1
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Kim DK, Park SS, Jung JY. [Clinical Application and Limitations of Myeloma Response Assessment and Diagnosis System (MY-RADS)]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:51-74. [PMID: 36818710 PMCID: PMC9935961 DOI: 10.3348/jksr.2022.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/22/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
Multiple myeloma, which is a proliferative disease of plasma cells that originate from a single clone, is the second most common hematologic malignancy following non-Hodgkin lymphoma. In the past, its diagnosis was made based on clinical findings (so-called "CRAB") and a skeletal survey using radiographs. However, since the implementation of the International Myeloma Working Group's revised guideline regarding the radiologic diagnosis of multiple myeloma, whole-body (WB) MRI has emerged to play a central role in the early diagnosis of multiple myeloma. Diffusion-weighted imaging and fat quantification using Dixon methods enable treatment response assessment by MRI. In keeping with the trend, a multi-institutional and multidisciplinary consensus for standardized image acquisition and reporting known as the Myeloma Response Assessment and Diagnostic System (MY-RADS) has recently been proposed. This review aims to describe the clinical application of WB-MRI based on MY-RADS in multiple myeloma, discuss its limitations, and suggest future directions for improvement.
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Affiliation(s)
- Dong Kyun Kim
- Department of Radiology, Seoul St. Mary’s Hospital, and, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Soo Park
- Department of Hematology, Seoul St. Mary’s Hospital, and, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary’s Hospital, and, College of Medicine, The Catholic University of Korea, Seoul, Korea
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2
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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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3
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Aparisi Gómez MP, Aparisi F, Morganti AG, Fanti S, Bazzocchi A. Effects of Radiation Therapy and Chemotherapy on the Musculoskeletal System. Semin Musculoskelet Radiol 2022; 26:338-353. [PMID: 35654099 DOI: 10.1055/s-0041-1740995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The effects of radiation and chemotherapy on the musculoskeletal (MSK) system are diverse, and interpretation may be challenging. The different lines of treatment have effects on diseased and normal marrow, and they may lead to complications that must be differentiated from recurrence or progression. This review analyzes the changes induced by radiotherapy and chemotherapy in the MSK system in the adult and pediatric population, and the expected associated imaging findings. Treatments are often combined, so the effects may blend. Awareness of the spectrum of changes, complications, and their imaging appearances is paramount for the correct diagnosis. The assessment of body composition during and after treatment allows potential interventions to implement long-term outcomes and personalize treatments. Imaging techniques such as computed tomography or magnetic resonance imaging provide information on body composition that can be incorporated into clinical pathways. We also address future perspectives in posttreatment assessment.
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Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology, IMSKE, Valencia, Spain
| | - Francisco Aparisi
- Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Alma Mater Studiroum Bologna University, Bologna, Italy
| | - Stefano Fanti
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Alma Mater Studiroum Bologna University, Bologna, Italy.,Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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4
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Baffour FI, Glazebrook KN, Kumar SK, Broski SM. Role of imaging in multiple myeloma. Am J Hematol 2020; 95:966-977. [PMID: 32350883 DOI: 10.1002/ajh.25846] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 12/17/2022]
Abstract
With rapid advancements in the diagnosis and treatment of multiple myeloma (MM), imaging has become instrumental in detection of intramedullary and extramedullary disease, providing prognostic information, and assessing therapeutic efficacy. Whole-body low dose computed tomography (WBLDCT) has emerged as the study of choice to detect osteolytic bone disease. Positron emission tomography/computed tomography (PET/CT) combines functional and morphologic information to identify MM disease activity and assess treatment response. Magnetic resonance imaging (MRI) has excellent soft-tissue contrast and is the modality of choice for bone marrow evaluation. This review focuses on the imaging modalities available for MM patient management, highlighting advantages, disadvantages, and applications of each.
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Affiliation(s)
| | | | - Shaji K. Kumar
- Department of Internal Medicine, Division of HematologyMayo Clinic Rochester Minnesota USA
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5
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Koutoulidis V, Papanikolaou N, Moulopoulos LA. Functional and molecular MRI of the bone marrow in multiple myeloma. Br J Radiol 2018; 91:20170389. [PMID: 29393672 DOI: 10.1259/bjr.20170389] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
MRI plays an important role in the management of patients with plasma cell neoplasms and has been recognized as a biomarker of malignancy in the novel criteria for the diagnosis of multiple myeloma. Functional and molecular MRI techniques such as diffusion-weighted imaging (spinal or whole body), intravoxel incoherent motion, and dynamic contrast enhanced MRI, provide additional information related to tumor cellularity and angiogenesis, which may have prognostic implications for patients with smoldering and symptomatic myeloma. These non-invasive functional techniques are also being evaluated as imaging biomarkers for response assessment in myeloma patients. The purpose of this article is to provide a comprehensive critical review on the current use and potential future applications of these advanced MRI techniques in multiple myeloma. In addition, we will address the technologies involved and describe the qualitative and quantitative characteristics of normal bone marrow with these techniques.
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Affiliation(s)
- Vassilis Koutoulidis
- 1 First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Nickolas Papanikolaou
- 2 Computational Clinical Imaging Group, Centre for the Unknown, Champalimaud Foundation , Lisbon , Portugal
| | - Lia A Moulopoulos
- 1 First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
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6
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Latifoltojar A, Hall-Craggs M, Bainbridge A, Rabin N, Popat R, Rismani A, D'Sa S, Dikaios N, Sokolska M, Antonelli M, Ourselin S, Yong K, Taylor SA, Halligan S, Punwani S. Whole-body MRI quantitative biomarkers are associated significantly with treatment response in patients with newly diagnosed symptomatic multiple myeloma following bortezomib induction. Eur Radiol 2017; 27:5325-5336. [PMID: 28656463 PMCID: PMC5674123 DOI: 10.1007/s00330-017-4907-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/13/2017] [Accepted: 05/23/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate whole-body MRI (WB-MRI) parameters significantly associated with treatment response in multiple myeloma (MM). METHODS Twenty-one MM patients underwent WB-MRI at diagnosis and after two cycles of chemotherapy. Scans acquired at 3.0 T included T2, diffusion-weighted-imaging (DWI) and mDixon pre- and post-contrast. Twenty focal lesions (FLs) matched on DWI and post-contrast mDixon were selected for each time point. Estimated tumour volume (eTV), apparent diffusion coefficient (ADC), enhancement ratio (ER) and signal fat fraction (sFF) were derived. Clinical treatment response to chemotherapy was assessed using conventional criteria. Significance of temporal parameter change was assessed by the paired t test and receiver operating characteristics/area under the curve (AUC) analysis was performed. Parameter repeatability was assessed by interclass correlation (ICC) and Bland-Altman analysis of 10 healthy volunteers scanned at two time points. RESULTS Fifteen of 21 patients responded to treatment. Of 254 FLs analysed, sFF (p < 0.0001) and ADC (p = 0.001) significantly increased in responders but not non-responders. eTV significantly decreased in 19/21 cases. Focal lesion sFF was the best discriminator of treatment response (AUC 1.0). Bone sFF repeatability was excellent (ICC 0.98) and better than bone ADC (ICC 0.47). CONCLUSION WB-MRI derived focal lesion sFF shows promise as an imaging biomarker of treatment response in newly diagnosed MM. KEY POINTS • Bone signal fat fraction using mDixon is a robust quantifiable parameter • Fat fraction and ADC significantly increase in myeloma lesions responding to treatment • Bone lesion fat fraction is the best discriminator of myeloma treatment response.
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Affiliation(s)
- Arash Latifoltojar
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
| | - Margaret Hall-Craggs
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Alan Bainbridge
- Department of Medical Physics and Bioengineering, University College London Hospital, London, UK
| | - Neil Rabin
- Department of Haematology, University College London Hospital, London, UK
| | - Rakesh Popat
- Department of Haematology, University College London Hospital, London, UK
| | - Ali Rismani
- Department of Haematology, University College London Hospital, London, UK
| | - Shirley D'Sa
- Department of Haematology, University College London Hospital, London, UK
| | - Nikolaos Dikaios
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
| | - Magdalena Sokolska
- Department of Medical Physics and Bioengineering, University College London Hospital, London, UK
| | - Michela Antonelli
- Translational Imaging Group, Centre for Medical Imaging Computing, University College London, London, UK
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Imaging Computing, University College London, London, UK
| | - Kwee Yong
- Department of Haematology, University College London Hospital, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE.
- Department of Radiology, University College London Hospital, London, UK.
