Assessing response of myeloma bone disease with diffusion-weighted MRI

Messiou, Christina; Giles, Sharon; Collins, David J.; West, Sharon; Davies, Faith E.; Morgan, Gareth J.; deSouza, Nandita M.

doi:10.1259/bjr/52759767

Cited by 131 publications

(120 citation statements)

References 12 publications

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“…Eight patients received the same treatment regimen of cyclophosphamide (Baxter Healthcare, Thetford, England), lenalidomide (Revlimid; Celgene, Uxbridge, England), and dexamethasone; seven patients underwent treatment with cyclophosphamide, bortezomib (Velcade; Janssen-Cilag, Wycombe, England), and dexamethasone; five patients underwent treatment with lenalidomide and dexamethasone; and 13 patients each received different combinations of treatment regimes. Fifteen of the 33 patients also received growth factors (eg, granulocyte colony stimulating factor [GCSF]) during treatment difference between normal and pathologic marrow (15) and offers potential to quantify response within individual lesions and the whole skeleton (6,16). The purpose of this study was to determine the feasibility of WB DW imaging for assessment of response in myeloma.…”

Section: Discussionmentioning

confidence: 99%

Whole-Body Diffusion-weighted MR Imaging for Assessment of Treatment Response in Myeloma

Giles

Messiou²,

Collins³

et al. 2014

Radiology

177

142

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FRCP, FRCP Nandita M. deSouza, MD, FRCP, FRCR Purpose:To determine the feasibility of whole-body diffusionweighted (DW) magnetic resonance (MR) imaging for assessment of treatment response in myeloma. Materials and Methods:This prospective single-institution study was HIPAAcompliant with local research ethics committee approval. Written informed consent was obtained from each subject. Eight healthy volunteers (cohort 1a) and seven myeloma patients (cohort 1b) were imaged twice to assess repeatability of quantitative apparent diffusion coefficient (ADC) estimates. Thirty-four additional myeloma patients (cohort 2) underwent whole-body DW imaging before treatment; 26 completed a posttreatment imaging. Wholebody DW data were compared before and after treatment by using qualitative (ie, observer scores) and quantitative (ie, whole-body segmentation of marrow ADC) methods. Serum paraproteins and/or light chains or bone marrow biopsy defined response. Results:Whole-body DW imaging scores were significantly different between observers (P , .001), but change in scores between observers after treatment was not (P = .49). Sensitivity and specificity for detecting response according to observer scores were 86% (18 of 21 patients) and 80% (4 of 5 patients) for both observers. ADC measurement was repeatable: mean coefficient of variation was 3.8% in healthy volunteers and 2.8% in myeloma patients. Pretreatment ADC in cohort 2 was significantly different from that in cohort 1a (P = .03), but not from that in cohort 1b (P = .2). Mean ADC increased in 95% (19 of 20) of responding patients and decreased in all (five of five) nonresponders (P = .002). A 3.3% increase in ADC helped identify response with 90% sensitivity and 100% specificity; an 8% increase (greater than repeatability of cohort 1b) resulted in 70% sensitivity and 100% specificity. There was a significant negative correlation between change in ADC and change in laboratory markers of response (r = 20.614; P = .001). Conclusion:Preliminary work demonstrates whole-body DW imaging is a repeatable, quantifiable technique for assessment of treatment response in myeloma.q RSNA, 2014 1

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Section: Discussionmentioning

confidence: 99%

Whole-Body Diffusion-weighted MR Imaging for Assessment of Treatment Response in Myeloma

Giles

Messiou²,

Collins³

et al. 2014

Radiology

177

142

View full text Add to dashboard Cite

show abstract

“…Treatment‐related increases in ADC have previously been reported in MM patients (Messiou et al , 2012; Bonaffini et al , 2015). Messiou et al (2012) assessed ADC of up to five ROIs on ADC maps (including diffuse marrow involvement and normal appearing bone marrow, as opposed to FL only), and observed an initial increase of ADC at 4–6 weeks of treatment in responding patients, followed by a decrease at 20 weeks.…”

Section: Discussionmentioning

confidence: 68%

“…Messiou et al (2012) assessed ADC of up to five ROIs on ADC maps (including diffuse marrow involvement and normal appearing bone marrow, as opposed to FL only), and observed an initial increase of ADC at 4–6 weeks of treatment in responding patients, followed by a decrease at 20 weeks. These authors also reported that significantly lower percentage of pixels representing fatty marrow in baseline ADC histograms in patients with active myeloma ( n = 8, 27·2%) compared to patients in remission ( n = 12, 83·0%).…”

Section: Discussionmentioning

confidence: 99%

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Whole body magnetic resonance imaging in newly diagnosed multiple myeloma: early changes in lesional signal fat fraction predict disease response

et al. 2016

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SummaryCross‐sectional imaging techniques are being increasingly used for disease evaluation in patients with multiple myeloma. Whole body magnetic resonance imaging (WB‐MRI) scanning is superior to plain radiography in baseline assessment of patients but changes following treatment have not been systematically explored. We carried out paired WB‐MRI scans in 21 newly diagnosed patients prior to, and 8‐weeks after, starting chemotherapy, and analysed stringently selected focal lesions (FLs) for parametric changes. A total of 323 FLs were evaluated, median 20 per patient. At 8 weeks, there was a reduction in estimated tumour volume (eTV), and an increase in signal fat fraction (sFF) and apparent diffusion coefficient (ADC) in the group as a whole (P < 0·001). Patients who achieved complete/very good partial response (CR/VGPR) to induction had a significantly greater increase in sFF compared to those achieving ≤ partial response (PR; P = 0·001). When analysed on a per‐patient basis, all patients achieving CR/VGPR had a significant sFF increase in their FL's, in contrast to patients achieving ≤PR. sFF changes in patients reaching maximal response within 100 days (fast responders) were greater compared to slow responders (P = 0·001). Receiver Operator Characteristic analysis indicated that sFF changes at 8 weeks were the best biomarker (area under the Curve 0·95) for an inferior response (≤PR). We conclude that early lesional sFF changes may provide important information on depth of response, and are worthy of further prospective study.

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“…23,24 These techniques allow at least semiquantitative measurements of the microcirculation and cellularity, and first results have demonstrated their potential value for diagnosis and treatment monitoring in MM. 23,25,26 Hillengass et al evaluated DCE-MRI of the lumbar spine in 222 patients with MGUS, SMM, and MM and 22 healthy controls. 27 They found significant differences between MM patients and normal controls, and were able to correlate the DCE-MRI peak intensity with the BM plasmacytosis.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

The role of positron emission tomography-computed tomography and magnetic resonance imaging in diagnosis and follow up of multiple myeloma

et al. 2014

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Assessing response of myeloma bone disease with diffusion-weighted MRI

Abstract: ADC of active myeloma is significantly higher than marrow in remission; the direction of ADC changes on treatment is dependent on the timing of measurements and is influenced by changes in marrow fat.

Cited by 131 publications

References 12 publications

Whole-Body Diffusion-weighted MR Imaging for Assessment of Treatment Response in Myeloma

Whole-Body Diffusion-weighted MR Imaging for Assessment of Treatment Response in Myeloma

Whole body magnetic resonance imaging in newly diagnosed multiple myeloma: early changes in lesional signal fat fraction predict disease response

The role of positron emission tomography-computed tomography and magnetic resonance imaging in diagnosis and follow up of multiple myeloma

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