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Cui S, Guo Y, Niu W, Li J, Bian W, Wu W, Zhang W, Zheng Q, Wang J, Niu J. The quantitative parameters based on marrow metabolism derived from synthetic MRI: A pilot study of prognostic value in participants with newly diagnosed multiple myeloma. Cancer Med 2024; 13:e7109. [PMID: 38553942 PMCID: PMC10980927 DOI: 10.1002/cam4.7109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 01/16/2024] [Accepted: 03/02/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The value of SyMRI-derived parameters from lumbar marrow for predicting early treatment response and optimizing the risk stratification of the Revised International Staging System (R-ISS) in participants with multiple myeloma (MM) is unknown. METHODS We prospectively enrolled participants with newly diagnosed MM before treatment. The SyMRI of lumbar marrow was used to calculate T1, T2, and PD values and the clinical features were collected. All participants were divided into good response (≥VGPR) and poor response ( RESULTS Fifty-nine participants (good response, n = 33; poor response, n = 26) were evaluated. The bone marrow plasma cell percentage, β2-microglobulin, T1 and T2 value were difference between two groups (all p < 0.05). The T1 (odds ratio 1.003, p = 0.005) and T2 values (odds ratio 0.910, p = 0.002) were independent predictors and the AUC and cut-off values were 0.787, 967.2 ms and 0.784, 75.9 ms, respectively. There were no significant differences in SyMRI parameters between genders. Participants with both T1 value ≥967.2 ms and T2 value ≤75.9 ms in the R-ISS II stage were potentially to get poor response. CONCLUSIONS Synthetic MRI is a promising tool for predicting early treatment response to MM and promoting R-ISS II stage risk stratification.
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Affiliation(s)
- Sha Cui
- Department of Medical ImagingShanxi Medical UniversityTaiyuanChina
- Department of RadiologySecond Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Yinnan Guo
- Department of PainFifth Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Weiran Niu
- Department of Medical ImagingShanxi Medical UniversityTaiyuanChina
| | - Jianting Li
- Department of RadiologySecond Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Wenjin Bian
- Department of Medical ImagingShanxi Medical UniversityTaiyuanChina
| | - Wenqi Wu
- Department of RadiologySecond Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Wenjia Zhang
- Department of RadiologySecond Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Qian Zheng
- Department of RadiologySecond Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Jun Wang
- Department of RadiologySecond Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Jinliang Niu
- Department of RadiologySecond Hospital of Shanxi Medical UniversityTaiyuanChina
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Zhang B, Zhang L, Bian B, Lin F, Zhu Z, Wang J. Diagnostic value of WB-DWI versus 18F-FDG PET/CT for the detection of multiple myeloma. Indian J Cancer 2023; 60:303-309. [PMID: 37787189 DOI: 10.4103/ijc.ijc_1129_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Background Whole-body diffusion-weighted imaging (WB-DWI) is commonly used for the detection of multiple myeloma (MM). Comparative data on the efficiency of WB-DWI compared with F-18 fluoro-2-deoxy-d-glucose positron emission tomography-computed tomography (18F-FDG PET/CT) to detect MM is limited. Methods This was a retrospective, single-center study of 22 patients with MM enrolled from January 2018 to December 2019. All patients underwent WB-DWI and 18F-FDG PET/CT. Pathological and clinical manifestations, as well as radiologic follow-up, were used for diagnosis. The overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of both methods were compared. The apparent diffusion coefficient (ADC) values of MM lesions and false-positive lesions were estimated. Results A total of 214 MM bone lesions were evaluated. There was no significant difference in the accuracy of WB-DWI and PET/CT (86.92 versus 88.32%). Though WB-DWI had a higher sensitivity (99.26% versus84.56%) and PET-CT had a higher specificity (96.10% versus 64.56%), these differences were not statistically significant. There was a statistically significant difference in PPV (83.33% versus 96.64%) and NPV (98.08% versus 77.89%) of WB-DWI and PET/CT, respectively. The ADC value for MM lesions was significantly lower than that for false-positive lesions (P < 0.001). Receiver operating curve analysis showed that the AUC was 0.846, and when the cut-off value was 0.745 × 10-3 mm2/s, the sensitivity and specificity were 86.3 and 83.4%, respectively, which distinguished MM lesions from non-MM lesions. Conclusion WB-DWI and PET-CT scans have similar overall accuracy for detecting MM lesions. The higher PPV of PET-CT and NPV of WB-DWI make them complementary imaging modalities. The ADC value for MM lesions is significantly lower than that for false-positive lesions. An ADC cutoff value of 0.745 × 10-3 mm2/s results in sensitivity and specificity of 86.3 and 83.4%, respectively.
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Affiliation(s)
- Bei Zhang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Li Zhang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Bingyang Bian
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Fang Lin
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Zining Zhu
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Jiping Wang
- Department of Radiology, First Hospital of Jilin University, Changchun, China
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Wennmann M, Neher P, Stanczyk N, Kahl KC, Kächele J, Weru V, Hielscher T, Grözinger M, Chmelik J, Zhang KS, Bauer F, Nonnenmacher T, Debic M, Sauer S, Rotkopf LT, Jauch A, Schlamp K, Mai EK, Weinhold N, Afat S, Horger M, Goldschmidt H, Schlemmer HP, Weber TF, Delorme S, Kurz FT, Maier-Hein K. Deep Learning for Automatic Bone Marrow Apparent Diffusion Coefficient Measurements From Whole-Body Magnetic Resonance Imaging in Patients With Multiple Myeloma: A Retrospective Multicenter Study. Invest Radiol 2023; 58:273-282. [PMID: 36256790 DOI: 10.1097/rli.0000000000000932] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
OBJECTIVES Diffusion-weighted magnetic resonance imaging (MRI) is increasingly important in patients with multiple myeloma (MM). The objective of this study was to train and test an algorithm for automatic pelvic bone marrow analysis from whole-body apparent diffusion coefficient (ADC) maps in patients with MM, which automatically segments pelvic bones and subsequently extracts objective, representative ADC measurements from each bone. MATERIALS AND METHODS In this retrospective multicentric study, 180 MRIs from 54 patients were annotated (semi)manually and used to train an nnU-Net for automatic, individual segmentation of the right hip bone, the left hip bone, and the sacral bone. The quality of the automatic segmentation was evaluated on 15 manually segmented whole-body MRIs from 3 centers using the dice score. In 3 independent test sets from 3 centers, which comprised a total of 312 whole-body MRIs, agreement between automatically extracted mean ADC values from the nnU-Net segmentation and manual ADC measurements from 2 independent radiologists was evaluated. Bland-Altman plots were constructed, and absolute bias, relative bias to mean, limits of agreement, and coefficients of variation were calculated. In 56 patients with newly diagnosed MM who had undergone bone marrow biopsy, ADC measurements were correlated with biopsy results using Spearman correlation. RESULTS The ADC-nnU-Net achieved automatic segmentations with mean dice scores of 0.92, 0.93, and 0.85 for the right pelvis, the left pelvis, and the sacral bone, whereas the interrater experiment gave mean dice scores of 0.86, 0.86, and 0.77, respectively. The agreement between radiologists' manual ADC measurements and automatic ADC measurements was as follows: the bias between the first reader and the automatic approach was 49 × 10 -6 mm 2 /s, 7 × 10 -6 mm 2 /s, and -58 × 10 -6 mm 2 /s, and the bias between the second reader and the automatic approach was 12 × 10 -6 mm 2 /s, 2 × 10 -6 mm 2 /s, and -66 × 10 -6 mm 2 /s for the right pelvis, the left pelvis, and the sacral bone, respectively. The bias between reader 1 and reader 2 was 40 × 10 -6 mm 2 /s, 8 × 10 -6 mm 2 /s, and 7 × 10 -6 mm 2 /s, and the mean absolute difference between manual readers was 84 × 10 -6 mm 2 /s, 65 × 10 -6 mm 2 /s, and 75 × 10 -6 mm 2 /s. Automatically extracted ADC values significantly correlated with bone marrow plasma cell infiltration ( R = 0.36, P = 0.007). CONCLUSIONS In this study, a nnU-Net was trained that can automatically segment pelvic bone marrow from whole-body ADC maps in multicentric data sets with a quality comparable to manual segmentations. This approach allows automatic, objective bone marrow ADC measurements, which agree well with manual ADC measurements and can help to overcome interrater variability or nonrepresentative measurements. Automatically extracted ADC values significantly correlate with bone marrow plasma cell infiltration and might be of value for automatic staging, risk stratification, or therapy response assessment.