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7
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Chantry A, Kazmi M, Barrington S, Goh V, Mulholland N, Streetly M, Lai M, Pratt G. Guidelines for the use of imaging in the management of patients with myeloma. Br J Haematol 2017; 178:380-393. [PMID: 28677897 DOI: 10.1111/bjh.14827] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The role of imaging in myeloma has gained increasing importance over the past few years. The recently revised definition of myeloma from the International Myeloma Working Group (IMWG) includes cross sectional imaging as a method to define bone disease and also incorporates its use in the disease definition for patients with suspected smouldering myeloma. The National Institute for Health and Care Excellence myeloma guidelines also recommend cross sectional imaging for patients with suspected myeloma. There is also increasing use of imaging in disease assessments and the International Myeloma Working Group has recently incorporated imaging in defining new response categories of minimal residual disease negativity, with or without imaging-based evidence of disease. Plain X-rays have previously been the standard imaging modality included in a myeloma work up at presentation but evidence is mounting for use of cross-sectional modalities such as computed tomography (CT), magnetic resonance imaging (MRI) and 18 fluoro-deoxyglucose (18 F-FDG) positron emission tomography (PET)/CT. Funding and therefore availability of newer imaging techniques remains a barrier. Here, we propose an evidence-based approach to the use and technical application of the latest imaging modalities at diagnosis and in the follow-up of patients with myeloma and plasmacytoma.
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Affiliation(s)
- Andrew Chantry
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Majid Kazmi
- Department of Haematology, Guys and St Thomas's NHS Foundation Trust, London, UK
| | - Sally Barrington
- Division of Imaging Sciences & Biomedical Engineering, King's College London Department of Cancer Imaging, London, UK
- The PET Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vicky Goh
- Division of Imaging Sciences & Biomedical Engineering, King's College London Department of Cancer Imaging, London, UK
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicola Mulholland
- Department of Radiology, Kings College Hospital NHS Foundation Trust, London, UK
| | - Matthew Streetly
- Department of Haematology, Guys and St Thomas's NHS Foundation Trust, London, UK
| | | | - Guy Pratt
- Department of Haematology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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8
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Abstract
Radiology provides a crucial clinical adjunct in patients with plasma cell disorders, in particular multiple myeloma, and its uses are evolving and expanding. This pictorial review illustrates the role of imaging throughout the patient's clinical course, with specific reference to recently updated international diagnostic criteria. At presentation, imaging optimises characterisation and staging of the plasma-cell disorder, while later in the course of the disease, its roles include the monitoring of disease progression, assessment of post-treatment response and the investigation of clinical deterioration.
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Affiliation(s)
- Arian Lasocki
- 1 Department of Cancer Imaging, Peter MacCallum Cancer Centre, Australia.,2 Monash Imaging, Monash Health, Australia
| | - Frank Gaillard
- 3 Department of Radiology, The Royal Melbourne Hospital, Australia.,4 Department of Radiology, The University of Melbourne, Australia
| | - Simon J Harrison
- 5 Department of Cancer Medicine, Peter MacCallum Cancer Centre, Australia.,6 Sir Peter MacCallum Department of Oncology, The University of Melbourne, Australia
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9
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Saviet BM, Marcoux JT, Narayanasami U. Rare Pedal Manifestation of Diffuse Multiple Myeloma Lesions. J Foot Ankle Surg 2017; 56:357-361. [PMID: 28231967 DOI: 10.1053/j.jfas.2016.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Indexed: 02/03/2023]
Abstract
Multiple myeloma is a malignancy of plasma cell proliferation leading to production of monoclonal immunoglobins. Among the classic features of multiple myeloma are bone lesions, which typically manifest in the axial skeleton, vertebrae, pelvis, skull, ribs, and proximal extremities. The several types of multiple myeloma include symptomatic multiple myeloma, monoclonal gammopathy of undetermined significance, smoldering/indolent myeloma, and solitary plasmacytoma of bone. Although rare, plasmacytomas of the foot and ankle have been described in published studies. We present, to the best of our knowledge, the first description of classic diffuse myelomatosis lesions associated with symptomatic myeloma in the foot of a patient with advanced disease who was treated in the podiatric surgery clinic for pathologic fracture.
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Affiliation(s)
- Benjamin M Saviet
- Resident, Department of Surgery, Steward St. Elizabeth's Medical Center, Brighton, MA.
| | - John T Marcoux
- Podiatric Surgery Residency Director, Department of Surgery, Steward St. Elizabeth's Medical Center, Brighton, MA
| | - Uma Narayanasami
- Attending Physician and Assistant Professor, Department of Hematology Oncology, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA
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10
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Catalano OA, Masch WR, Catana C, Mahmood U, Sahani DV, Gee MS, Menezes L, Soricelli A, Salvatore M, Gervais D, Rosen BR. An overview of PET/MR, focused on clinical applications. Abdom Radiol (NY) 2017; 42:631-644. [PMID: 27624499 DOI: 10.1007/s00261-016-0894-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hybrid PET/MR scanners are innovative imaging devices that simultaneously or sequentially acquire and fuse anatomical and functional data from magnetic resonance (MR) with metabolic information from positron emission tomography (PET) (Delso et al. in J Nucl Med 52:1914-1922, 2011; Zaidi et al. in Phys Med Biol 56:3091-3106, 2011). Hybrid PET/MR scanners have the potential to greatly impact not only on medical research but also, and more importantly, on patient management. Although their clinical applications are still under investigation, the increased worldwide availability of PET/MR scanners, and the growing published literature are important determinants in their rising utilization for primarily clinical applications. In this manuscript, we provide a summary of the physical features of PET/MR, including its limitations, which are most relevant to clinical PET/MR implementation and to interpretation. Thereafter, we discuss the most important current and emergent clinical applications of such hybrid technology in the abdomen and pelvis, both in the field of oncologic and non-oncologic imaging, and we provide, when possible, a comparison with clinically consolidated imaging techniques, like for example PET/CT.
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Affiliation(s)
- Onofrio Antonio Catalano
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 49 13th St, Charlestown, MA, 02129, USA.
- Abdominal Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
| | - William Roger Masch
- Department of Radiology, Abdominal Imaging, University of Michigan Health System, 1550E Medical Center Dr, SPC5030, Ann Arbor, MI, 48109, USA
| | - Ciprian Catana
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 49 13th St, Charlestown, MA, 02129, USA
| | - Umar Mahmood
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 49 13th St, Charlestown, MA, 02129, USA
- Institute of Precision Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Dushyant Vasudeo Sahani
- Abdominal Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Michael Stanley Gee
- Abdominal Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
- Martinos Center for Pediatric Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Leon Menezes
- Institute of Nuclear Medicine, University College Hospital, 235 Euston Rd, Fitzrovia, London, NW1 2BU, UK
| | - Andrea Soricelli
- University of Naples "Parthenope", Via Medina 40, 80133, Naples, Italy
| | - Marco Salvatore
- Medicina Nucleare, Fondazione SDN, Via Gianturco 113, Naples, 80113, Italy
| | - Debra Gervais
- Abdominal Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Bruce Robert Rosen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 49 13th St, Charlestown, MA, 02129, USA
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11
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Terpos E, Dimopoulos MA, Moulopoulos LA. The Role of Imaging in the Treatment of Patients With Multiple Myeloma in 2016. Am Soc Clin Oncol Educ Book 2017; 35:e407-17. [PMID: 27249748 DOI: 10.1200/edbk_159074] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The novel criteria for the diagnosis of symptomatic multiple myeloma have revealed the value of modern imaging for the management of patients with myeloma. Whole-body low-dose CT (LDCT) has increased sensitivity over conventional radiography for the detection of osteolytic lesions, and several myeloma organizations and institutions have suggested that whole-body LDCT should replace conventional radiography for the work-up of patients with myeloma. MRI is the best imaging method for the depiction of marrow infiltration by myeloma cells. Whole-body MRI (or at least MRI of the spine and pelvis if whole-body MRI is not available) should be performed for all patients with smoldering multiple myeloma with no lytic lesions to look for occult disease, which may justify treatment. In addition, MRI accurately illustrates the presence of plasmacytomas, spinal cord, and/or nerve compression for surgical intervention or radiation therapy; it is also recommended for the work-up of solitary bone plasmacytoma, and it may distinguish malignant from benign fractures (which is very important in cases of patients in biochemical remission with no other signs of progression). Diffusion weighted imaging (DWI) seems to improve MRI diagnosis in patients with myeloma. PET/CT is a functional imaging technique, more sensitive than conventional radiography for the detection of lytic lesions, which probably allows better definition of complete response and minimal residual disease compared with all other imaging methods. PET/CT has shown the best results in the follow-up of patients with myeloma and has an independent prognostic value both at diagnosis and following treatment. PET/CT can also be used for the work-up of solitary bone plasmacytoma and nonsecretory myeloma.
