Hyperattenuating bone marrow abnormalities in myeloma patients using whole-body non-enhanced low-dose MDCT: correlation with haematological parameters

Abstract

We aimed to establish the role of hyperattenuating medullary abnormalities detected by whole-body non-enhanced low-dose multidetector CT (WBLD-MDCT) in multiple myeloma (MM) patients referred for primary evaluation. 50 consecutive patients with untreated Stage I (n(I) = 11), Stage II (n(II) = 10) and Stage III (n(III) = 29) MM underwent WBLD-MDCT for staging. The number and size of osteolysis, as well as haematologic parameters including paraprotein and beta2-microglobulin levels, were assessed and related to the number, size and density of medullary abnormalities assumed to represent myeloma involvement. Bone marrow abnormalities were found in 2/11 (18%) Stage I, 6/10 (60%) Stage II and 20/29 (69%) Stage III myeloma patients, and did not parallel the incidence of osteolysis. Patients with medullary lesions had higher levels of immunoglobulin A (median, 4730 mg dl(-1) vs 1520 mg dl(-1)), light-chain proteinuria (median, 690 mg dl(-1) vs 214 mg dl(-1)) and IgG paraprotein (median, 3270 mg dl(-1) vs 2610 mg dl(-1)) compared with patients without medullary lesions. In patients with medullary abnormalities, levels of serum beta2-microglobulin were significantly higher than in patients without detectable marrow infiltrates (median, 4.3 mg dl(-1) vs 2.4 mg dl(-1); p = 0.0015). In conclusion, medullary abnormalities visualized by WBLD-MDCT are encountered in all stages of myeloma, including cases without osteolysis. They are associated with significantly elevated serum levels of paraprotein (reflecting tumour mass) and beta2-microglobulin, a prospective prognostic marker for myeloma. The nature and possible prognostic significance of medullary abnormalities detected by WBLD-MDCT therefore warrants further investigation.

Improvement of diagnostic confidence for detection of multiple myeloma involvement of the ribs by a new CT software generating rib unfolded images: Comparison with 5- and 1-mm axial images

“…First of all, whole-body CT imaging as an alternative x-ray technique has advanced to a potential substitute for the classical skeletal survey at many specialized centers [12][13][14][15]. MR imaging and later FDG-PET have demonstrated their strengths in terms of either increased tissue contrast (MRI) or glucose metabolism for more accurate tumor diagnosis.…”

Prognostic significance of bone marrow abnormalities in the appendicular skeleton of patients with multiple myeloma

“…Our results were consistent with previous reports 6,7 that normal healthy adult appendicular bone marrow is usually filled with adipose tissue (yellow bone marrow). Based on a report by Horger et al, 2 our previous studies, 9,15 and the current observations, we set the normal medullary CT value of the AS between 230.0 and 2100.0 HU. CT values .230.0 HU, which were observed in the long bony canals, were considered high-density lesions in this study.…”

“…[1][2][3] Recent guidelines from the International Myeloma Working Group (IMWG) 4 and the European Myeloma Network 5 have incorporated the use of low-dose MDCT for evaluating the extent of lytic bone involvement in MM. MDCT also provides information on bone marrow involvement in the appendicular skeleton (AS).…”

“…[6][7][8] However, in myeloma patients, the intramedullary space is often infiltrated by neoplastic plasma cells (PCs), with such medullary infiltrations often improving after successful antimyeloma treatment. 1,2 In addition, medullary abnormalities may be associated with myeloma cell burden, as assessed by laboratory parameters, although little information is available regarding the incidence and prognostic value of such abnormalities in patients with monoclonal gammopathy of undetermined significance and MM. Previously, we reported the prognostic implications of medullary abnormalities of the AS in patients with MM and related diseases.…”

Early response assessment in patients with multiple myeloma during anti-angiogenic therapy using arterial spin labelling: first clinical results

“…However, as already remarked by Salmon and Durie in 1975, tumour load is not always adequately reflected by the serum paraprotein level. Moreover, changes in paraprotein levels, especially in patients treated with these novel agents, may be at times discordant with the actual development of the disease [17]. Recent data in patients treated with bortezomib have shown that discrepancies exist between therapy response determined by laboratory and imaging data [18].…”