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Affiliation(s)
| | - Peter Neher
- Medical Image Computing, German Cancer Research Center (DKFZ)
| | | | - Kim-Celine Kahl
- Medical Image Computing, German Cancer Research Center (DKFZ)
| | - Jessica Kächele
- Medical Image Computing, German Cancer Research Center (DKFZ)
| | - Vivienn Weru
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | | | | | | | | | - Sandra Sauer
- Department of Internal Medicine V, Section Multiple Myeloma
| | | | | | | | - Elias Karl Mai
- Department of Internal Medicine V, Section Multiple Myeloma
| | - Niels Weinhold
- Department of Internal Medicine V, Section Multiple Myeloma
| | - Saif Afat
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, Tuebingen
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, Tuebingen
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Diffusion-weighted imaging (DWI) in diagnosis, staging, and treatment response assessment of multiple myeloma: a systematic review and meta-analysis. Skeletal Radiol 2023; 52:565-583. [PMID: 35881152 DOI: 10.1007/s00256-022-04119-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the role of diffusion-weighted imaging (DWI) in the initial diagnosis, staging, and assessment of treatment response in patients with multiple myeloma (MM). MATERIALS AND METHODS A systematic literature review was conducted in PubMed, the Cochrane Library, EMBASE, Scopus, and Web of Science databases. The primary endpoints were defined as the diagnostic performance of DWI for disease detection, staging of MM, and assessing response to treatment in these patients. RESULTS Of 5881 initially reviewed publications, 33 were included in the final qualitative and quantitative meta-analysis. The diagnostic performance of DWI in the detection of patients with MM revealed pooled sensitivity and specificity of 86% (95% CI: 84-89) and 63% (95% CI: 56-70), respectively, with a diagnostic odds ratio (OR) of 14.98 (95% CI: 4.24-52.91). The pooled risk difference of 0.19 (95% CI: - 0.04-0.42) was reported in favor of upstaging with DWI compared to conventional MRI (P value = 0.1). Treatment response evaluation and ADCmean value changes across different studies showed sensitivity and specificity of approximately 78% (95% CI: 72-83) and 73% (95% CI: 61-83), respectively, with a diagnostic OR of 7.21 in distinguishing responders from non-responders. CONCLUSIONS DWI is not only a promising tool for the diagnosis of MM, but it is also useful in the initial staging and re-staging of the disease and treatment response assessment. This can aid clinicians with earlier initiation or change in treatment strategy, which could have prognostic significance for patients.
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Barilà G, Crimì F, Arangio Febbo M, Pavan L, Vedovato S, Cabrelle G, Zanon C, Campi C, Cecchin D, Zucchetta P, Lacognata C, Semenzato G, Zambello R. Imaging minimal residual disease evaluation in multiple myeloma using [ 18F]FDG PET/MRI. Leuk Lymphoma 2023; 64:503-506. [PMID: 36382776 DOI: 10.1080/10428194.2022.2142053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Gregorio Barilà
- Hematology Unit, Azienda ULSS3 Serenissima, Ospedale dell'Angelo, Venezia-Mestre, Italy
| | - Filippo Crimì
- Department of Medicine (DIMED), Institute of Radiology, Padua University School of Medicine, Padova, Italy
| | - Massimiliano Arangio Febbo
- Department of Medicine (DIMED), Hematology and Clinical Immunology, Padua University School of Medicine, Padova, Italy
| | - Laura Pavan
- Department of Medicine (DIMED), Hematology and Clinical Immunology, Padua University School of Medicine, Padova, Italy
| | | | - Giulio Cabrelle
- Department of Medicine (DIMED), Institute of Radiology, Padua University School of Medicine, Padova, Italy
| | - Chiara Zanon
- Department of Medicine (DIMED), Institute of Radiology, Padua University School of Medicine, Padova, Italy
| | - Cristina Campi
- Department of Mathematics (DIMA), University of Genoa, Genoa, Italy
| | - Diego Cecchin
- Department of Medicine (DIMED), Nuclear Medicine Unit, School of Medicine, University Hospital of Padova, Padova, Italy
| | - Pietro Zucchetta
- Department of Medicine (DIMED), Nuclear Medicine Unit, School of Medicine, University Hospital of Padova, Padova, Italy
| | - Carmelo Lacognata
- Department of Medicine (DIMED), Institute of Radiology, Padua University School of Medicine, Padova, Italy
| | - Gianpietro Semenzato
- Department of Medicine (DIMED), Hematology and Clinical Immunology, Padua University School of Medicine, Padova, Italy
| | - Renato Zambello
- Department of Medicine (DIMED), Hematology and Clinical Immunology, Padua University School of Medicine, Padova, Italy
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Knill AK, Blackledge MD, Curcean A, Larkin J, Turajlic S, Riddell A, Koh DM, Messiou C, Winfield JM. Optimisation of b-values for the accurate estimation of the apparent diffusion coefficient (ADC) in whole-body diffusion-weighted MRI in patients with metastatic melanoma. Eur Radiol 2023; 33:863-871. [PMID: 36169688 PMCID: PMC9889461 DOI: 10.1007/s00330-022-09088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/12/2022] [Accepted: 08/04/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To establish optimised diffusion weightings ('b-values') for acquisition of whole-body diffusion-weighted MRI (WB-DWI) for estimation of the apparent diffusion coefficient (ADC) in patients with metastatic melanoma (MM). Existing recommendations for WB-DWI have not been optimised for the tumour properties in MM; therefore, evaluation of acquisition parameters is essential before embarking on larger studies. METHODS Retrospective clinical data and phantom experiments were used. Clinical data comprised 125 lesions from 14 examinations in 11 patients with multifocal MM, imaged before and/or after treatment with immunotherapy at a single institution. ADC estimates from these data were applied to a model to estimate the optimum b-value. A large non-diffusing phantom was used to assess eddy current-induced geometric distortion. RESULTS Considering all tumour sites from pre- and post-treatment examinations together, metastases exhibited a large range of mean ADC values, [0.67-1.49] × 10-3 mm2/s, and the optimum high b-value (bhigh) for ADC estimation was 1100 (10th-90th percentile: 740-1790) s/mm2. At higher b-values, geometric distortion increased, and longer echo times were required, leading to reduced signal. CONCLUSIONS Theoretical optimisation gave an optimum bhigh of 1100 (10th-90th percentile: 740-1790) s/mm2 for ADC estimation in MM, with the large range of optimum b-values reflecting the wide range of ADC values in these tumours. Geometric distortion and minimum echo time increase at higher b-values and are not included in the theoretical optimisation; bhigh in the range 750-1100 s/mm2 should be adopted to maintain acceptable image quality but performance should be evaluated for a specific scanner. KEY POINTS • Theoretical optimisation gave an optimum high b-value of 1100 (10th-90th percentile: 740-1790) s/mm2 for ADC estimation in metastatic melanoma. • Considering geometric distortion and minimum echo time (TE), a b-value in the range 750-1100 s/mm2 is recommended. • Sites should evaluate the performance of specific scanners to assess the effect of geometric distortion and minimum TE.
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Affiliation(s)
- Annemarie K Knill
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Andra Curcean
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - James Larkin
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Samra Turajlic
- The Royal Marsden NHS Foundation Trust, London, UK
- The Francis Crick Institute, London, UK
| | | | - Dow Mu Koh
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Christina Messiou
- The Institute of Cancer Research, London, UK.
- The Royal Marsden NHS Foundation Trust, London, UK.
| | - Jessica M Winfield
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
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Santoni A, Simoncelli M, Franceschini M, Ciofini S, Fredducci S, Caroni F, Sammartano V, Bocchia M, Gozzetti A. Functional Imaging in the Evaluation of Treatment Response in Multiple Myeloma: The Role of PET-CT and MRI. J Pers Med 2022; 12:jpm12111885. [PMID: 36579605 PMCID: PMC9696713 DOI: 10.3390/jpm12111885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
Bone disease is among the defining characteristics of symptomatic Multiple Myeloma (MM). Imaging techniques such as fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) and magnetic resonance imaging (MRI) can identify plasma cell proliferation and quantify disease activity. This function renders these imaging tools as suitable not only for diagnosis, but also for the assessment of bone disease after treatment of MM patients. The aim of this article is to review FDG PET/CT and MRI and their applications, with a focus on their role in treatment response evaluation. MRI emerges as the technique with the highest sensitivity in lesions' detection and PET/CT as the technique with a major impact on prognosis. Their comparison yields different results concerning the best tool to evaluate treatment response. The inhomogeneity of the data suggests the need to address limitations related to these tools with the employment of new techniques and the potential for a complementary use of both PET/CT and MRI to refine the sensitivity and achieve the standards for minimal residual disease (MRD) evaluation.
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Advanced Imaging in Multiple Myeloma: New Frontiers for MRI. Diagnostics (Basel) 2022; 12:diagnostics12092182. [PMID: 36140583 PMCID: PMC9497462 DOI: 10.3390/diagnostics12092182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/17/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Plasma cell dyscrasias are estimated to newly affect almost 40,000 people in 2022. They fall on a spectrum of diseases ranging from relatively benign to malignant, the malignant end of the spectrum being multiple myeloma (MM). The International Myeloma Working Group (IMWG) has traditionally outlined the diagnostic criteria and therapeutic management of MM. In the last two decades, novel imaging techniques have been employed for MM to provide more information that can guide not only diagnosis and staging, but also treatment efficacy. These imaging techniques, due to their low invasiveness and high reliability, have gained significant clinical attention and have already changed the clinical practice. The development of functional MRI sequences such as diffusion weighted imaging (DWI) or intravoxel incoherent motion (IVIM) has made the functional assessment of lesions feasible. Moreover, the growing availability of positron emission tomography (PET)–magnetic resonance imaging (MRI) scanners is leading to the potential combination of sensitive anatomical and functional information in a single step. This paper provides an organized framework for evaluating the benefits and challenges of novel and more functional imaging techniques used for the management of patients with plasma cell dyscrasias, notably MM.