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Affiliation(s)
- Evangelos Terpos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Meletios A Dimopoulos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Lia A Moulopoulos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
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12
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Imaging Measurable (Minimal) Residual Disease in Multiple Myeloma. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Horger M, Thaiss WM, Ditt H, Weisel K, Fritz J, Nikolaou K, Liao S, Kloth C. Improved MDCT monitoring of pelvic myeloma bone disease through the use of a novel longitudinal bone subtraction post-processing algorithm. Eur Radiol 2016; 27:2969-2977. [PMID: 27882427 DOI: 10.1007/s00330-016-4642-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 09/16/2016] [Accepted: 10/10/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of a novel CT post-processing software that generates subtraction maps of baseline and follow-up CT examinations in the course of myeloma bone lesions. MATERIALS AND METHODS This study included 61 consecutive myeloma patients who underwent repeated whole-body reduced-dose MDCT at our institution between November 2013 and June 2015. CT subtraction maps classified a progressive disease (PD) vs. stable disease (SD)/remission. Bone subtraction maps (BSMs) only and in combination with 1-mm (BSM+) source images were compared with 5-mm axial/MPR scans. RESULTS Haematological response categories at follow-up were: complete remission (n = 9), very good partial remission (n = 2), partial remission (n = 17) and SDh (n = 19) vs. PDh (n = 14). Five-millimetre CT scan yielded PD (n = 14) and SD/remission (n = 47) whereas bone subtraction + 1-mm axial scans (BSM+) reading resulted in PD (n = 18) and SD/remission (n = 43). Sensitivity/ specificity/accuracy for 5-mm/1-mm/BSM(alone)/BSM + in "lesion-by-lesion" reading was 89.4 %/98.9 %/98.3 %/ 99.5 %; 69.1 %/96.9 %/72 %/92.1 % and 83.8 %/98.4 %/92.1 %/98.3 %, respectively. The use of BSM+ resulted in a change of response classification in 9.8 % patients (n = 6) from SD to PD. CONCLUSION BSM reading is more accurate for monitoring myeloma compared to axial scans whereas BSM+ yields similar results with 1-mm reading (gold standard) but by significantly reduced reading time. KEY POINTS • CT evaluation of myeloma bone disease using a longitudinal bone subtraction post-processing algorithm. • Bone subtraction post-processing algorithm is more accurate for assessment of therapy. • Bone subtraction allowed improved and more efficient detection of myeloma bone lesions. • Post-processing tool demonstrating a change in response classification in 9.8 % patients (all showing PD). • Reading time could be substantially shortened as compared to regular CT assessment.
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Affiliation(s)
- Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str.3, D-72076, Tuebingen, Germany
| | - Wolfgang M Thaiss
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str.3, D-72076, Tuebingen, Germany
| | - Hendrik Ditt
- Siemens AG Healthcare, Sector Imaging and Interventional Radiology, Siemensstr. 1, D-91301, Forchheim, Germany
| | - Katja Weisel
- Department of Internal Medicine II, Eberhard-Karls-University Tübingen, D-72076, Tübingen, Germany
| | - Jan Fritz
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medcine, 601 N. Caroline Street, JHOC 3142, Baltimore, MD, 21287, USA
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str.3, D-72076, Tuebingen, Germany
| | - Shu Liao
- Siemens Medical Solutions, Malvern, PA, 19355, USA
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str.3, D-72076, Tuebingen, Germany.
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14
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Gonzalez FM, Mitchell J, Monfred E, Anguh T, Mulligan M. Knee MRI patterns of bone marrow reconversion and relationship to anemia. Acta Radiol 2016; 57:964-70. [PMID: 26494803 DOI: 10.1177/0284185115610932] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 09/09/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bone marrow changes are commonly encountered on knee magnetic resonance imaging (MRI). The clinical relevance of these changes, especially as they relate to anemia, has not been studied in a large patient series. PURPOSE To determine if the extent of bone marrow reconversion (BMR) can assist the radiologist in making recommendations for further evaluation for underlying anemia. MATERIAL AND METHODS This study included 457 patients who had knee MRI over a 2-year period. Bone marrow patterns in the distal femur, proximal tibia, and fibula were graded as follows: 1, homogeneous fatty marrow; 2, patchy red marrow in the distal femur; 3, patchy red marrow in the distal femur and tibia and/or fibula; and 4, complete BMR in the femoral, tibial, and/or fibular metaphyses. RESULTS There was a statistically significant difference (P < 0.001) between the hemoglobin concentration and BMR grades. In women, anemia (Hb ≤12.0 g/dL) was found in 31 of 127 (24%) patients with grade 1, 31 of 83 (37%) with grade 2, 24 of 64 (37%) with grade 3, and 12 of 24 (50%) with grade 4. In men, anemia (Hb ≤13.0 g/dL) was found in 33 of 125 (26%) patients with grade 1, 12 of 19 (63%) with grade 2, five of 14 (36%) with grade 3, but not in the one patient with grade 4. CONCLUSION Women demonstrating marrow changes of a grade 4 BMR pattern should get a laboratory assessment for anemia.
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Affiliation(s)
- Felix M Gonzalez
- Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Jason Mitchell
- Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Erica Monfred
- Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Terence Anguh
- Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Michael Mulligan
- Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
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15
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Abstract
Imaging manifestations of hematological diseases and their potential complications are broad, and there may be significant overlap in features of various disease processes. Knowledge of appropriate choice of imaging test, pertinent imaging patterns, and pathophysiology of disease can help the reader increase specificity in the diagnosis and treatment of the patient. Most importantly, we encourage readers of this review to engage their radiologists during the diagnostic, treatment, and management phases of care delivery.
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16
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Rubini G, Niccoli-Asabella A, Ferrari C, Racanelli V, Maggialetti N, Dammacco F. Myeloma bone and extra-medullary disease: Role of PET/CT and other whole-body imaging techniques. Crit Rev Oncol Hematol 2016; 101:169-83. [DOI: 10.1016/j.critrevonc.2016.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/08/2016] [Accepted: 03/03/2016] [Indexed: 01/08/2023] Open
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17
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Ferraro R, Agarwal A, Martin-Macintosh EL, Peller PJ, Subramaniam RM. MR imaging and PET/CT in diagnosis and management of multiple myeloma. Radiographics 2016; 35:438-54. [PMID: 25763728 DOI: 10.1148/rg.352140112] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Multiple myeloma is a common hematologic malignancy among the elderly population. Although there have been many advances in treatment over the past few decades, the overall prognosis for the disease remains poor. Conventional radiography has long been the standard of reference for the imaging of multiple myeloma. However, 10%-20% of patients with multiple myeloma do not have evidence of disease at conventional radiography. There is a growing body of evidence supporting use of magnetic resonance (MR) imaging and 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) in diagnosis and management of multiple myeloma. MR imaging is useful in detection of bone marrow infiltration, a finding often missed at conventional radiography. FDG PET/CT is especially sensitive for the detection of extramedullary disease and can help detect the metabolically active lesions that often precede evidence of osseous destruction at conventional radiography. MR imaging and FDG PET/CT are useful tools that can provide essential information for diagnosis and management of patients with multiple myeloma. Both modalities allow accurate localization of disease after chemotherapy or autologous stem cell transplantation and can provide important prognostic information that can influence further clinical decision making regarding therapy, particularly when tumor serum markers may be a less reliable indicator of disease burden after repeated treatments.
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Affiliation(s)
- Regan Ferraro
- From the Department of Radiology, Boston University School of Medicine, Boston, Mass (R.F., A.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.L.M.M., P.J.P.); Russell H. Morgan Department of Radiology and Radiological Sciences, Department of Oncology, and Department of Otolaryngology and Head and Neck Surgery, Johns Hopkins School of Medicine, 601 N Caroline St, JHOC 3235, Baltimore, MD 21287 (R.M.S.); and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (R.M.S.)
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18
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Keraliya AR, Krajewski KM, Jagannathan JP, Shinagare AB, Braschi-Amirfarzan M, Tirumani SH, Ramaiya NH. Multimodality imaging of osseous involvement In haematological malignancies. Br J Radiol 2016; 89:20150980. [PMID: 26781757 DOI: 10.1259/bjr.20150980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The purpose of this article is to provide a comprehensive review of the imaging features of osseous involvement in haematological malignancies. Osseous involvement can be seen in various haematological malignancies including lymphomas, plasma cell neoplasms, leukaemias and myeloproliferative neoplasms. Imaging plays a crucial role in initial diagnosis, staging and in the assessment of treatment response in these patients.
