjh.12007 · 4.71 Impact Factor
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    • "The prognostic significance of the number and presence of those lesions has been shown recently (Hillengass, et al 2010, Walker, et al 2007). Diffuse infiltration, which can be detected in nearly the same proportion of patients, has also been demonstrated to be of prognostic as well as pathophysiologic significance (Hillengass, et al 2010, Moulopoulos, et al 2010, Moulopoulos, et al 2005), but it is hard to assess and impossible to quantify. "
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    ABSTRACT: Bone marrow plasma cell infiltration is a crucial parameter of disease activity in monoclonal plasma cell disorders. Until now, the only way to quantify such infiltration was bone marrow biopsy or aspiration. Diffusion-weighted imaging (DWI) is a magnetic resonance imaging-technique that may mirror tissue cellularity by measuring random movements of water molecules. To investigate if DWI is capable of assessing bone marrow cellularity in monoclonal plasma cell disease, we investigated 56 patients with multiple myeloma or monoclonal gammopathy of undetermined significance, and 30 healthy controls using DWI of the pelvis and/or the lumbar spine. In 25 of 30 patients who underwent biopsy, bone marrow trephine and DWI could be compared. Of the patients with symptomatic disease 15 could be evaluated after systemic treatment. There was a positive correlation between the DWI-parameter apparent diffusion coefficient (ADC) and bone marrow cellularity as well as micro-vessel density (P<0·001 respectively). ADC was significantly different between patients and controls (P<0·01) and before and after systemic therapy (P<0·001). In conclusion, DWI enabled bone marrow infiltration to be monitored in a non-invasive, quantitative way, suggesting that after further investigations on larger patient groups this might become an useful tool in the clinical work-up to assess tumour burden.
    British Journal of Haematology 06/2011; 153(6):721-8. DOI:10.1111/j.1365-2141.2011.08658.x · 4.71 Impact Factor
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    ABSTRACT: Klinisches/methodisches Problem Aufgabe der bildgebenden Diagnostik monoklonaler Plasmazellerkrankungen ist der Nachweis der Endorganschädigung, d. h. der Osteoporose oder der Destruktion des mineralisierten Knochens. Die alleinige umschriebene oder diffuse Markrauminfiltration ohne knöcherne Destruktion gilt nach heutiger Konvention nicht als Endorganschädigung. Radiologische Standardverfahren Konventioneller Röntgenskelettstatus zur Erfassung umschriebener Knochendestruktionen, von Osteoporose oder Frakturen. Methodische Innovationen Die Ganzkörper-low-dose-CT und Ganzkörper-MRT ermöglichen eine Darstellung sowohl des mineralisierten Knochens als auch des Knochenmarks mit einer höheren Sensitivität, höherem Patientenkomfort und im Falle der MRT ohne Strahlenbelastung. Leistungsfähigkeit Nach den Ergebnissen der Literatur sind Schnittbildverfahren dem Röntgenskelettstatus signifikant überlegen, wobei die Ganzkörper-MRT für den Nachweis insbesondere eines diffusen Knochenmarkbefalls signifikant besser ist als die Ganzkörper-CT. Praktisch jeder osteodestruktive Herd ist in der MRT sichtbar. Allerdings ist für die Beurteilung der Osteodestruktion selbst wiederum eine CT erforderlich. Die Sensitivitäten von PET/CT und MRT sind vergleichbar. Bewertung Wie bereits in einigen Zentren insbesondere in Deutschland umgesetzt, sollten bei Verfügbarkeit das Ganzkörper-MRT und das Ganzkörper-CT den konventionellen Röntgenskelettstatus ersetzen. Empfehlung für die Praxis Bei Erstdiagnose bzw. Verdacht auf eine monoklonale Gammopathie unklarer Signifikanz (MGUS), „smoldering multiple myeloma“ und symptomatisches multiples Myelom sollten sowohl eine Ganzkörper-MRT als auch eine Ganzkörper-CT durchgeführt werden. Bei asymptomatischem Myelom oder MGUS wäre die Ganzkörper-MRT bis zur Detektion des ersten umschriebenen Myelomherdes ausreichend. Beim symptomatischen Myelom mit Knochenläsionen sollten in der Regel die Ganzkörper-CT und für spezielle Fragestellungen die MRT eingesetzt werden.
    Der Radiologe 04/2012; 52(4). DOI:10.1007/s00117-011-2257-0 · 0.43 Impact Factor
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