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Heidemeier A, Schloetelburg W, Thurner A, Metz C, Heidemeier H, Rasche L, Martin Kortuem K, Boeckle D, Weiland E, Benkert T, Nickel D, Werner R, Buck AK, Bley TA. Multi-parametric whole-body MRI evaluation discerns vital from non-vital multiple myeloma lesions as validated by 18F-FDG and 11C-methionine PET/CT. Eur J Radiol 2022; 155:110493. [PMID: 36027759 DOI: 10.1016/j.ejrad.2022.110493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE We tested a novel multi-parametric (mp) whole body (WB)-MRI evaluation algorithm for medullary lesions in comparison to positron emission tomography (PET) radiotracers 18F-fluorodeoxyglucose (18F-FDG) and 11C-methionine (11C-MET). METHODS AND MATERIALS This retrospective single-center study included 44 MM patients, who received both 18F-FDG-PET and WB-MRI within ten days. MRI classified focal lesions as vital when showing 1) significant diffusion-restriction, 2) a fat fraction (FF) less than 20 % and 3) homogenous hypointensity on T2-weighted images. On a lesion-by-lesion level the findings were compared to 18F-FDG PET by using a 5-point scoring system (analogous to the Deauville score [DS]). In 24/44 (55 %) patients additional comparison to 11C-MET PET was available. RESULTS Among two radiologists, an excellent inter-observer reliability for mpWB-MRI in a total of 84 medullary lesions was observed (ICC = 1, k = 1, p <.01). 16/17 (94.1 %) MRI-classified vital lesions had a DS of 4 or 5 on either 18F-FDG-PET or 11C-MET-PET. MRI-rated non-vital lesions correlated with PET-based DS ≤ 3. When results of mpWB-MRI were compared to 18F-FDG, a fair inter-observer agreement was recorded (ICC = 0.52, k = 0.53, p <.01), while for 11C-MET, an excellent concordance rate was achieved (ICC = 0.81, k = 0.79, p <.01). CONCLUSION The proposed mpWB-MRI interpretation algorithm allowed to assess tumor activity of myeloma lesions with high inter-observer reproducibility. We observed a substantial concordance between the mpWB-MRI classification of lesions and PET assessment based on a semi-automatically calculated 5-point scoring system analogous to the Deauville scores.
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Affiliation(s)
- Anke Heidemeier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany.
| | - Wiebke Schloetelburg
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Annette Thurner
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Corona Metz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Heike Heidemeier
- Department of Psychology, Private University Göttingen, Weender Landstrasse 3-7, 37073 Göttingen, Germany
| | - Leo Rasche
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - K Martin Kortuem
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - David Boeckle
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Elisabeth Weiland
- Department of MR Application Predevelopment, Siemens Healthcare, 91301 Erlangen, Germany
| | - Thomas Benkert
- Department of MR Application Predevelopment, Siemens Healthcare, 91301 Erlangen, Germany
| | - Dominik Nickel
- Department of MR Application Predevelopment, Siemens Healthcare, 91301 Erlangen, Germany
| | - Rudolf Werner
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Andreas Konrad Buck
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
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Koutoulidis V, Terpos E, Papanikolaou N, Fontara S, Seimenis I, Gavriatopoulou M, Ntanasis-Stathopoulos I, Bourgioti C, Santinha J, Moreira JM, Kastritis E, Dimopoulos MA, Moulopoulos LA. Comparison of MRI Features of Fat Fraction and ADC for Early Treatment Response Assessment in Participants with Multiple Myeloma. Radiology 2022; 304:137-144. [PMID: 35380497 DOI: 10.1148/radiol.211388] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background An imaging-based predictor of response could provide prognostic information early during treatment course in patients with multiple myeloma (MM). Purpose To investigate if very early changes in bone marrow relative fat fraction (rFF) and apparent diffusion coefficient (ADC) histogram metrics, occurring after one cycle of induction therapy in participants with newly diagnosed MM, could help predict overall best response status. Materials and Methods This prospective study included participants with MM who were enrolled between August 2014 and December 2017. Histogram metrics were extracted from ADC and rFF maps from MRI examinations performed before treatment and after the first treatment cycle. Participants were categorized into the very good partial response (VGPR) or better group and the less than VGPR group per the International Myeloma Working Group response criteria. ADC and rFF map metrics for predicting treatment response were compared using the Wilcoxon rank test, and the false discovery rate (FDR) was used to correct for multiple comparisons. Results A total of 23 participants (mean age, 65 years ± 11 [SD]; 13 men) were evaluated. There was no evidence of a difference in ADC metrics between the two responder groups after correcting for multiple comparisons. The rFF histogram changes between pretreatment MRI and MRI after the first treatment cycle (ΔrFF) that provided significant differences between the VGPR or better and less than VGPR groups were as follows: ΔrFF_10th Percentile (median, 0.5 [95% CI: 0, 1] vs -2.5 [95% CI: -5.1, 0.1], respectively), ΔrFF_90th Percentile (median, 2 [95% CI: 1, 6.8] vs -0.5 [95% CI: -1, 0]), ΔrFF_Mean (median, 3.4 [95% CI: 0.3, 7.6] vs -1.1 [95% CI: -1.8, -0.7]), and ΔrFF_Root Mean Squared (median, 3.2 [95% CI: 0.3, 6.1] vs -0.7 [95% CI: -1.3, -0.4]) (FDR-adjusted P = .03 for all), and the latter two also presented mean group increases in the VGPR or better group that were above the upper 95% CI limit for repeatability. Conclusion Very early changes in bone marrow relative fat fraction histogram metrics, calculated from MRI examination at baseline and after only one cycle of induction therapy, may help to predict very good partial response or better in participants with newly diagnosed multiple myeloma. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Vassilis Koutoulidis
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Evangelos Terpos
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Nikolaos Papanikolaou
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Sophia Fontara
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Ioannis Seimenis
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Maria Gavriatopoulou
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Ioannis Ntanasis-Stathopoulos
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Charis Bourgioti
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - João Santinha
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - José Maria Moreira
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Efstathios Kastritis
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Meletios A Dimopoulos
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Lia A Moulopoulos
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
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11
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Application of diffusion-weighted whole-body MRI for response monitoring in multiple myeloma after chemotherapy: a systematic review and meta-analysis. Eur Radiol 2022; 32:2135-2148. [PMID: 35028748 DOI: 10.1007/s00330-021-08311-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/27/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Myeloma Response Assessment and Diagnosis System recently published provides a framework for the standardised interpretation of DW-WBMRI in response assessment of multiple myeloma (MM) based on expert opinion. However, there is a lack of meta-analysis providing higher-level evidence to support the recommendations. In addition, some disagreement exists in the literature regarding the effect of timing and lesion subtypes on apparent diffusion coefficient (ADC) value changes post-treatment. METHOD Medline, Cochrane and Embase were searched from inception to 20th July 2021, using terms reflecting multiple myeloma and DW-WBMRI. Using PRISMA reporting guidelines, data were extracted by two investigators. Quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 method. RESULTS Of the 74 papers screened, 10 studies were included comprising 259 patients (127 males and 102 females) and 1744 reported lesions. Responders showed a significant absolute ADC change of 0.21×10-3 mm/s2 (95% CI, 0.01-0.41) with little evidence of heterogeneity (Cochran Q, p = 0.12, I2 = 45%) or publication bias (p = 0.737). Non-responders did not show a significant absolute difference in ADC (0.06 ×10-3 mm/s2, 95% CI, -0.07 to 0.19). A percentage ADC increase of 34.78% (95% CI, 10.75-58.81) was observed in responders. Meta-regression showed an inverse trend between ADC increases and time since chemotherapy initiation which did not reach statistical significance (R2 = 20.46, p = 0.282). CONCLUSIONS This meta-analysis supports the use of the DW-WBMRI as an imaging biomarker for response assessment. More evidence is needed to further characterise ADC changes by lesion subtypes over time. KEY POINTS • In multiple myeloma patients who received chemotherapy, responders have a significant absolute increase in ADC values that is not seen in non-responders. • A 35% increase in ADC from baseline values is found to classify response post-induction chemotherapy which corroborates with expert opinion from the Myeloma Response Assessment and Diagnosis System. • More evidence is needed to further characterise ADC changes by lesion subtypes over time after induction of therapy.
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12
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Heidemeier A, Thurner A, Metz C, Pabst T, Heidemeier H, Rasche L, Kortüm KM, Einsele H, Grimm R, Weiland E, Bley TA. Whole-Body MRI with an Ultrahigh b-Value of 2000 s/mm 2 Improves the Specificity of Diffusion-Weighted Imaging in Patients with Plasma Cell Dyscrasias. Acad Radiol 2022; 29:e1-e8. [PMID: 33139155 DOI: 10.1016/j.acra.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/13/2020] [Accepted: 09/21/2020] [Indexed: 01/07/2023]
Abstract
RATIONALE AND OBJECTIVES Our study compared sensitivity, specificity, and accuracy of whole-body diffusion-weighted imaging (WB-DWI) using a b-value of 2000 s/mm2 with that of the commonly used b-value of 800 s/mm2 for depiction of active tumor sites in patients with plasma cell diseases. We introduced an ultrahigh b-value to reduce interfering signals from benign and post-therapeutic inactive lesions by suppressing T2-shine-through effects. MATERIALS AND METHODS The prospective single-center study included patients when they went through a whole-body MRI (WB-MRI) staging or response evaluation procedure. The apparent diffusion coefficient (ADC) and morphologic appearance served as reference for classifying focal lesions on WB-DWI as vital or post-therapeutic. Additionally, we compared our classification with patients' serological markers of disease activity. RESULTS One hundred participants (65 ± 10 years, 58 men) underwent WB-DWI between June and October 2019. The detection rate of vital focal lesions was similar for both b-values with a sensitivity of 0.99 using b = 800 s/mm2 and 0.98 using b = 2000 s/mm2. By contrast, specificity and accuracy were 0.09 and 0.71 when using a b-value of 800 s/mm2, and 0.96 and 0.98 when using a b-value of 2000 s/mm2, respectively. The difference in specificity and accuracy was statistically significant (p < 0.001). CONCLUSION Using a b-value of 2000 s/mm2 significantly improved the specificity of lesion detection with WB-DWI as compared to the commonly used b-value of 800 s/mm2. The high b-value significantly reduced signal intensities of post-therapeutic or benign lesions and provided a significantly more accurate representation of active tumor load.