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Affiliation(s)
- Abhishek R Keraliya
- 1 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.,2 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Katherine M Krajewski
- 1 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.,2 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jyothi P Jagannathan
- 1 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.,2 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Atul B Shinagare
- 1 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.,2 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marta Braschi-Amirfarzan
- 1 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.,2 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sree H Tirumani
- 1 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.,2 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nikhil H Ramaiya
- 1 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.,2 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Mai EK, Hielscher T, Kloth JK, Merz M, Shah S, Raab MS, Hillengass M, Wagner B, Jauch A, Hose D, Weber MA, Delorme S, Goldschmidt H, Hillengass J. A magnetic resonance imaging-based prognostic scoring system to predict outcome in transplant-eligible patients with multiple myeloma. Haematologica 2015; 100:818-25. [PMID: 25795721 DOI: 10.3324/haematol.2015.124115] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/11/2015] [Indexed: 12/18/2022] Open
Abstract
Diffuse and focal bone marrow infiltration patterns detected by magnetic resonance imaging have been shown to be of prognostic significance in all stages of monoclonal plasma cell disorders and have, therefore, been incorporated into the definition of the disease. The aim of this retrospective analysis was to develop a rapidly evaluable prognostic scoring system, incorporating the most significant information acquired from magnetic resonance imaging. Therefore, the impact of bone marrow infiltration patterns on progression-free and overall survival in 161 transplant-eligible myeloma patients was evaluated. Compared to salt and pepper/minimal diffuse infiltration, moderate/severe diffuse infiltration had a negative prognostic impact on both progression-free survival (P<0.001) and overall survival (P=0.003). More than 25 focal lesions on whole-body magnetic resonance imaging or more than seven on axial magnetic resonance imaging were associated with an adverse prognosis (progression-free survival: P=0.001/0.003 and overall survival: P=0.04/0.02). A magnetic resonance imaging-based prognostic scoring system, combining grouped diffuse and focal infiltration patterns, was formulated and is applicable to whole-body as well as axial magnetic resonance imaging. The score identified high-risk patients with median progression-free and overall survival of 23.4 and 55.9 months, respectively (whole-body-based). Multivariate analyses demonstrated that the magnetic resonance imaging-based prognostic score stage III (high-risk) and adverse cytogenetics are independent prognostic factors for both progression-free and overall survival (whole-body-based, progression-free survival: hazard ratio=3.65, P<0.001; overall survival: hazard ratio=5.19, P=0.005). In conclusion, we suggest a magnetic resonance imaging-based prognostic scoring system which is a robust, easy to assess and interpret parameter summarizing significant magnetic resonance imaging findings in transplant-eligible patients with multiple myeloma.
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Affiliation(s)
- Elias K Mai
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Heidelberg, Germany
| | - Jost K Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Maximilian Merz
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Sofia Shah
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Marc S Raab
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Michaela Hillengass
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Barbara Wagner
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Anna Jauch
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - Dirk Hose
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Stefan Delorme
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Jens Hillengass
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
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Dimopoulos MA, Hillengass J, Usmani S, Zamagni E, Lentzsch S, Davies FE, Raje N, Sezer O, Zweegman S, Shah J, Badros A, Shimizu K, Moreau P, Chim CS, Lahuerta JJ, Hou J, Jurczyszyn A, Goldschmidt H, Sonneveld P, Palumbo A, Ludwig H, Cavo M, Barlogie B, Anderson K, Roodman GD, Rajkumar SV, Durie BG, Terpos E. Role of Magnetic Resonance Imaging in the Management of Patients With Multiple Myeloma: A Consensus Statement. J Clin Oncol 2015; 33:657-64. [DOI: 10.1200/jco.2014.57.9961] [Citation(s) in RCA: 277] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose The aim of International Myeloma Working Group was to develop practical recommendations for the use of magnetic resonance imaging (MRI) in multiple myeloma (MM). Methods An interdisciplinary panel of clinical experts on MM and myeloma bone disease developed recommendations for the value of MRI based on data published through March 2014. Recommendations MRI has high sensitivity for the early detection of marrow infiltration by myeloma cells compared with other radiographic methods. Thus, MRI detects bone involvement in patients with myeloma much earlier than the myeloma-related bone destruction, with no radiation exposure. It is the gold standard for the imaging of axial skeleton, for the evaluation of painful lesions, and for distinguishing benign versus malignant osteoporotic vertebral fractures. MRI has the ability to detect spinal cord or nerve compression and presence of soft tissue masses, and it is recommended for the workup of solitary bone plasmacytoma. Regarding smoldering or asymptomatic myeloma, all patients should undergo whole-body MRI (WB-MRI; or spine and pelvic MRI if WB-MRI is not available), and if they have > one focal lesion of a diameter > 5 mm, they should be considered to have symptomatic disease that requires therapy. In cases of equivocal small lesions, a second MRI should be performed after 3 to 6 months, and if there is progression on MRI, the patient should be treated as having symptomatic myeloma. MRI at diagnosis of symptomatic patients and after treatment (mainly after autologous stem-cell transplantation) provides prognostic information; however, to date, this does not change treatment selection.
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Affiliation(s)
- Meletios A. Dimopoulos
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Jens Hillengass
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Saad Usmani
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Elena Zamagni
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Suzanne Lentzsch
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Faith E. Davies
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Noopur Raje
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Orhan Sezer
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Sonja Zweegman
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Jatin Shah
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Ashraf Badros
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Kazuyuki Shimizu
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Philippe Moreau
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Chor-Sang Chim
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Juan José Lahuerta
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Jian Hou
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Artur Jurczyszyn
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Hartmut Goldschmidt
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Pieter Sonneveld
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Antonio Palumbo
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Heinz Ludwig
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Michele Cavo
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Bart Barlogie
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Kenneth Anderson
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - G. David Roodman
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - S. Vincent Rajkumar
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Brian G.M. Durie
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Evangelos Terpos
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
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Song IC, Kim JN, Choi YS, Ryu H, Lee MW, Lee HJ, Yun HJ, Kim S, Kwon ST, Jo DY. Diagnostic and Prognostic Implications of Spine Magnetic Resonance Imaging at Diagnosis in Patients with Multiple Myeloma. Cancer Res Treat 2014; 47:465-72. [PMID: 25544578 PMCID: PMC4506104 DOI: 10.4143/crt.2014.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/05/2014] [Indexed: 01/16/2023] Open
Abstract
Purpose The aim of this study is to determine the diagnostic and prognostic role of baseline spinal magnetic resonance imaging (MRI) in patients with multiple myeloma. Materials and Methods We enrolled patients newly diagnosed with multiple myeloma from 2004-2011 at a single center. Abnormal MRI findings that were not detected in radiographs have been analyzed and categorized as malignant compression fractures or extramedullary plasmacytoma. The bone marrow (BM) infiltration patterns on MRI have been classified into five categories. Results A total of 113 patients with a median age of 65 years (range, 40 to 89 years) were enrolled in the study. Malignant compression fractures not detected in the bone survey were found in 26 patients (23.0%), including three patients (2.6%) with no related symptoms or signs. Extramedullary plasmacytoma was detected in 22 patients (19.5%), including 15 (13.3%) with epidural extension of the tumor. Of these 22 patients, 11 (50.0%) had no relevant symptoms or signs. The presence of malignant compression fractures did not influence overall survival; whereas non-epidural extramedullary plasmacytoma was associated with poor overall survival in the multivariate analysis (hazard ratio, 3.205; 95% confidence interval [CI], 1.430 to 9.845; p=0.042). During the follow-up for a median of 21 months (range, 1 to 91 months), overall survival with the mixed BM infiltrative pattern (median, 24.0 months; 95% CI, 22.9 to 25.1 months) was shorter than those with other patterns (median 56 months; 95% CI, 48.9 to 63.1 months; p=0.030). Conclusion These results indicate that spine MRI at the time of diagnosis is useful for detecting skeletal lesions and predicting the prognosis in patients with multiple myeloma.
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Affiliation(s)
- Ik-Chan Song
- Departments of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Ji-Na Kim
- Departments of Diagnostic Radiology, Chungnam National University Hospital, Daejeon, Korea
| | - Yoon-Seok Choi
- Departments of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Haewon Ryu
- Departments of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Myung-Won Lee
- Departments of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hyo-Jin Lee
- Departments of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hwan-Jung Yun
- Departments of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Samyong Kim
- Departments of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Soon Tae Kwon
- Departments of Diagnostic Radiology, Chungnam National University Hospital, Daejeon, Korea
| | - Deog-Yeon Jo
- Departments of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
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Derlin T, Bannas P. Imaging of multiple myeloma: Current concepts. World J Orthop 2014; 5:272-282. [PMID: 25035830 PMCID: PMC4095020 DOI: 10.5312/wjo.v5.i3.272] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/11/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Medical imaging is of crucial importance for diagnosis and initial staging as well as for differentiation of multiple myeloma (MM) from other monoclonal plasma cell diseases. Conventional radiography represents the reference standard for diagnosis of MM due to its wide availability and low costs despite its known limitations such as low sensitivity, limited specificity and its inability to detect extraosseous lesions. Besides conventional radiography, newer cross-sectional imaging modalities such as whole-body low-dose computed tomography (CT), whole-body magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT are available for the diagnosis of osseous and extraosseous manifestations of MM. Whole-body low-dose CT is used increasingly, replacing conventional radiography at selected centers, due to its higher sensitivity for the detection of osseous lesions and its ability to diagnose extraosseous lesions. The highest sensitivity for both detection of bone marrow disease and extraosseous lesions can be achieved with whole-body MRI and 18F-FDG PET/CT. According to current evidence, MRI is the most sensitive method for initial staging while 18F-FDG PET/CT allows monitoring of treatment of MM. There is an evolving role for assessment of treatment response using newer MR imaging techniques. Future studies are needed to further define the exact role of the different imaging modalities for individual risk stratification and therapy monitoring.
