Waldenström's macroglobulinemia has a wide clinical spectrum that practicing physicians need to recognize early to reach the correct diagnosis. When therapy is indicated, oral chlorambucil is the standard primary treatment, but cladribine or fludarabine can be used when a rapid cytoreduction is desirable. Prospective randomized trials are required to elucidate the impact of nucleoside analogs on patients' survival. A nucleoside analog is the treatment of choice for patients who have been previously treated with an alkylating agent.

Abnormal marrow patterns were present in half of patients with asymptomatic myeloma. An abnormal MR study of the spine identified asymptomatic patients who were likely to require treatment earlier than those with a normal MR study. A normal MR pattern provided additional justification to defer institution of chemotherapy. However, MR imaging remains an investigational tool to stage patients with multiple myeloma until more data are accumulated.

Most patients with multiple myeloma (MM) present with symptoms, have evidence of generalized disease, and require chemotherapy promptly to reduce the malignant clone. Some patients present with a local symptom from a single plasmacytoma but no myeloma elsewhere. Such patients usually become free of symptoms after local radiotherapy. In patients with MM without symptoms, the diagnosis is made on the basis of screening laboratory tests. In patients with either solitary plasmacytoma of bone or asymptomatic MM, systemic treatment should be deferred until there is evidence of disease progression.

Uterine cervical cancer still remains an important socioeconomic issue because it largely affects women of reproductive age. Prognosis is highly depended on extent of the disease at diagnosis and, therefore, accurate staging is crucial for optimal management. Cervical cancer is clinically staged, according to International Federation of Gynecology and Obstetrics guidelines, but, currently, there is increased use of cross sectional imaging modalities [computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT)] for the study of important prognostic factors like tumor size, parametrial invasion, endocervical extension, pelvic side wall or adjacent/distal organs involvement and lymph node status. Imaging indications also include cervical cancer follow-up, evaluation of tumor response to treatment and selection of suitable candidates for less radical surgeries like radical trachelectomy for fertility preservation. The preferred imaging method for local cervical cancer evaluation is MRI; CT is equally effective for evaluation of extrauterine spread of the disease. PET-CT shows high diagnostic performance for the detection of tumor relapse and metastatic lymph nodes. The aim of this review is to familiarize radiologists with the MRI appearance of cervical carcinoma and to discuss the indications of cross sectional imaging during the course of the disease in patients with cervical carcinoma.

Purpose To evaluate the apparent diffusion coefficients (ADCs) of magnetic resonance (MR) imaging patterns in the bone marrow of patients with multiple myeloma (MM) and to determine a threshold ADC that may help distinguish a diffuse from a normal pattern with high accuracy. Materials and Methods This prospective study was approved by the ethics review board, and informed consent was obtained. Ninety-nine patients with newly diagnosed, untreated MM and 16 healthy control subjects underwent spinal MR imaging including diffusion-weighted imaging, and bone marrow ADCs were calculated. Pattern assignment was based on visual assessment of conventional MR images. The Kruskal-Wallis H test, the Mann-Whitney test, and the one-way analysis of variance were used to compare ADCs between patient subsets and control subjects, and a receiver operating characteristic analysis was performed. Results Mean ADCs ± standard deviation in patients with MM for the normal, focal, and diffuse MR imaging patterns were 0.360 × 10 mm/sec ± 0.110, 1.046 × 10 mm/sec ± 0.232, and 0.770 × 10 mm/sec ± 0.135, respectively. There were significant differences in ADCs between diffuse and normal (P < .001), diffuse and focal (P < .001), and focal and normal (P < .001) patterns. Patients with a diffuse pattern had more features of advanced disease, higher international staging system score, increased incidence of high-risk cytogenetics, and higher revised international staging system score. ADCs greater than 0.548 × 10 mm/sec showed 100% sensitivity (26 of 26) and 98% specificity (48 of 49) for the diagnosis of a diffuse (vs normal) MR imaging pattern, whereas an ADC greater than 0.597 × 10 mm/sec showed 96% sensitivity (25 of 26) and 100% specificity (49 of 49). Conclusion ADCs of MR imaging patterns in patients with MM differ significantly. A diffuse MR imaging pattern can be distinguished more objectively from a normal MR imaging pattern by adding quantitative diffusion-weighted imaging to standard MR imaging protocols. RSNA, 2016 Online supplemental material is available for this article.

the bone marrow. All MR images shown were acquired with M a 1.5 T unit.AGNETIC RESONANCE (MR) imaging has become preferred over other imaging modalities in evaluating T1-weighted images. On T1-weighted MR images, tisdisease in the bone marrow. 1,2 It is a noninvasive technique sue contrast is determined primarily by T1 characteristics. that complements bone marrow aspirations and biopsies by Fat has a short T1 relaxation time and is hyperintense (bright) sampling a large volume of bone marrow and by providing on T1-weighted images. Fatty marrow, because it is cominformation that aids the diagnosis, staging, and follow-up posed primarily of fat, has a characteristic bright signal, of hematologic malignancies.similar to that of subcutaneous fat (Figs 1 and 2). Water, on The MR imaging appearance of the bone marrow depends the other hand, has a long T1 relaxation time and is hypoinon the presence and relative proportions of trabecular bone, tense (dark) on T1-weighted images. Tissues rich in free fat, and water. Each of these constituents of the bone marrow water, such as cerebrospinal fluid, are dark on T1-weighted produces a different MR signal. It is the summation of these images. Red marrow is composed of 40% water, 40% fat, signals that creates the final MR image. Because the bone and 20% protein. On T1-weighted images, red marrow is marrow is a dynamic organ that changes continuously from considerably darker than fatty marrow and has a signal intenbirth through life, the MR appearance of the bone marrow sity similar to or slightly higher than muscle (Figs 1 and 2). 2 varies with age. The predictable rate and patterns of redThe bright signal of fatty marrow facilitates the detection of (hematopoietic) to yellow (fatty) marrow conversion and the marrow lesions, the vast majority of which have a longer unique characteristics of red and yellow marrow on MR T1 relaxation time than fat. 2 However, marrow lesions may images have allowed for the mapping of their age-related have similar T1 relaxation times to red marrow, and their distributions in the skeleton.detection on a background of hematopoietic marrow may be Fatty replacement of the functioning hematopoietic mardifficult with T1-weighted MR images alone. row begins in the periphery of the appendicular skeleton and T2-weighted images. Fat has a short T2 relaxation time, proceeds centrally (Fig 1). In the long bones, fatty marrow which means that, on T2-weighted images, in which T2 first appears in the diaphyses and epiphyses and later in the characteristics prevail, fat is dark and the signal intensity of metaphyses. [2][3][4] The adult pattern of red and yellow marrow fatty marrow decreases (Fig 2). Water has a long T2 relaxdistribution is reached in the early 20s; hematopoietic maration time and is bright on T2-weighted images. The appearrow remains throughout life in the spine, sternum, ribs, pelance of red marrow on T2-weighted MR images varies vis, skull, calcaneus, and proximal metaphysis of the huslightly. 2 It usually shows a small increase in signal, b...

The combination of paclitaxel with cisplatin seems relatively well tolerated and moderately active in patients with metastatic or recurrent cervical cancer. The significant incidence of neurotoxicity is of concern, and alternative methods of administration of the two agents could be evaluated. Then, further study of this combination, alone or with the addition of other active agents, is warranted.

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.