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13
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Nouh M, Doweidar A, Khalil AME. Apparent diffusion coefficient (ADC): A potential in vivo biological surrogate of the incidentally discovered bone lesions at 3T MRI. Eur J Radiol Open 2021; 8:100386. [PMID: 34877369 PMCID: PMC8628214 DOI: 10.1016/j.ejro.2021.100386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To probe the potential of apparent diffusion coefficient (ADC) to rectify the incidentally detected bone lesion on MRI into benign or malignant lesions. MATERIALS AND METHODS We retrospectively recruited 44 patients (24 males and 20 females); with 52 bone lesions, who underwent diffusion weighted (DW) imaging using multiple b-values on 3 T MRI. ADC maps were derived and analyzed by two radiologists; blinded to the final diagnosis. The mean ADC values were used for statistical analyses. The diagnosis was deduced by histopathological confirmation; in 32 lesions and strict clinical and imaging follow-up for at least 12 months; in 20 lesions. RESULTS The mean ADC value (mean±SD) of all malignant tumors (including cartilaginous neoplasms) was [0.92 ± 0.40] × 10-3 mm2/s. This significantly differed from those of both primary benign tumors [1.14 ± 0.24] × 10-3 mm2/s, (p = 0.011), and all non-malignant lesions collectively [1.29 ± 0.44] × 10-3 mm2/s, (p < 0.001). Using mADC value of ≤ 1.1 × 10-3 mm2/s resulted in 86.1% sensitivity and 62.5% specificity for characterizing a lesion as a malignant. The inter-rater reliability was almost perfect (95% CI = 0.954-0.985). CONCLUSION ADC could be a non-invasive in-vivo surrogate that may be able to discern the incidentally discovered osseous lesions into benign and malignant pathologies and guide further diagnostic workup.
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Affiliation(s)
- M.R. Nouh
- Department of Radiology, Faculty of Medicine, Alexandria University, Egypt
| | - Ahmed Doweidar
- Department of Radiology, SWBH NHS TRUST, Birmingham, West Midlands B187QH, UK
| | - Abdullah Mohie-Eddin Khalil
- Department of Radiology and Clinical Imaging, El-Razi Hospital, Gamal Abd El-Nasser Street, Sulibakhat, 13001 Kuwait City, Kuwait
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14
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Prediction of Early Treatment Response in Multiple Myeloma Using MY-RADS Total Burden Score, ADC, and Fat Fraction From Whole-Body MRI: Impact of Anemia on Predictive Performance. AJR Am J Roentgenol 2021; 218:310-319. [PMID: 34523949 DOI: 10.2214/ajr.21.26534] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: The recently released Myeloma Response Assessment and Diagnosis System (MY-RADS) for multiple myeloma (MM) evaluation by whole-body MRI (WB-MRI) describes the total burden score. However, assessment is confounded by red bone marrow hyperplasia in anemia. Objective: To assess utility of the MY-RADS total burden score, ADC, and fat fraction (FF) from WB-MRI in predicting early treatment response in patients with newly diagnosed MM and to compare these measures' utility between patients with and without anemia. Methods: This retrospective study included 56 patients (mean age 57.4±9.6 years; 40 men, 16 women) with newly diagnosed MM who underwent baseline WB-MRI including DWI and mDixon sequences. Two radiologists recorded total burden score using MY-RADS and measured ADC and FF of diffuse and focal disease sites. Mean values across sites were derived. Interobserver agreement was evaluated; readers' mean assessments were used for further analyses. Presence of deep response after four cycles of induction chemotherapy was recorded. Patients were classified as anemic if having hemoglobin less than 100 g/L. Utility of WB-MRI parameters in predicting deep response was assessed. Results: A total of 24/56 patients showed deep response; a total of 25/56 patients had anemia. Interobserver agreement, expressed using intraclass correlation coefficients, ranged from 0.95 to 0.99. Among patients without anemia, those with deep response compared with those without deep response exhibited lower total burden score (9.0 vs 18.0), lower ADC (0.79x10-3mm2/s vs 1.08x10-3mm2/s), and higher FF (0.21 vs 0.10) (all p<.001). The combination of these three parameters (optimal cutoffs: <15 for total burden score, <0.84×10-3mm2/s for ADC, >0.16 for FF) achieved sensitivity of 93.8%, specificity of 93.3%, and accuracy of 93.5% for predicting deep response. In patients with anemia, none of the three parameters were significantly different between those with and without deep response (all p>.05), and the combination of parameters achieved sensitivity of 56.3%, specificity of 100.0%, and accuracy of 72.0%. Conclusion: Low total burden score, low ADC, and high FF from WB-MRI may predict deep response in MM, though only among those patients without anemia. Clinical Impact: WB-MRI findings may help guide determination of prognosis and initial treatment selection in MM.
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Lee K, Kim KW, Ko Y, Park HY, Chae EJ, Lee JH, Ryu JS, Chung HW. Comprehensive Updates in the Role of Imaging for Multiple Myeloma Management Based on Recent International Guidelines. Korean J Radiol 2021; 22:1497-1513. [PMID: 34448381 PMCID: PMC8390819 DOI: 10.3348/kjr.2020.0886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 01/18/2021] [Accepted: 01/31/2021] [Indexed: 02/02/2023] Open
Abstract
The diagnostic and treatment methods of multiple myeloma (MM) have been rapidly evolving owing to advances in imaging techniques and new therapeutic agents. Imaging has begun to play an important role in the management of MM, and international guidelines are frequently updated. Since the publication of 2015 International Myeloma Working Group (IMWG) criteria for the diagnosis of MM, whole-body magnetic resonance imaging (MRI) or low-dose whole-body computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/CT have entered the mainstream as diagnostic and treatment response assessment tools. The 2019 IMWG guidelines also provide imaging recommendations for various clinical settings. Accordingly, radiologists have become a key component of MM management. In this review, we provide an overview of updates in the MM field with an emphasis on imaging modalities.
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Affiliation(s)
- Koeun Lee
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.,Department of Nuclear Medicine, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Yousun Ko
- Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Ho Young Park
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jin Chae
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Won Chung
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Updates and Ongoing Challenges in Imaging of Multiple Myeloma: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 217:775-785. [PMID: 33978464 DOI: 10.2214/ajr.21.25878] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Advances in the understanding and treatment of multiple myeloma have led to the need for more sensitive and accurate imaging of intramedullary and extramedullary disease. This role of imaging is underscored by recently revised imaging recommendations of the International Myeloma Working Group (IMWG). This narrative review discusses these recommendations from the IMWG for different disease stages, focusing on advanced whole-body modalities, and addresses related challenges and controversies. In the recommendations, whole-body low-dose CT is central in initial patient assessment, replacing the conventional skeletal survey. Although the recommendations favor MRI for diagnosis because of its superior sensitivity and utility in identifying myeloma-defining events, FDG PET/CT is recommended as the modality of choice for assessing treatment response. Consensus opinions are offered regarding the role of imaging in multiple myeloma for characterization of disease distribution, determination of prognosis, and response evaluation.
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Mesguich C, Latrabe V, Hulin C, Lascaux A, Bordenave L, Hindié E, Marit G. Prospective Comparison of 18-FDG PET/CT and Whole-Body MRI with Diffusion-Weighted Imaging in the Evaluation of Treatment Response of Multiple Myeloma Patients Eligible for Autologous Stem Cell Transplant. Cancers (Basel) 2021; 13:cancers13081938. [PMID: 33923781 PMCID: PMC8074107 DOI: 10.3390/cancers13081938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
To compare the prognostic values of 18-FDG PET/CT (FDG-PET) and Whole-Body MRI with Diffusion-Weighted Imaging (WB-DW-MRI) in the evaluation of treatment response of Multiple Myeloma (MM) patients eligible for ASCT. Thirty patients with newly diagnosed MM prospectively underwent FDG-PET and WB-DW-MRI at baseline, after induction chemotherapy and after ASCT. Response on WB-DW-MRI was evaluated with the MY-RADS criteria. FDG-PET was considered positive if residual uptake was superior to liver uptake. Imaging results were not used for treatment modification. The impact of imaging results on PFS was analyzed. After a median follow-up of 32 months, 10 patients relapsed. With WB-DW-MRI, post-induction examination was positive in 3/25 and post-ASCT examination was positive in 3/27 patients. However, neither study showed prognostic impact on PFS. FDG-PET was positive in 5/22 post-induction and 3/26 patients post-ASCT, respectively. Positivity of FDG-PET, post-induction or post-ASCT, was associated with a shorter PFS (post-induction: median PFS 19 months vs. not reached, log-rank p = 0.0089; post-ASCT: median PFS 18 months vs. not reached, log-rank p = 0.0005). Preliminary results from this small, single-center, prospective study show that, whether performed post-induction or post-ASCT, FDG-PET has a higher prognostic value than WB-DW-MRI for treatment response evaluation of newly diagnosed MM.
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Affiliation(s)
- Charles Mesguich
- Nuclear Medicine Department, CHU Bordeaux, F-33000 Bordeaux, France; (L.B.); (E.H.)