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Kloth JK, Hillengass J, Listl K, Kilk K, Hielscher T, Landgren O, Delorme S, Goldschmidt H, Kauczor HU, Weber MA. Appearance of monoclonal plasma cell diseases in whole-body magnetic resonance imaging and correlation with parameters of disease activity. Int J Cancer 2014; 135:2380-6. [DOI: 10.1002/ijc.28877] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/20/2014] [Indexed: 01/25/2023]
Affiliation(s)
- Jost K. Kloth
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
- Department of Radiology; German Cancer Research Center (dkfz); Heidelberg Germany
| | - Jens Hillengass
- Department of Radiology; German Cancer Research Center (dkfz); Heidelberg Germany
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Karin Listl
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
| | - Kerstin Kilk
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
| | - Thomas Hielscher
- Department of Biostatistics; German Cancer Research Center (dkfz); Heidelberg Germany
| | - Ola Landgren
- Multiple Myeloma Section; National Cancer Institute, Nationl Institutes of Health; Bethesda MD
| | - Stefan Delorme
- Department of Radiology; German Cancer Research Center (dkfz); Heidelberg Germany
| | - Hartmut Goldschmidt
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
- Department of Radiology; German Cancer Research Center (dkfz); Heidelberg Germany
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Boutry N, Dutouquet B, Leleu X, Vieillard MH, Duhamel A, Cotten A. Low-dose biplanar skeletal survey versus digital skeletal survey in multiple myeloma. Eur Radiol 2013; 23:2236-45. [DOI: 10.1007/s00330-013-2812-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/25/2013] [Accepted: 02/02/2013] [Indexed: 02/03/2023]
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Lecouvet FE, Larbi A, Pasoglou V, Omoumi P, Tombal B, Michoux N, Malghem J, Lhommel R, Vande Berg BC. MRI for response assessment in metastatic bone disease. Eur Radiol 2013; 23:1986-97. [PMID: 23455764 DOI: 10.1007/s00330-013-2792-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 12/24/2012] [Accepted: 01/16/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Beyond lesion detection and characterisation, and disease staging, the quantification of the tumour load and assessment of response to treatment are daily expectations in oncology. METHODS Bone lesions have been considered "non-measurable" for years as opposed to lesions involving soft tissues and "solid" organs like the lungs or liver, for which response evaluation criteria are used in every day practice. This is due to the lack of sensitivity, specificity and measurement capabilities of imaging techniques available for bone assessment, i.e. skeletal scintigraphy (SS), radiographs and computed tomography (CT). RESULTS This paper reviews the possibilities and limitations of these techniques and highlights the possibilities of positron emission tomography (PET), but mainly concentrates on magnetic resonance imaging (MRI). CONCLUSION Practical morphological and quantitative approaches are proposed to evaluate the treatment response of bone marrow lesions using "anatomical" MRI. Recent developments of MRI, i.e. dynamic contrast-enhanced (DCE) imaging and diffusion-weighted imaging (DWI), are also covered. KEY POINTS • MRI offers improved evaluation of skeletal metastases and their response to treatment. • This new indication for MRI has wide potential impact on radiological practice. • MRI helps meet the expectations of the oncological community. • We emphasise the practical aspects, with didactic cases and illustrations.
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Affiliation(s)
- F E Lecouvet
- Department of Radiology, Cliniques Universitaires Saint-Luc, IREC, Institut de Recherche Clinique, Centre du Cancer, UCL, Université Catholique de Louvain, Hippocrate Avenue, 10/2942, 1200 Brussels, Belgium.
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Isoda A, Higuchi T, Nakano S, Arisaka Y, Kaira K, Kamio T, Mawatari M, Matsumoto M, Sawamura M, Tsushima Y. ¹⁸F-FAMT in patients with multiple myeloma: clinical utility compared to ¹⁸F-FDG. Ann Nucl Med 2012; 26:811-6. [PMID: 22903817 DOI: 10.1007/s12149-012-0645-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 07/29/2012] [Indexed: 12/28/2022]
Abstract
OBJECTIVE L-[3-(18)F]-alpha-methyltyrosine ((18)F-FAMT) is an amino-acid tracer for positron emission tomography (PET), with uptake related to overexpression of L-type amino-acid transporter 1 and proliferative activity in tumour cells. This study evaluated the diagnostic performance of (18)F-FAMT PET compared with 2-[(18)F]-fluoro-2-deoxy-D-glucose ((18)F-FDG) PET in patients with multiple myeloma (MM). METHODS Eleven patients with MM (newly diagnosed, n = 3; relapsed after treatment, n = 8) underwent whole-body (18)F-FAMT and (18)F-FDG PET within a 2-week interval. Magnetic resonance imaging (MRI) of the spine was also performed to assess patterns of bone marrow infiltration. Tracer uptake was semi-quantitatively evaluated using maximal standardized uptake value (SUV(max)). Mean SUV was also determined for normal bone marrow and the aortic arch as mediastinal background SUV to calculate lesion-to-bone marrow (L/B) and lesion-to-mediastinum (L/M) ratios, respectively. Those values were statistically compared using Student's t test. RESULTS In 8 patients showing focal infiltration on MRI, 34 FDG-avid bone lesions were identified, with each showing increased FAMT uptake. Mean SUV(max) and L/B ratio of FDG (3.1 ± 1.2 and 3.3 ± 1.9, respectively) were significantly higher than those of FAMT (2.0 ± 1.0 and 2.6 ± 1.1, respectively; p < 0.05 each). In contrast, the L/M ratio of FDG showed no significant difference to that of FAMT (2.2 ± 1.0 and 2.4 ± 1.2, respectively; p = 0.3). CONCLUSIONS Clear (18)F-FAMT PET uptake was seen in most (18)F-FDG-avid lesions among patients with MM, and an equivalent semi-quantitative value was obtained using L/M ratio. Our preliminary data suggest that (18)F-FAMT PET provides a useful imaging modality for detecting active myelomatous lesions.
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Affiliation(s)
- Atsushi Isoda
- Department of Hematology, National Hospital Organization Nishigunma National Hospital, 2854, Kanai, Shibukawa, Gunma 377-8511, Japan.
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Zamagni E, Cavo M. The role of imaging techniques in the management of multiple myeloma. Br J Haematol 2012; 159:499-513. [PMID: 22881361 DOI: 10.1111/bjh.12007] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Bone disease is the major feature of multiple myeloma (MM). Imaging is required for correct staging, in the follow-up after treatment and, as recently highlighted, is predictor of prognosis. In the near future, whole-body X-Ray may be replaced by more sensitive techniques, such as whole-body low-dose computerized tomography (CT). Magnetic resonance imaging (MRI) is the gold standard method for assessing bone marrow infiltration of the spine, predicting the risk of vertebral fracture and distinguishing between benign and malignant osteoporosis. Positron emission tomography (PET) with CT (PET/CT) provides important information about the extent of whole-body disease, including soft tissue masses, and is the best tool to distinguish between active or inactive disease after therapy. Both MRI and PET/CT are predictors of clinical outcome. A prospective use of these newer imaging techniques in both clinical trials and clinical practice may help optimize MM management in the near future.
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Affiliation(s)
- Elena Zamagni
- Seràgnoli Institute of Haematology, Bologna University School of Medicine, Bologna, Italy.
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Kim SH, Smith SE, Mulligan ME. Hematopoietic tumors and metastases involving bone. Radiol Clin North Am 2011; 49:1163-83, vi. [PMID: 22024293 DOI: 10.1016/j.rcl.2011.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This review explores in depth the most common malignant process involving the bone, namely metastatic disease, as well as some of the more common proliferative forms of hematopoietic disease of bone marrow. These are commonly encountered pathologic processes that often have vague nonspecific symptoms. Imaging findings are frequently subtle on initial radiographs; however, advanced imaging techniques, including CT, MR, and positron emission tomography, allow for accurate diagnosis, staging, and follow-up in most cases.