- INSERM U1035, University of Bordeaux, F-33000 Bordeaux, France;
- Correspondence: ; Tel.: +33-5-57656335
| | - Valérie Latrabe
- Radiology Department, CHU Bordeaux, F-33000 Bordeaux, France;
| | - Cyrille Hulin
- Haematology Department, CHU Bordeaux, F-33000 Bordeaux, France; (C.H.); (A.L.)
| | - Axelle Lascaux
- Haematology Department, CHU Bordeaux, F-33000 Bordeaux, France; (C.H.); (A.L.)
| | - Laurence Bordenave
- Nuclear Medicine Department, CHU Bordeaux, F-33000 Bordeaux, France; (L.B.); (E.H.)
| | - Elif Hindié
- Nuclear Medicine Department, CHU Bordeaux, F-33000 Bordeaux, France; (L.B.); (E.H.)
| | - Gerald Marit
- INSERM U1035, University of Bordeaux, F-33000 Bordeaux, France;
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Paternain A, García-Velloso MJ, Rosales JJ, Ezponda A, Soriano I, Elorz M, Rodríguez-Otero P, Aquerreta JD. The utility of ADC value in diffusion-weighted whole-body MRI in the follow-up of patients with multiple myeloma. Correlation study with 18F-FDG PET-CT. Eur J Radiol 2020; 133:109403. [PMID: 33202373 DOI: 10.1016/j.ejrad.2020.109403] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To analyze the feasibility of DWI-MRI and ADC to evaluate treatment response in patients with multiple myeloma (MM). To correlate the variations of ADC and SUVmax in 18F-FDG PET-CT. METHODS 27 patients with MM that had a whole-body MRI and 18F-FDG PET-CT performed at baseline and after treatment were retrospectively recruited between February 2018 and May 2020. Three target bone lesions were selected for each patient and their ADC, SUVmax and Deauville score were measured in every study. Correlation between ADC and SUVmax of the lesions was evaluated, as well as changes in mean ADC, SUVmax, and Deauville score between studies. Patients were classified as responder or non-responder according to the IMWG, MRI (MY-RADS) and PET-CT (IMPeTUs) response criteria. Agreement between the MRI and PET-CT criteria with the IMWG criteria was evaluated. RESULTS The correlation between the ADC and SUVmax of all the target lesions was strong, negative and significant (r=-0.603; p < 0.001). After treatment, mean ADC in lesions from responders was significantly higher than in non-responders (1585.51 × 10-6 mm2/s vs 698.17 × 10-6 mm2/s; p < 0.001). SUVmax of the same lesions was significantly lower in responders than in non-responders (2.05 vs 5.33; p < 0.001). There was a very strong or strong agreement of the IMWG response criteria with both MRI (κ = 0.852; p < 0.001) and PET (κ = 0.767; p < 0.001) criteria. CONCLUSION DWI-MRI and ADC may be used to assess treatment response in MM patients, showing a good correlation with 18F-FDG PET-CT and the IMWG response criteria.
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Affiliation(s)
- Alberto Paternain
- Clínica Universidad de Navarra, Avenida Pío XII, 36., Pamplona, Spain.
| | | | - Juan José Rosales
- Clínica Universidad de Navarra, Avenida Pío XII, 36., Pamplona, Spain
| | - Ana Ezponda
- Clínica Universidad de Navarra, Avenida Pío XII, 36., Pamplona, Spain
| | - Ignacio Soriano
- Clínica Universidad de Navarra, Avenida Pío XII, 36., Pamplona, Spain
| | - Mariana Elorz
- Clínica Universidad de Navarra, Avenida Pío XII, 36., Pamplona, Spain
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Zamagni E, Tacchetti P, Barbato S, Cavo M. Role of Imaging in the Evaluation of Minimal Residual Disease in Multiple Myeloma Patients. J Clin Med 2020; 9:jcm9113519. [PMID: 33142671 PMCID: PMC7692446 DOI: 10.3390/jcm9113519] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 01/13/2023] Open
Abstract
The International Myeloma Working Group (IMWG) recently introduced the evaluation of minimal residual disease (MRD) within the multiple myeloma (MM) response criteria, and MRD negativity assessed inside and outside the bone marrow is currently considered the most powerful predictor of favorable long-term outcomes. However, MRD evaluation has thus far relied on flow-cytometry or molecular-based methods, despite the limitations associated with the patchy infiltration of bone marrow (BM) plasma cells and the presence of extra-medullary (EMD). On the contrary, imaging-based sensitive response assessment through the use of functional rather than morphological whole-body (WB) imaging techniques, such as positron emission tomography with computed tomography (PET/CT) and magnetic resonance imaging (MRI), likely is a promising strategy to overcome these limitations in evaluating response to therapy and in the assessment of the MRD status in MM patients. However, despite the significant advances in the development and availability of novel functional imaging techniques for MRD evaluation, a worldwide standardization of imaging criteria for acquisition, interpretation, and reporting is yet to be determined and will be object of future investigations.
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Affiliation(s)
- Elena Zamagni
- Correspondence: ; Tel.: +39-051-2143831; Fax: +39-051-6364037
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20
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Perl RM, Gronbach F, Fritz J, Horger MS, Hepp T. Longitudinal monitoring of apparent diffusion coefficient (ADC) in myeloma patients with lower M-gradient levels undergoing systemic treatment and whole-body MRI monitoring. Eur J Radiol 2020; 132:109306. [PMID: 33038578 DOI: 10.1016/j.ejrad.2020.109306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/19/2020] [Accepted: 09/20/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Longitudinal assessment of changes in apparent diffusion coefficient (ADC)-values in multiple myeloma (MM) patients and their potential role for classifying disease activity. METHODS Retrospective analysis of whole-body-MRI data in 73 stage III MM patients undergoing systemic treatment. Bone marrow involvement was evaluated using a standardized unenhanced 4-sequences whole-body-MRI protocol. We measured ADC-values in focal lesions (FL) and diffusely involved bone marrow (DIBM) areas. Response to treatment was based on the course of hematologic parameters. The time points of MRI-examinations were baseline, 1st (mean, 3 months), 2nd (mean, 10 months), and 3rd (mean, 18 months) follow up (FU). RESULTS Mean IgG and IgA serum values at baseline were 2.1 mg/dl and 1.8 mg/dl, respectively. Patients were classified into responders (n = 59) and non-responders (n = 34). Some patients were re-enrolled for new treatment regimens as they became therapy-refractory. Patterns of medullary involvement were focal (n = 44), diffuse (n = 61) and mixed (n = 30). In FL, a subgroup of myeloma patients undergoing short-term 1st FU experienced a significant increase in ADC in responders (p = 0.001), but not in non-responders (p = 0.9). In the further course of the study, ADC levels decreased continuously in responders (p = 0.02) and increased slightly in non-responders (p = 0.8). In patients with DIBM, ADC values decreased in the responders (p < 0.001) and in the non-responders (p = 0.78). An ADC cut-off value of 0.5-0.6 × 10-3 mm2/s for diagnosing inactive disease at follow-up proved unreliable. CONCLUSIONS In myeloma-patients with lower tumor burden, the longitudinal course of ADC-values is predictable only for FL whereas for DIBM ADC-changes considerably overlap between responders and non-responders and are not indicative for assessment of the disease activity.
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Affiliation(s)
- Regine Mariette Perl
- Department of Diagnostic and Interventional Radiology University-Hospital of Tuebingen, Germany.
| | - Felix Gronbach
- Department of Diagnostic and Interventional Radiology University-Hospital of Tuebingen, Germany
| | - Jan Fritz
- New York University Langone HealthGrossman School of Medicine, Department of Radiology, New York, USA
| | - Marius Stefan Horger
- Department of Diagnostic and Interventional Radiology University-Hospital of Tuebingen, Germany
| | - Tobias Hepp
- Department of Diagnostic and Interventional Radiology University-Hospital of Tuebingen, Germany; Max Planck Institute for Intelligent Systems, Tuebingen, Germany
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Reinert CP, Krieg E, Esser M, Nikolaou K, Bösmüller H, Horger M. Role of computed tomography texture analysis using dual-energy-based bone marrow imaging for multiple myeloma characterization: comparison with histology and established serologic parameters. Eur Radiol 2020; 31:2357-2367. [PMID: 33011876 PMCID: PMC7979667 DOI: 10.1007/s00330-020-07320-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/02/2020] [Accepted: 09/17/2020] [Indexed: 11/05/2022]
Abstract
Objective To identify textural features on dual-energy CT (DECT)–based bone marrow images in myeloma which correlate with serum markers of myeloma activity and the degree of medullary involvement. Methods A total of 110 patients (63.0 ± 11.0 years, 51 female) who underwent unenhanced whole-body DECT between September 2015 and February 2019 were retrospectively included, which was approved by our institutional ethics committee with a waiver of the informed consent requirement. All patients had current hematologic laboratory tests. Using DECT post-processing, non-calcium bone marrow images were reconstructed. The vertebral bodies T10–L5 were segmented for quantification of textural features, which were compared with serologic parameters and myeloma stages by the Mann-Whitney U test. In a subgroup of 56/110 patients with current bone marrow biopsies, textural features were correlated with the degree of bone marrow infiltration. Results First-order features were higher in patients with advanced stage of myeloma (p < .02), whereas the 2nd-order “gray-level co-occurrence matrix (GLCM) cluster prominence” was lower (p < .04). In patients with elevated serum-free light chains (SFLC) or kappa/lambda SFLC ratio above 1.56, the “entropy” and 2nd-order GLCM features were lower (p < .03). The degree of bone marrow infiltration correlated with 1st-order features (e.g., “uniformity”; rP = 0.49; p < .0001), whereas “entropy” and 2nd-order GLCM features were negatively correlated (e.g., “difference entropy”; rP = − 0.54; p < .0001). Conclusions CT textural features applied on non-calcium bone marrow images correlate well with myeloma-related serologic parameters and histology showing a more uniform tissue structure and higher attenuation with increasing medullary infiltration and could therefore be used as additional imaging biomarkers for non-invasive assessment of medullary involvement. Key Points • Texture analysis applied on dual-energy reconstructed non-calcium bone marrow images provides information about marrow structure and attenuation. • Myeloma-related serologic parameters and the degree of myeloma cell infiltration correlate with 1st- and 2nd-order features which could be useful as additional imaging biomarkers for non-invasive assessment of medullary involvement. Electronic supplementary material The online version of this article (10.1007/s00330-020-07320-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian Philipp Reinert
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Eva Krieg
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Michael Esser
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK), Partner Site Tübingen, Tübingen, Germany
| | - Hans Bösmüller
- Institute of Pathology and Neuropathology, University Hospital Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Zhang L, Wang Q, Wu X, Zhao A, Feng J, Zhang H, Cao X, Li S, Cai H, Sun Z, Duan M, Zhu T, Zhang W, Jin Z, Zhou D, Xue H, Li J. Baseline bone marrow ADC value of diffusion-weighted MRI: a potential independent predictor for progression and death in patients with newly diagnosed multiple myeloma. Eur Radiol 2020; 31:1843-1852. [PMID: 32965573 DOI: 10.1007/s00330-020-07295-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/07/2020] [Accepted: 09/15/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To illuminate the prognostic value of ADC (apparent diffusion coefficient), an important quantitative parameter of diffusion-weighted MRI, for multiple myeloma (MM). METHODS A prospective single-center study which enrolled 114 consecutive newly diagnosed MM patients with baseline whole-body diffusion-weighted MRI (WB DW-MRI) results was conducted. Baseline clinical and MRI parameters were analyzed with univariate and multivariate approaches to identify independent risk factors for progression-free survival (PFS) and overall survival (OS). RESULTS Five different DW-MRI patterns were seen, and the mean ADC value of the representative background bone marrow was 0.4662 ± 0.1939 × 10-3 mm2/s. After a mean follow-up of 50.2 months (range, 15.7-75.8 months), twenty-four patients died and seven were lost to follow-up. The mean ADC value of the representative background bone marrow was showed to be an independent risk factor for both PFS (HR 4.664; 95% confidence interval (CI) 1.138-19.121; p = 0.032) and OS (HR 14.130; 95% CI 1.544-129.299; p = 0.019). Normal/salt-and-pepper pattern on DW-MRI was associated with PFS using univariate analysis (p = 0.035) but lost the significance with multivariate Cox regression. CONCLUSIONS Mean ADC value of the representative background bone marrow predicts both PFS and OS which suggests the role of baseline DW-MRI for risk stratification in newly diagnosed MM patients. KEY POINTS • Whole-body diffusion-weighted MRI (WB DW-MRI) might be helpful to improve the current risk stratification systems for newly diagnosed multiple myeloma (MM). • Morphological parameters as MRI pattern and focal lesion-associated parameters have been reported to be related to survival. However, important functional parameters such as apparent diffusion coefficient (ADC) values were not incorporated into the current risk stratification model. • This study is one of the first endeavors to delineate the correlation of baseline ADC values and survival in MM patients. It is revealed that the mean ADC value of the representative background bone marrow (L3-S1 and iliac bone) was an independent risk factor for both PFS and OS.
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Affiliation(s)
- Lu Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Qin Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xia Wu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Ailin Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jun Feng
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Haibo Zhang
- Department of Radiology, China-Japan Friendship Hospital, Yinghua East Road 2#, Heping Street, Chaoyang District, Beijing, 100029, China
| | - Xinxin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Shuo Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Huacong Cai
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Zhaoyong Sun
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Minghui Duan
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Tienan Zhu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Di Giuliano F, Picchi E, Muto M, Calcagni A, Ferrazzoli V, Da Ros V, Minosse S, Chiaravalloti A, Garaci F, Floris R, Muto M. Radiological imaging in multiple myeloma: review of the state-of-the-art. Neuroradiology 2020; 62:905-923. [DOI: 10.1007/s00234-020-02417-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/26/2020] [Indexed: 12/16/2022]
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Malyarenko DI, Swanson SD, Konar AS, LoCastro E, Paudyal R, Liu MZ, Jambawalikar SR, Schwartz LH, Shukla-Dave A, Chenevert TL. Multicenter Repeatability Study of a Novel Quantitative Diffusion Kurtosis Imaging Phantom. ACTA ACUST UNITED AC 2020; 5:36-43. [PMID: 30854440 PMCID: PMC6403043 DOI: 10.18383/j.tom.2018.00030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Quantitative kurtosis phantoms are sought by multicenter clinical trials to establish accuracy and precision of quantitative imaging biomarkers on the basis of diffusion kurtosis imaging (DKI) parameters. We designed and evaluated precision, reproducibility, and long-term stability of a novel isotropic (i)DKI phantom fabricated using four families of chemicals based on vesicular and lamellar mesophases of liquid crystal materials. The constructed iDKI phantoms included negative control monoexponential diffusion materials to independently characterize noise and model-induced bias in quantitative kurtosis parameters. Ten test-retest DKI studies were performed on four scanners at three imaging centers over a six-month period. The tested prototype phantoms exhibited physiologically relevant apparent diffusion, Dapp, and kurtosis, Kapp, parameters ranging between 0.4 and 1.1 (×10-3 mm2/s) and 0.8 and 1.7 (unitless), respectively. Measured kurtosis phantom Kapp exceeded maximum fit model bias (0.1) detected for negative control (zero kurtosis) materials. The material-specific parameter precision [95% CI for Dapp: 0.013-0.022(×10-3 mm2/s) and for Kapp: 0.009-0.076] derived from the test-retest analysis was sufficient to characterize thermal and temporal stability of the prototype DKI phantom through correlation analysis of inter-scan variability. The present study confirms a promising chemical design for stable quantitative DKI phantom based on vesicular mesophase of liquid crystal materials. Improvements to phantom preparation and temperature monitoring procedures have potential to enhance precision and reproducibility for future multicenter iDKI phantom studies.
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Affiliation(s)
- Dariya I Malyarenko
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI
| | - Scott D Swanson
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI
| | | | | | | | - Michael Z Liu
- Department of Radiology, Columbia University Irving Medical Center, New York, NY
| | | | - Lawrence H Schwartz
- Department of Radiology, Columbia University Irving Medical Center, New York, NY
| | - Amita Shukla-Dave
- Departments of Medical Physics and.,Radiology, Memorial Sloan Kettering Cancer Center, New York, NY; and
| | - Thomas L Chenevert
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI
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25
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Park HY, Kim KW, Yoon MA, Lee MH, Chae EJ, Lee JH, Chung HW, Yoon DH. Role of whole-body MRI for treatment response assessment in multiple myeloma: comparison between clinical response and imaging response. Cancer Imaging 2020; 20:14. [PMID: 32000858 PMCID: PMC6993415 DOI: 10.1186/s40644-020-0293-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/20/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Whole-body MRI (WB-MRI) including diffusion-weighted image (DWI) have been widely used in patients with multiple myeloma. However, evidence for the value of WB-MRI in the evaluation of treatment response remains sparse. Therefore, we evaluated the role of WB-MRI in the response assessment. METHODS In our WB-MRI registry, we searched multiple myeloma patients treated with chemotherapy who underwent both baseline and follow-up WB-MRI scans. Clinical responses were categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD), using IMWG criteria. Using RECIST 1.1, MD Anderson (MDA) criteria, and MDA-DWI criteria, imaging responses on WB-MRI were rated as CR, PR, SD, or PD by two radiologists independently. Then, discrepancy cases were resolved by consensus. Weighted Kappa analysis was performed to evaluate agreement between the imaging and clinical responses. The diagnostic accuracy of image responses in the evaluation of clinical CR, objective response (CR and PR), and PD was calculated. RESULTS Forty-two eligible patients were included. There was moderate agreement between imaging and clinical responses (κ = 0.54 for RECIST 1.1, κ = 0.58 for MDA criteria, κ = 0.69 for MDA-DWI criteria). WB-MRI showed excellent diagnostic accuracy in assessment of clinical PD (sensitivity 88.9%, specificity 94.7%, positive predictive value [PPV] 84.2%, negative predictive value [NPV] 96.4% in all three imaging criteria). By contrast, WB-MRI showed low accuracy in assessment of clinical CR (sensitivity 4.5%, specificity 98.1%, PPV 50.0%, NPV 71.2% in all three imaging criteria). As to the clinical objective response, the diagnostic accuracy was higher in MDA-DWI criteria than RECIST 1.1 and MDA criteria (sensitivity/specificity/PPV/NPV, 84.2%/94.4%/98.0%/65.4, 54.4%/100%/100%/40.9, and 61.4%/94.4%/97.2%/43.6%, respectively). CONCLUSIONS In the imaging response assessment of multiple myeloma, WB-MRI showed excellent performance in the evaluation of PD, but not in the assessment of CR or objective response. When adding DWI to imaging response criteria, diagnostic accuracy for objective response was improved and agreement between imaging and clinical responses was increased.