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Affiliation(s)
- Sung H Kim
- Department of Radiology, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA
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Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel 3. Blood 2011; 117:4701-5. [PMID: 21292778 DOI: 10.1182/blood-2010-10-299529] [Citation(s) in RCA: 288] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AbstractA panel of members of the 2009 International Myeloma Workshop developed guidelines for standard investigative workup of patients with suspected multiple myeloma. Both serum and urine should be assessed for monoclonal protein. Measurement of monoclonal protein both by densitometer tracing and/by nephelometric quantitation is recommended, and immunofixation is required for confirmation. The serum-free light chain assay is recommended in all newly diagnosed patients with plasma cell dyscrasias. Bone marrow aspiration and/or biopsy along with demonstration of clonality of plasma cells are necessary. Serum β2-microglobulin, albumin, and lactate dehydrogenase are necessary for prognostic purposes. Standard metaphase cytogenetics and fluorescent in situ hybridization for 17p, t(4;14), and t(14;16) are recommended. The skeletal survey remains the standard method for imaging screening, but magnetic resonance imaging frequently provides valuable diagnostic and prognostic information. Most of these tests are repeated during follow-up or at relapse.
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Christoulas D, Terpos E, Dimopoulos MA. Pathogenesis and management of myeloma bone disease. Expert Rev Hematol 2011; 2:385-98. [PMID: 21082944 DOI: 10.1586/ehm.09.36] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Osteolytic bone disease is a frequent complication of multiple myeloma, resulting in skeletal complications that are a significant cause of morbidity and mortality. It is the result of increased activity of osteoclasts that is not followed by reactive bone formation by osteoblasts. Recent studies have revealed novel molecules and pathways that are implicated in osteoclast activation and osteoblast inhibition, including the RANKL/osteoprotegerin pathway, macrophage inflammatory proteins and the wingless type signaling pathway. These molecules also appear to interfere with tumor growth and survival, providing possible targets for the development of novel drugs for the management of lytic disease in myeloma. Currently, bisphosphonates are the mainstay of treatment for myeloma bone disease, although several novel agents appear promising. This review focuses on recent advances in understanding the biology of bone disease in multiple myeloma, diagnosis and recent progress in treatment options.
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Affiliation(s)
- Dimitrios Christoulas
- Department of Clinical Therapeutics, University of Athens School of Medicine, Alexandra General Hospital, 80 Vas. Sofias Avenue, Athens, Greece.
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Terpos E, Moulopoulos LA, Dimopoulos MA. Advances in imaging and the management of myeloma bone disease. J Clin Oncol 2011; 29:1907-15. [PMID: 21483016 DOI: 10.1200/jco.2010.32.5449] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Osteolytic disease is a major complication of multiple myeloma that may lead to devastating skeletal-related events (SREs). Conventional radiography remains the gold standard for the evaluation of bone disease in patients with myeloma. However, whole-body magnetic resonance imaging (MRI) is recommended in patients with normal conventional radiography and should be performed as part of staging in all patients with a solitary plasmacytoma of bone. Urgent MRI is also the diagnostic procedure of choice to assess suspected cord compression, whereas computed tomography can guide tissue biopsy. Positron emission tomography with computed tomography can provide complementary information to MRI, but its use in multiple myeloma must be better defined by further studies. The incorporation of abnormal MRI findings into the definition of symptomatic myeloma also needs to be clarified. Bisphosphonates remain the cornerstone for the management of myeloma bone disease. Intravenous pamidronate and zoledronic acid are equally effective in reducing SREs, whereas zoledronic acid seems to offer survival benefits in symptomatic patients. Caution is needed to avoid adverse events, such as renal impairment and osteonecrosis of the jaw. Novel antiresorptive agents, such as denosumab, have given encouraging results, but further studies are needed before their approval for managing myeloma bone disease. Combination approaches with novel antimyeloma agents, such as bortezomib (which has anabolic effects on bone) with bisphosphonates or with drugs that enhance osteoblast function, such as antidickkopf-1 agents, antisclerostin drugs, or sotatercept, may favorably alter our way of managing myeloma bone disease in the near future.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Alexandra General Hospital, 80 Vas. Sofias Ave, 11528, Athens, Greece.
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Hanrahan CJ, Christensen CR, Crim JR. Current concepts in the evaluation of multiple myeloma with MR imaging and FDG PET/CT. Radiographics 2010; 30:127-42. [PMID: 20083590 DOI: 10.1148/rg.301095066] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Multiple myeloma is a heterogeneous group of plasma cell neoplasms that primarily involve bone marrow but also may occur in the soft tissue. Although the disease varies in its manifestations and its course, it is eventually fatal in all cases. Over the past 2 decades, significant advances have been made in our understanding of the genetics and pathogenesis of multiple myeloma and in its treatment. The use of magnetic resonance (MR) imaging and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) with computed tomography (CT) has improved sensitivity for the detection of this disease. PET aids in the identification of active multiple myeloma on the basis of FDG uptake, and MR imaging helps identify multiple myeloma from its infiltration of normal fat within the bone marrow, which occurs in characteristic patterns that correlate with the disease stage. The increased sensitivity of these advanced cross-sectional imaging techniques has led to further refinement of the classic Durie and Salmon staging system. In addition, these imaging techniques allow a more reliable assessment of the disease response to treatment with current regimens, which may include autologous stem cell transplantation as well as various medications. In lesions that respond to chemotherapeutic agents, the replacement of previously infiltrated marrow by fat is seen at MR imaging and decreased FDG uptake is seen at FDG PET; however, a lengthy and intensive regimen may be necessary before the MR imaging appearance of marrow normalizes. Lytic lesions seen at CT almost always persist even after successful treatment. To provide an accurate assessment, radiologists must be familiar not only with the appearances of multiple myeloma and its mimics but also with common treatment-related findings.
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Affiliation(s)
- Christopher J Hanrahan
- Department of Radiology, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, UT 84132, USA.
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Ailawadhi S, Abdelhalim AN, Derby L, Mashtare TL, Miller KC, Wilding GE, Alberico RA, Gottlieb R, Klippenstein DL, Lee K, Chanan-Khan AA. Extent of disease burden determined with magnetic resonance imaging of the bone marrow is predictive of survival outcome in patients with multiple myeloma. Cancer 2010; 116:84-92. [PMID: 19862816 DOI: 10.1002/cncr.24704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Multiple myeloma (MM) remains an incurable cancer. Treatment often is initiated at the time patients experience a progressive increase in tumor burden. The authors of this report investigated magnetic resonance imaging of the bone marrow (BM-MRI) as a novel approach to quantify disease burden and validated a staging system by correlating BM-MRI with common clinical and laboratory parameters. METHODS The extent of bone marrow involvement was evaluated by BM-MRI. Clinical and laboratory parameters were assessed in patients with active MM, and correlations between variables were assessed statistically. Bone marrow involvement by BM-MRI was defined as stage A (0%), stage B (<10%), stage C (10%-50%), and stage D (>50%). RESULTS In total, 170 consecutive patients were evaluated (77 women and 93 men), including 144 patients who had active MM. The median age was 61 years (age range, 35-83 years). Advance stage disease (stage >I) based on Durie-Salmon (DS) staging or International Staging System (ISS) criteria was observed in 122 patients (84%) and 77 patients (53%), respectively. Lytic bone disease was noted in 120 patients (83%). There was a significant association between BM-MRI involvement and DS stage (P = .0006), ISS stage (P = .0001), the presence of lytic bone disease (P < .0001) and mean beta-2 microglobulin levels (P < .0001). Among the patients with previously untreated MM, there was a significant association between BM-MRI stage and overall survival (OS) (univariate P = .013; multivariate P = .045). Plasmacytosis on bone marrow biopsy at diagnosis was not predictive of OS (P = .91). CONCLUSIONS BM-MRI is a novel approach for quantifying disease burden in patients with MM. The current investigation in a large cohort of nontransplantion MM patients demonstrated that the extent of bone marrow involvement determined by BM-MRI correlates accurately with other conventional parameters of disease burden and can independently predict survival in patients with MM at the time of initial diagnosis.