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Affiliation(s)
- Ho Young Park
- Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Min A Yoon
- Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Min Hee Lee
- Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Eun Jin Chae
- Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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26
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Almeida SD, Santinha J, Oliveira FPM, Ip J, Lisitskaya M, Lourenço J, Uysal A, Matos C, João C, Papanikolaou N. Quantification of tumor burden in multiple myeloma by atlas-based semi-automatic segmentation of WB-DWI. Cancer Imaging 2020; 20:6. [PMID: 31931880 PMCID: PMC6958755 DOI: 10.1186/s40644-020-0286-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 01/06/2020] [Indexed: 12/31/2022] Open
Abstract
Background Whole-body diffusion weighted imaging (WB-DWI) has proven value to detect multiple myeloma (MM) lesions. However, the large volume of imaging data and the presence of numerous lesions makes the reading process challenging. The aim of the current study was to develop a semi-automatic lesion segmentation algorithm for WB-DWI images in MM patients and to evaluate this smart-algorithm (SA) performance by comparing it to the manual segmentations performed by radiologists. Methods An atlas-based segmentation was developed to remove the high-signal intensity normal tissues on WB-DWI and to restrict the lesion area to the skeleton. Then, an outlier threshold-based segmentation was applied to WB-DWI images, and the segmented area’s signal intensity was compared to the average signal intensity of a low-fat muscle on T1-weighted images. This method was validated in 22 whole-body DWI images of patients diagnosed with MM. Dice similarity coefficient (DSC), sensitivity and positive predictive value (PPV) were computed to evaluate the SA performance against the gold standard (GS) and to compare with the radiologists. A non-parametric Wilcoxon test was also performed. Apparent diffusion coefficient (ADC) histogram metrics and lesion volume were extracted for the GS segmentation and for the correctly identified lesions by SA and their correlation was assessed. Results The mean inter-radiologists DSC was 0.323 ± 0.268. The SA vs GS achieved a DSC of 0.274 ± 0.227, sensitivity of 0.764 ± 0.276 and PPV 0.217 ± 0.207. Its distribution was not significantly different from the mean DSC of inter-radiologist segmentation (p = 0.108, Wilcoxon test). ADC and lesion volume intraclass correlation coefficient (ICC) of the GS and of the correctly identified lesions by the SA was 0.996 for the median and 0.894 for the lesion volume (p < 0.001). The duration of the lesion volume segmentation by the SA was, on average, 10.22 ± 0.86 min, per patient. Conclusions The SA provides equally reproducible segmentation results when compared to the manual segmentation of radiologists. Thus, the proposed method offers robust and efficient segmentation of MM lesions on WB-DWI. This method may aid accurate assessment of tumor burden and therefore provide insights to treatment response assessment.
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Affiliation(s)
- Sílvia D Almeida
- Computational Clinical Imaging Group, Champalimaud Foundation, Centre for the Unknown, Av. Brasília, Doca de Pedrouços, 1400-038, Lisbon, Portugal
| | - João Santinha
- Computational Clinical Imaging Group, Champalimaud Foundation, Centre for the Unknown, Av. Brasília, Doca de Pedrouços, 1400-038, Lisbon, Portugal
| | - Francisco P M Oliveira
- Radiopharmacology, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Joana Ip
- Radiology Department, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Maria Lisitskaya
- Radiology Department, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038, Lisbon, Portugal
| | - João Lourenço
- Radiology Department, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Aycan Uysal
- Radiology Department, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Celso Matos
- Radiology Department, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Cristina João
- Hematology Department, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038, Lisbon, Portugal.,Immunology Department, Nova Medical School, Nova University of Lisbon, 1169-056, Lisbon, Portugal
| | - Nikolaos Papanikolaou
- Computational Clinical Imaging Group, Champalimaud Foundation, Centre for the Unknown, Av. Brasília, Doca de Pedrouços, 1400-038, Lisbon, Portugal.
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27
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Zhang Y, Xiong X, Fu Z, Dai H, Yao F, Liu D, Deng S, Hu C. Whole-body diffusion-weighted MRI for evaluation of response in multiple myeloma patients following bortezomib-based therapy: A large single-center cohort study. Eur J Radiol 2019; 120:108695. [PMID: 31589995 DOI: 10.1016/j.ejrad.2019.108695] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/14/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the feasibility of whole-body diffusion-weighted imaging (WB-DWI) MRI for evaluation of response in patients with multiple myeloma (MM) following bortezomib-based therapy and to explore the direction of apparent diffusion coefficient (ADC) changes upon treatment. METHOD Seventy-two MM patients who underwent WB-DWI MRI before and after bortezomib-based chemotherapy (21 weeks) were evaluated retrospectively. The estimated tumor volume (eTV) and ADCmean values before and after chemotherapy were calculated and compared between deep and non-deep responders. Predictive value of baseline ADCmean was calculated to predict the trend of ADCmean change following treatment. RESULTS Fifty-five patients were classified as deep responders, and 17 cases were assigned as non-deep responders. For 327 focal lesions (FLs), the ADCmean value was significantly increased from baseline to post-treatment. However, the ADCmean value was significantly decreased following treatment in 846 representative diffuse lesions. Diffuse lesions showed a significantly decreased ADCmean value in deep responders, whereas no significant variation in ADCmean value in FLs was found between deep and non-deep responders. Baseline ADCmean at a specific value (0.808 × 10-3 mm2/s) yielded a maximum specificity (68.05%) and sensitivity (54.09%) in predicting increase of post-treatment ADCmean. CONCLUSIONS The ADCmean value was significantly decreased in MM patients with diffuse pattern, while it was significantly increased in those with focal pattern following bortezomib-based treatment. WB-DWI MRI could be used to discriminate deep response to induction treatment in MM patients with diffuse infiltration pattern. Baseline ADCmean value might have a potential to predict the trend of ADCmean change following treatment.
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Affiliation(s)
- Yu Zhang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Xing Xiong
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Zhengzheng Fu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Hui Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Feirong Yao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Dong Liu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Shengming Deng
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.
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Comparison of Whole-Body DWI and 18F-FDG PET/CT for Detecting Intramedullary and Extramedullary Lesions in Multiple Myeloma. AJR Am J Roentgenol 2019; 213:514-523. [PMID: 31166755 DOI: 10.2214/ajr.18.20989] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE. The purpose of this study was to compare the ability of whole-body (WB) DWI and 18F-FDG PET/CT in detecting intramedullary and extramedullary lesions in multiple myeloma. MATERIALS AND METHODS. The study included 49 patients with multiple myeloma who had undergone WB DWI and PET/CT. Intramedullary lesions for each region were scored by a scoring system using WB DWI and PET/CT separately. Extramedullary lesions seen separately on WB DWI and PET/CT per patient were recorded. Patients with diffuse lesions of the whole spine seen using both modalities were defined as group A, and those with such lesions seen on WB DWI only were defined as group B. The mean scores assigned to intramedullary lesions using the two modalities, the numbers of extramedullary lesions detected by WB DWI and PET/CT, and the mean percentages of plasma cells in the two patient groups were compared. RESULTS. Scores were higher for WB DWI than for PET/CT in all regions of the body (p < 0.05) except the skull, both in patients with a new diagnosis of multiple myeloma and in previously treated patients. Mean (± SD) percentages of plasma cells were significantly higher in group A than group B (50.458% ± 16.036% vs 18.682% ± 15.524%; p = 0.00). The mean number of extramedullary lesions detected by WB DWI was slightly higher than the mean number detected by PET/CT, although there was no statistical difference (4.48 ± 6.70 vs 4.39 ± 6.46 lesions; p = 0.86). CONCLUSION. For detecting intramedullary lesions, WB DWI is more sensitive than PET/CT in all regions except the skull, both in patients with a new diagnosis and previously treated patients and especially in patients with a low percentage of plasma cells. For detecting extramedullary lesions, WB DWI has sensitivity equivalent to that of PET/CT. The use of both modalities may offer complementary information.