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Affiliation(s)
- Sikander Ailawadhi
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
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Lin C, Luciani A, Belhadj K, Deux JF, Kuhnowski F, Maatouk M, Beaussart P, Cuenod CA, Haioun C, Rahmouni A. Multiple myeloma treatment response assessment with whole-body dynamic contrast-enhanced MR imaging. Radiology 2010; 254:521-31. [PMID: 20093523 DOI: 10.1148/radiol.09090629] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To compare posttreatment bone marrow changes at whole-body dynamic contrast material-enhanced magnetic resonance (MR) imaging with clinical response in patients with multiple myeloma (MM) and to determine if this technique can be used to assess treatment response in patients with MM. MATERIALS AND METHODS This study was approved by an institutional review board; all patients gave informed written consent. Thirty patients (21 men, nine women; mean age, 58 years +/- 10 [standard deviation]) underwent whole-body dynamic contrast-enhanced MR imaging before treatment, after induction chemotherapy (n = 30), and after autologous stem cell transplantation (ASCT) (n = 20). Maximal percentages of bone marrow (BME(max)) and focal lesion (FLE(max)) enhancement were assessed at each MR imaging examination. Clinical responses were determined on the basis of international uniform response criteria. Posttreatment changes in BME(max)and FLE(max)were compared with clinical response to therapy by using the Mann-Whitney U test. Receiver operating characteristic (ROC) analysis of posttreatment BME(max)was used to identify poor responders. RESULTS Eleven of 30 patients were good responders to induction chemotherapy; 16 of 20 patients were good responders to ASCT. After induction chemotherapy, mean BME(max)differed between good and poor responders (94.3% vs 138.4%, respectively; P = .02). With the exclusion of results from six examinations with focal lesions in which a poor clinical response was classified but BME(max)had normalized, a posttreatment BME(max)of more than 96.8% had 100% sensitivity for the identification of poor responders (specificity, 76.9%; area under the ROC curve, 0.90; P = .0001). Mean FLE(max)after induction chemotherapy did not differ between good and poor responders. Mean timing (ie, the number of postcontrast dynamic acquisitions where FLE(max)was observed) was significantly delayed in good responders compared with poor responders (4.7 vs 2.9, P < .0001). Post-ASCT MR imaging results correctly depicted all four clinically good responders whose disease subsequently progressed. CONCLUSION With quantitative analysis of BME(max)and the timing of FLE(max), whole-body dynamic contrast-enhanced MR imaging can be used to assess treatment response in patients with MM.
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Affiliation(s)
- Chieh Lin
- Department of Medical Imaging, AP-HP, Groupe Henri-Mondor Albert-Chenevier, 51 Avenue du Malréchal de Lattre de Tassigny, 94010 Créteil, France
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Abstract
Advances in the imaging and treatment of multiple myeloma have occurred over the past decade. This article summarises the current status and highlights how an understanding of both is necessary for optimum management.
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Affiliation(s)
- Conor D Collins
- St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Bäuerle T, Hillengass J, Fechtner K, Zechmann CM, Grenacher L, Moehler TM, Christiane H, Barbara WG, Neben K, Kauczor HU, Goldschmidt H, Delorme S. Multiple Myeloma and Monoclonal Gammopathy of Undetermined Significance: Importance of Whole-Body versus Spinal MR Imaging. Radiology 2009; 252:477-85. [DOI: 10.1148/radiol.2522081756] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dimopoulos M, Terpos E, Comenzo RL, Tosi P, Beksac M, Sezer O, Siegel D, Lokhorst H, Kumar S, Rajkumar SV, Niesvizky R, Moulopoulos LA, Durie BGM. International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple Myeloma. Leukemia 2009; 23:1545-56. [PMID: 19421229 DOI: 10.1038/leu.2009.89] [Citation(s) in RCA: 306] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Several imaging technologies are used for the diagnosis and management of patients with multiple myeloma (MM). Conventional radiography, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine imaging are all used in an attempt to better clarify the extent of bone disease and soft tissue disease in MM. This review summarizes all available data in the literature and provides recommendations for the use of each of the technologies. Conventional radiography still remains the 'gold standard' of the staging procedure of newly diagnosed and relapsed myeloma patients. MRI gives information complementary to skeletal survey and is recommended in MM patients with normal conventional radiography and in all patients with an apparently solitary plasmacytoma of bone. Urgent MRI or CT (if MRI is not available) is the diagnostic procedure of choice to assess suspected cord compression. Bone scintigraphy has no place in the routine staging of myeloma, whereas sequential dual-energy X-ray absorptiometry scans are not recommended. Positron emission tomography/CT or MIBI imaging are also not recommended for routine use in the management of myeloma patients, although both techniques may be useful in selected cases that warrant clarification of previous imaging findings, but such an approach should ideally be made within the context of a clinical trial.
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Affiliation(s)
- M Dimopoulos
- Department of Therapeutics, Alexandra Hospital, Athens, Greece.
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Lin C, Luciani A, Belhadj K, Maison P, Vignaud A, Deux JF, Zerbib P, Pigneur F, Itti E, Kobeiter H, Haioun C, Rahmouni A. Patients with plasma cell disorders examined at whole-body dynamic contrast-enhanced MR imaging: initial experience. Radiology 2009; 250:905-15. [PMID: 19244054 DOI: 10.1148/radiol.2503081017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
UNLABELLED This study was approved by the institutional review board, and informed consent was obtained from all subjects. The authors prospectively evaluated the feasibility of multistation whole-body dynamic contrast material-enhanced magnetic resonance (MR) imaging performed in patients with plasma cell disorders to assess disease extension and the time-signal intensity curves of diffuse and focal bone marrow infiltration. Three healthy adult male volunteers (age range, 29-31 years) and 21 patients (12 men, nine women; age range, 34-79 years) underwent whole-body dynamic unenhanced (volunteers) and contrast-enhanced MR imaging, which was performed by using an 18-channel 1.5-T MR system. A five-station (three sagittal and two coronal planes) fat-saturated three-dimensional gradient-echo sequence (3.3-3.6/1.3 [repetition time msec/echo time msec], 20 degrees flip angle, voxel size of 2 x 2.6 x [3-5] mm) was performed seven times. The temporal resolution of the five-station dynamic contrast-enhanced examination was 60 seconds with use of parallel imaging. Time-signal intensity curves for the bone marrow and the focal lesions were successfully obtained in all patients. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/250/3/905/DC1http://radiology.rsnajnls.org/cgi/content/full/250/3/905/DC2http://radiology.rsnajnls.org/cgi/content/full/250/3/905/DC3.
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Affiliation(s)
- Chieh Lin
- Department of Medical Imaging, AP-HP, Groupe Henri-Mondor Albert-Chenevier, 51 Avenue du Malréchal de Lattre de Tassigny, 94010 Créteil, France
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Detection of osseous metastases of the spine: Comparison of high resolution multi-detector-CT with MRI. Eur J Radiol 2009; 69:567-73. [DOI: 10.1016/j.ejrad.2007.11.039] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 11/26/2007] [Indexed: 11/23/2022]
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Baur-Melnyk A, Reiser M. Oncohaematologic disorders affecting the skeleton in the elderly. Radiol Clin North Am 2008; 46:785-98, vii. [PMID: 18922293 DOI: 10.1016/j.rcl.2008.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Multiple myeloma is a hemato-oncologic disease in the elderly population, with a peak incidence in the eighth decade, and represents a malignant bone marrow neoplasia in which a monoclonal strain of atypical plasma cells proliferates and may result in bone destruction. Skeletal metastases represent the most common malignant bone tumor and are the third most common location for distant metastases. They occur predominantly in adults, especially in the elderly population. Chronic lymphatic leukemia is a typical malignancy of the elderly patient and aplastic anemia is a hematologic disorder characterized by pancytopenia, bone marrow hypoplasia, and lack of extramedullary hematopoiesis. Osteomyelofibrosis and sclerosis are chronic myeloproliferative diseases of the elderly, with a peak incidence in the sixth and seventh decade of life. This article addresses these oncohaematologic disorders affecting the skeleton in the elderly, examining the radiographic scanning methods, staging, and prognosis for each.
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Affiliation(s)
- Andrea Baur-Melnyk
- Department of Clinical Radiology, University of Munich, Grosshadern, Germany.
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42
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Winterbottom AP, Shaw AS. Imaging patients with myeloma. Clin Radiol 2008; 64:1-11. [PMID: 19070692 DOI: 10.1016/j.crad.2008.07.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 07/07/2008] [Accepted: 07/15/2008] [Indexed: 11/26/2022]
Abstract
Multiple myeloma (MM) is a neoplastic proliferation of plasma cells within the bone marrow. The disease is characterized by a plasma cell infiltrate of the bone marrow, osteolytic bone lesions, and the presence of monoclonal protein in the serum or urine with extraosseous involvement by disease less common. Although the skeletal survey has long been the standard investigation in these patients, there have been significant recent advances in computed tomography (CT), magnetic resonance imaging (MRI), and functional imaging. We present a comprehensive review of the evidence for the use of each of these studies in the diagnosis, prognosis, assessment of complications, and response evaluation in patients with MM.
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Affiliation(s)
- A P Winterbottom
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Lin C, Luciani A, Itti E, Haioun C, Rahmouni A. Whole body MRI and PET/CT in haematological malignancies. Cancer Imaging 2007; 7 Spec No A:S88-93. [PMID: 17921084 PMCID: PMC2727965 DOI: 10.1102/1470-7330.2007.9004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The usefulness of whole body magnetic resonance imaging (MRI) and positron emission tomography (PET)/computed tomography (CT) in haematological malignancies is reviewed. PET/CT combining functional and anatomical information is currently a valuable tool in the management of patients with lymphoma, especially in the assessment of early treatment response. MRI is advantageous in evaluating bone marrow involvement and therefore plays an important role in clinical decision making for patients with myeloma. The development of whole body functional MR studies is underway and can potentially complement the PET/CT for better patient care.