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Albrecht J, Polenz D, Kühl AA, Rogasch JMM, Leder A, Sauer IM, Babos M, Mócsai G, Beindorff N, Steffen IG, Brenner W, Koziolek EJ. Diffusion-weighted magnetic resonance imaging using a preclinical 1 T PET/MRI in healthy and tumor-bearing rats. EJNMMI Res 2019; 9:21. [PMID: 30796555 PMCID: PMC6386759 DOI: 10.1186/s13550-019-0489-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/08/2019] [Indexed: 02/07/2023] Open
Abstract
Background Hybrid positron emission tomography and magnetic resonance imaging (PET/MRI) scanners are increasingly used for both clinical and preclinical imaging. Especially functional MRI sequences such as diffusion-weighted imaging (DWI) are of great interest as they provide information on a molecular level, thus, can be used as surrogate biomarkers. Due to technical restrictions, MR sequences need to be adapted for each system to perform reliable imaging. There is, to our knowledge, no suitable DWI protocol for 1 Tesla PET/MRI scanners. We aimed to establish such DWI protocol with focus on the choice of b values, suitable for longitudinal monitoring of tumor characteristics in a rat liver tumor model. Material and methods DWI was first performed in 18 healthy rat livers using the scanner-dependent maximum of 4 b values (0, 100, 200, 300 s/mm2). Apparent diffusion coefficients (ADC) were calculated from different b value combinations and compared to the reference measurement with four b values. T2-weighted MRI and optimized DWI with best agreement between accuracy, scanning time, and system performance stability were used to monitor orthotopic hepatocellular carcinomas (HCC) in five rats of which three underwent additional 2-deoxy-2-(18F)fluoro-d-glucose(FDG)-PET imaging. ADCs were calculated for the tumor and the surrounding liver parenchyma and verified by histopathological analysis. Results Compared to the reference measurements, the combination b = 0, 200, 300 s/mm2 showed the highest correlation coefficient (rs = 0.92) and agreement while reducing the acquisition time. However, measurements with less than four b values yielded significantly higher ADCs (p < 0.001). When monitoring the HCC, an expected drop of the ADC was observed over time. These findings were paralleled by FDG-PET showing both an increase in tumor size and uptake heterogeneity. Interestingly, surrounding liver parenchyma also showed a change in ADC values revealing varying levels of inflammation by immunohistochemistry. Conclusion We established a respiratory-gated DWI protocol for a preclinical 1 T PET/MRI scanner allowing to monitor growth-related changes in ADC values of orthotopic HCC liver tumors. By monitoring the changes in tumor ADCs over time, different cellular stages were described. However, each study needs to adapt the protocol further according to their question to generate best possible results. Electronic supplementary material The online version of this article (10.1186/s13550-019-0489-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jakob Albrecht
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. .,German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Dietrich Polenz
- Department of Surgery, Campus Charité Mitte, Luisenstraße 64, 10117, Berlin, Germany.,Department of Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Mittelallee 4, 13353, Berlin, Germany
| | - Anja A Kühl
- iPATH.Berlin - Immunopathology for Experimental Models, Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Core Unit, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Julian M M Rogasch
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Annekatrin Leder
- Department of Surgery, Campus Charité Mitte, Luisenstraße 64, 10117, Berlin, Germany.,Department of Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Mittelallee 4, 13353, Berlin, Germany
| | - Igor M Sauer
- Department of Surgery, Campus Charité Mitte, Luisenstraße 64, 10117, Berlin, Germany.,Department of Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Mittelallee 4, 13353, Berlin, Germany
| | - Magor Babos
- Mediso Medical Imaging Systems, Laborc utca 3, Budapest, 1037, Hungary
| | - Gabor Mócsai
- Mediso Medical Imaging Systems, Laborc utca 3, Budapest, 1037, Hungary
| | - Nicola Beindorff
- Berlin Experimental Radionuclide Imaging Center (BERIC), Charité - Universitätsmedizin Berlin, Südstraße 3, 13353, Berlin, Germany
| | - Ingo G Steffen
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Berlin Experimental Radionuclide Imaging Center (BERIC), Charité - Universitätsmedizin Berlin, Südstraße 3, 13353, Berlin, Germany
| | - Eva J Koziolek
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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Lee K, Park HY, Kim KW, Lee AJ, Yoon MA, Chae EJ, Lee JH, Chung HW. Advances in whole body MRI for musculoskeletal imaging: Diffusion-weighted imaging. J Clin Orthop Trauma 2019; 10:680-686. [PMID: 31316239 PMCID: PMC6611843 DOI: 10.1016/j.jcot.2019.05.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 02/07/2023] Open
Abstract
Recent advances in imaging technology have enabled the acquisition of anatomical and functional imaging from head to toe in a reasonably short scan time. Accordingly, whole body magnetic resonance imaging (WB-MRI) and diffusion-weighted imaging (WB-DWI) have gained recent attention for the management of musculoskeletal problems such as bone tumors and rheumatologic diseases. WB-MRI is especially useful in diagnosing systemic or widespread disease requiring whole body evaluation, such as bone metastases, multiple myeloma, lymphoma, neurofibromatosis, and spondyloarthropathies. Among WB-MRI sequences, the WB-DWI technique greatly increases the value of WB-MRI in the evaluation of disease extent and characterization as well as treatment monitoring. In support of the utilization of WB-MRI and WB-DWI in orthopedic clinics for various musculoskeletal diseases, we provide an overview of the technical aspects of WB-MRI and WB-DWI and their clinical applications in musculoskeletal tumors and rheumatic diseases.
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Affiliation(s)
- Koeun Lee
- Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Young Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyung Won Kim
- Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea,Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea,Corresponding author. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Amy Junghyun Lee
- Asan Image Metrics, Clinical Trial Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min A. Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun Jin Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Abstract
Bone disease is the most frequent feature of multiple myeloma (MM) and represents a marker of end-organ damage; it is used to establish the diagnosis and to dictate the immediate need for therapy. For this reason, imaging plays a significant role in the management of MM patients. Although conventional radiography has traditionally been the standard imaging modality, its low sensitivity in detecting osteolytic lesions and inability to evaluate response to therapy has called for the use of more sophisticated techniques, such as whole-body low-dose computed tomography (WBLDCT), whole-body magnetic resonance imaging, and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT). In this review, the advantages, indications of use, and applications of the 3 techniques in the management of patients with MM in different settings will be discussed. The European Myeloma Network and the European Society for Medical Oncology guidelines have recommended WBLDCT as the imaging modality of choice for the initial assessment of MM-related lytic bone lesions. Magnetic resonance imaging is the gold-standard imaging modality for detection of bone marrow involvement, whereas PET/CT provides valuable prognostic data and is the preferred technique for assessment of response to therapy. Standardization of most of the techniques is ongoing.
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Whole-body low-dose CT recognizes two distinct patterns of lytic lesions in multiple myeloma patients with different disease metabolism at PET/MRI. Ann Hematol 2018; 98:679-689. [PMID: 30539276 PMCID: PMC6373185 DOI: 10.1007/s00277-018-3555-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/10/2018] [Indexed: 12/31/2022]
Abstract
We evaluated differences in density and 18F-FDG PET/MRI features of lytic bone lesions (LBLs) identified by whole-body low-dose CT (WB-LDCT) in patients affected by newly diagnosed multiple myeloma (MM). In 18 MM patients, 135 unequivocal LBLs identified by WB-LDCT were characterized for inner density (negative or positive Hounsfield unit (HU)), where negative density (HU < 0) characterizes normal yellow marrow whereas positive HU correlates with tissue-like infiltrative pattern. The same LBLs were analyzed by 18F-FDG PET/DWI-MRI, registering DWI signal with ADC and SUV max values. According to HU, 35 lesions had a negative density (− 56.94 ± 31.87 HU) while 100 lesions presented positive density (44.87 ± 23.89 HU). In seven patients, only positive HU LBLs were demonstrated whereas in eight patients, both positive and negative HU LBLs were detected. Intriguingly, in three patients (16%), only negative HU LBLs were shown. At 18F-FDG PET/DWI-MRI analysis, negative HU LBLs presented low ADC values (360.69 ± 154.38 × 10−6 mm2/s) and low SUV max values (1.69 ± 0.56), consistent with fatty marrow, whereas positive HU LBLs showed an infiltrative pattern, characterized by higher ADC (mean 868.46 ± 207.67 × 10−6 mm2/s) and SUV max (mean 5.04 ± 1.94) values. Surprisingly, histology of negative HU LBLs documented infiltration by neoplastic plasma cells scattered among adipocytes. In conclusion, two different patterns of LBLs were detected by WB-LDCT in MM patients. Both types of lesions were indicative for active disease, although only positive HU LBL were captured by 18F-FDG PET/DWI-MRI imaging, indicating that WB-LDCT adds specific information.
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Zamagni E, Cavo M, Fakhri B, Vij R, Roodman D. Bones in Multiple Myeloma: Imaging and Therapy. Am Soc Clin Oncol Educ Book 2018; 38:638-646. [PMID: 30231385 DOI: 10.1200/edbk_205583] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
F-fluorodeoxyglucose (FDG)-PET/CT, MRI, and other novel imaging modalities in the management of disease in patients with plasma cell dyscrasias. We also review the state of the art in treatment of MM bone disease (MMBD) and the role of bisphosphonates and denosumab, a monoclonal antibody that binds and blocks the activity of receptor activator of nuclear factor-kappa B ligand (RANKL), which was recently approved by the U.S. Food and Drug Administration for MMBD.
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Affiliation(s)
- Elena Zamagni
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - Michele Cavo
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - Bita Fakhri
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - Ravi Vij
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - David Roodman
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
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Hillengass J, Merz M, Delorme S. Minimal residual disease in multiple myeloma: use of magnetic resonance imaging. Semin Hematol 2018; 55:19-21. [PMID: 29759148 DOI: 10.1053/j.seminhematol.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/06/2018] [Indexed: 12/25/2022]
Abstract
The increasing percentage of patients achieving deep responses in multiple myeloma has led to the need for more sophisticated instruments to measure residual disease as a potential source of relapse. As minimal residual disease assessment is mostly performed on a bone marrow specimen from a certain area of the body, such samples have the limitation that they might not really represent the actual tumor burden, because focal accumulations of malignant cells might be either hit or missed. Magnetic resonance imaging is a highly sensitive technique for the assessment of tumor burden and can be performed as whole-body protocol, overcoming the problem of sampling error for minimal residual disease assessment. Despite its high sensitivity, however, magnetic resonance imaging cannot differentiate between vital and necrotic lesions after therapy. Therefore, new fusion and functional techniques are currently under investigation, and image-guided biopsies are performed to combine the strengths of all available methods.
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Affiliation(s)
- Jens Hillengass
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY; Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Maximilian Merz
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Stefan Delorme
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
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Functional Imaging with 18F-FDG PET/CT and Diffusion Weighted Imaging (DWI) in Early Response Evaluation of Combination Therapy of Elotuzumab, Lenalidomide, and Dexamethasone in a Relapsed Multiple Myeloma Patient. Diagnostics (Basel) 2017; 7:diagnostics7040061. [PMID: 29244720 PMCID: PMC5745397 DOI: 10.3390/diagnostics7040061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 11/16/2022] Open
Abstract
Elotuzumab is the first monoclonal antibody approved for the treatment of relapsed-refractory multiple myeloma (MM) in combination with lenalidomide, an immunodulatory drug, and dexamethasone. We report on a multiply pre-treated MM patient with disease progression due to appearance of new focal lesions on imaging modalities, who was started on a combination treatment of elotuzumab, lenalidomide, and dexamethasone. After completion of three cycles of the new therapy the patient responded very well with a major decline of serological myeloma activity parameters serum monoclonal protein, kappa light chains, free light chains (FLC) ratio. The patient was also monitored with the functional imaging modalities 18F-FDG PET/CT and diffusion weighted imaging (DWI), which exhibited a mismatch of almost complete metabolic remission on positron emission tomography/computed tomography (PET/CT) with 18F-fluoro-2-deoxy-d-glucose (18F-FDG) (consistent with the serological response), and signal elevation persistence on DWI. This case demonstrates the potentially superior performance of 18F-FDG PET/CT over DWI in early response evaluation of combined treatment with a monoclonal antibody, an immunomodulatory drug, and dexamethasone in MM.
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