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Affiliation(s)
- Chieh Lin
- Department of Radiology, Department of Nuclear Medicine and Department of Haematology, Centre Hospitalo-Universitaire Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Alain Luciani
- Department of Radiology, Department of Nuclear Medicine and Department of Haematology, Centre Hospitalo-Universitaire Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Emmanuel Itti
- Department of Radiology, Department of Nuclear Medicine and Department of Haematology, Centre Hospitalo-Universitaire Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Corinne Haioun
- Department of Radiology, Department of Nuclear Medicine and Department of Haematology, Centre Hospitalo-Universitaire Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Alain Rahmouni
- Department of Radiology, Department of Nuclear Medicine and Department of Haematology, Centre Hospitalo-Universitaire Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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Steinbach LS. "MRI in the detection of malignant infiltration of bone marrow"--a commentary. AJR Am J Roentgenol 2007; 188:1443-5. [PMID: 17515361 DOI: 10.2214/ajr.06.1531] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lynne S Steinbach
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Suite M392, San Francisco, CA 94143-0628, USA.
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Alyas F, Saifuddin A, Connell D. MR Imaging Evaluation of the Bone Marrow and Marrow Infiltrative Disorders of the Lumbar Spine. Magn Reson Imaging Clin N Am 2007; 15:199-219, vi. [PMID: 17599640 DOI: 10.1016/j.mric.2007.03.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of MR imaging in assessing lumbar bone marrow first requires an understanding of the bone marrow's normal composition and the various imaging sequences available for use. One of the most useful sequences is the T1-weighted spin-echo sequence. This sequence may be combined with other sequences such as T2-weighted or diffusion-weighted sequences; techniques such as fat suppression, chemical shift imaging, and contrast-enhanced imaging are discussed. The varying features of normal lumbar marrow related to the normal physiologic changes that occur with aging and with changes in hematopoietic demand are important to understand and are described. The appearances of infiltrative marrow disease are explained on the basis of marrow composition and whether disease causes proliferation, replacement, or depletion of normal marrow components.
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Affiliation(s)
- Faisal Alyas
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London, UK, HA7 4LP
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Oriol A, Valverde D, Capellades J, Cabañas ME, Ribera JM, Arús C. In vivo quantification of response to treatment in patients with multiple myeloma by 1H magnetic resonance spectroscopy of bone marrow. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2007; 20:93-101. [PMID: 17410391 DOI: 10.1007/s10334-007-0072-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 03/06/2007] [Accepted: 03/07/2007] [Indexed: 11/24/2022]
Abstract
OBJECT Magnetic resonance imaging (MRI) is the gold standard non-invasive technique to detect malignant disease in the bone marrow. Proton magnetic resonance spectroscopy (MRS) can be performed as a quick adjunct to routine spinal MRI. We performed proton MRS to patients with multiple myeloma (MM) at diagnosis and after treatment to investigate the possible correlation of MRS data with response to therapy. PATIENTS AND METHODS Twenty-one patients with newly diagnosed MM underwent combined MRI/MRS explorations of a transverse center section in the fifth lumbar vertebral body. MRS was acquired with STEAM and 40 ms TE. Areas of unsuppressed water and lipid resonances were used to calculate the lipid-to-water ratio (LWR). RESULTS No association was detected between initial LWRs and the clinical characteristics of patients. Post treatment MRS was available in 16 patients of whom 11 (69%) presented an LWR increase, this included all complete responders (8/8, 100%, P = 0.012). A post-treatment LWR value equal to or larger than one is proposed as a non-invasive marker of complete response to treatment. CONCLUSION Only patients responding to treatment presented a significant increase in bone marrow LWR after therapy. MRS may provide an adequate quantification of response to chemotherapy in patients with MM.
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Affiliation(s)
- Albert Oriol
- Servei d'Hematologia Clínica, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Ctra. Canyet s/n, 08916 Badalona, Barcelona, Spain.
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D'Sa S, Abildgaard N, Tighe J, Shaw P, Hall-Craggs M. Guidelines for the use of imaging in the management of myeloma. Br J Haematol 2007; 137:49-63. [PMID: 17359371 DOI: 10.1111/j.1365-2141.2007.06491.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 2001, reference to the use of imaging in the British Committee for Standards in Haematology guidelines for the diagnosis and management of myeloma was confined to the standard use of plain X-rays in the diagnostic skeletal survey and emergency use of computed tomography (CT) and magnetic resonance (MR) imaging in the setting of cord compression. Since then, there has been a steady rise in interest in the use of various imaging techniques in the management of myeloma. The purpose of imaging in the management of myeloma includes the assessment of the extent and severity of the disease at presentation, the identification and characterisation of complications, and the assessment of response to therapy. Plain radiography, CT, and MR imaging are generally established examination techniques in myeloma whilst positron emission tomography (PET) and (99)Technetium sestamibi (MIBI) imaging are promising newer scanning techniques under current evaluation. These stand-alone imaging guidelines discuss recommendations for the use of each modality of imaging at diagnosis and in the follow up of patients with myeloma.
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Affiliation(s)
- Shirley D'Sa
- Department of Haematology, University College Hospital, London, UK.
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Abstract
OBJECTIVES Discuss intramedullary, intradural/extramedullary, and extradural spinal tumors including imaging characteristics with emphasis on MR and advances in treatment. METHODS Literature and institutional review. RESULTS Spinal tumors: intramedullary, intradural/extramedullary, and extradural, comprise a wide range of histological tumors with an even wider range of clinical symptoms and prognostic features. They are relatively rare and if left untreated, can cause serious neurological deficits and disability. An accurate diagnosis is therefore crucial in determining prognosis and directing therapy. Magnetic resonance imaging (MRI) has revolutionized the diagnosis of intraspinal tumors, allowing for early detection and improved anatomical localization. Magnetic resonance has also become an integral part in staging of both primary and metastatic neoplasms of the spine for guiding therapy and is an excellent modality for follow-up. Advances in MRI (perfusion and molecular imaging) may help refine and describe these neoplasms for accurate treatment and prognosis in the future. Surveillance protocols and role of magnetic resonance are not well established. CONCLUSIONS Magnetic resonance plays an integral role in evaluation of spinal tumors with increasing role in staging and treatment.
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Affiliation(s)
- Courtnay W Bloomer
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Miami, FL 33136, USA
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Walker R, Barlogie B, Haessler J, Tricot G, Anaissie E, Shaughnessy JD, Epstein J, van Hemert R, Erdem E, Hoering A, Crowley J, Ferris E, Hollmig K, van Rhee F, Zangari M, Pineda-Roman M, Mohiuddin A, Yaccoby S, Sawyer J, Angtuaco EJ. Magnetic resonance imaging in multiple myeloma: diagnostic and clinical implications. J Clin Oncol 2007; 25:1121-8. [PMID: 17296972 DOI: 10.1200/jco.2006.08.5803] [Citation(s) in RCA: 271] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI) permits the detection of diffuse and focal bone marrow infiltration in the absence of osteopenia or focal osteolysis on standard metastatic bone surveys (MBSs). PATIENTS AND METHODS Both baseline MBS and MRI were available in 611 of 668 myeloma patients who were treated uniformly with a tandem autologous transplantation-based protocol and were evaluated to determine their respective merits for disease staging, response assessment, and outcome prediction. RESULTS MRI detected focal lesions (FLs) in 74% and MBS in 56% of imaged anatomic sites; 52% of 267 patients with normal MBS results and 20% of 160 with normal MRI results had FL on MRI and MBS, respectively. MRI- but not MBS-defined FL independently affected survival. Cytogenetic abnormalities (CAs) and more than seven FLs on MRI (MRI-FLs) distinguished three risk groups: 5-year survival was 76% in the absence of both more than seven MRI-FLs and CA (n = 276), 61% in the presence of one MRI-FL (n = 262), and 37% in the presence of both unfavorable parameters (n = 67). MRI-FL correlated with low albumin and elevated levels of C-reactive protein, lactate dehydrogenase, and creatinine, but did not correlate with age, beta-2-microglobulin, and CA. Resolution of MRI-FL, occurring in 60% of cases and not seen with MBS-defined FL, conferred superior survival. CONCLUSION MRI is a more powerful tool for detection of FLs than is MBS. MRI-FL number had independent prognostic implications; additionally, MRI-FL resolution identified a subgroup with superior survival. We therefore recommend that, in addition to MBS, MRI be used routinely for staging, prognosis, and response assessment in myeloma.
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Affiliation(s)
- Ronald Walker
- Department of Radiology, Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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