Imaging in myeloma with focus on advanced imaging techniques

Barwick, Tara; Bretsztajn, Laure; Wallitt, Kathryn; Amiras, Dimitri; Rockall, Andrea; Messiou, Christina

doi:10.1259/bjr.20180768

Cited by 26 publications

(24 citation statements)

References 59 publications

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“…While this is an unexpected finding, we appreciate that there are better methods and parameters for assessment of tumor load, risk prediction and therapy response. Yet, we see some clinical use for the spleen signal, further increasing the value of DW-MRI as a diagnostic tool in MM 9, 11, 16-18. First, despite its strong association with the ISS, absence of spleen signal has independent prognostic value: patients with high risk disease according to a GEP signature or FISH markers suffered from dismal outcome when the spleen was not detectable.…”

Section: Discussionmentioning

confidence: 99%

Lack of Spleen Signal on Diffusion Weighted MRI is associated with High Tumor Burden and Poor Prognosis in Multiple Myeloma: A Link to Extramedullary Hematopoiesis?

et al. 2019

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Due to the low frequency of abnormalities affecting the spleen, this organ is often overlooked during radiological examinations. Here, we report on the unexpected finding, that the spleen signal on diffusion-weighted MRI (DW-MRI) is associated with clinical parameters in patients with plasma cell dyscrasias. Methods : We investigated the spleen signal on DW-MRI together with clinical and molecular parameters in 295 transplant-eligible newly diagnosed Multiple Myeloma (NDMM) patients and in 72 cases with monoclonal gammopathy of undetermined significance (MGUS). Results : Usually, the spleen is the abdominal organ with the highest intensities on DW-MRI. Yet, significant signal loss on DW-MRI images was seen in 71 of 295 (24%) NDMM patients. This phenomenon was associated with the level of bone marrow plasmacytosis ( P =1x10 -10 ) and International Staging System 3 ( P =0.0001) but not with gain(1q), and del(17p) or plasma cell gene signatures. The signal was preserved in 72 individuals with monoclonal gammopathy of undetermined significance and generally re-appeared in MM patients responding to treatment, suggesting that lack of signal reflects increased tumor burden. While absence of spleen signal in MM patients with high risk disease defined a subgroup with very poor outcome, re-appearance of the spleen signal after autologous stem cell transplantation was seen in patients with improved outcome. Our preliminary observation suggests that extramedullary hematopoiesis in the spleen is a factor that modifies the DW-MRI signal of this organ. Conclusions : The DW-MRI spleen signal is a promising marker for tumor load and provides prognostic information in MM.

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Section: Discussionmentioning

confidence: 99%

Lack of Spleen Signal on Diffusion Weighted MRI is associated with High Tumor Burden and Poor Prognosis in Multiple Myeloma: A Link to Extramedullary Hematopoiesis?

et al. 2019

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“…Cytological examination for malignant plasma cells in the pleural uid has a limited diagnostic sensitivity. Despite guidance from NICE which positioned wholebody MRI as the rst-line diagnostic imaging test for suspected myeloma (6), it is currently performed at only a few centers due to limited MRI capacity (7). 99 m-Tc MDP bone scan is a sensitive but insu cient method for detecting bone lesions in MM (8) and may show the "donut"-like change due to the lytic center.…”

Section: Discussionmentioning

confidence: 99%

An Uncommon Etiology for Pleural Effusion with Rib Lesion in a 78-year-old Woman: A Case Report

Qin

Ren

Jiang

et al. 2020

Preprint

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Background: Pleural effusion with rib lesion is generally considered as metastasis of thoracic carcinoma or rib tuberculosis and tuberculous pleuritis. Myelomatous pleural effusion with rib lesion is rare and poses a great diagnostic challenge. We described an easily-misdiagnosed extrapulmonary disease with concomitant pulmonary and rib manifestations, bilateral pleural effusion with lytic rib lesion in multiple myeloma, in order to raise awareness of this disease and avoid misdiagnose. Case presentation: A 78-year-old woman was referred to the thoracic department with chest distress, breathlessness, poor appetite and weight loss for 3 months. Chest computed tomography demonstrated bilateral pleural effusion and lytic lesion on the left 5th rib. Whole-body bone scan showed the intense uptake lesions on the sixth, seventh vertebrae and a central defect with the peripheral uptake of the "donut"-like change sign on the left 5th rib. Percutaneous CT-guided core biopsy for the rib lesion was performed and the diagnosis was multiple myeloma. Combined chemotherapy and supportive treatment were prescribed. She did not respond to the therapy and died 3 months later due to pleural cavity infection and cardiopulmonary failure.Conclusion: Some uncommon extrapulmonary diseases with concomitant pulmonary and rib manifestations should be reminded in order to avoid misdiagnose. Extramedullary multiple myeloma can affect any tissue and is an aggressive entity with poor prognosis. Percutaneous CT-guided core biopsy for the rib lesion is of higher positive rate than pleural fluid cytology and more minimally invasive than pleural biopsy via thoracoscope or rib excision biopsy.

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“…Myeloma bone disease is caused by malignant plasma cells disrupting the usual balance between osteoclasts and osteoblasts by promoting osteoclast activation and bone turnover and inhibiting osteoblast function. This imbalance may be seen as lytic lesions on imaging (although these may only be visible on plain X-rays when 30-50% of trabecular bone is lost) or as diffuse osteoporosis (Barwick et al, 2019). This process can lead to hypercalcaemia and the associated symptoms of thirst, abdominal pain and confusion.…”

Section: Who To Test?mentioning

confidence: 99%

“…The choice of initial imaging will depend on the patient's presentation and the differential diagnosis at the time of assessment. An X-ray can detect lytic lesions, but whole MRI scanning is much more sensitive (Barwick et al, 2019) and is currently recommended as the first-line imaging choice in NICE guidance (NICE, 2016).…”

Section: Which Investigations Should Be Performed In Primary Care?mentioning

confidence: 99%

Early detection of myeloma

et al. 2021

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Myeloma is a rare, life-limiting blood cancer arising from plasma cells. Early diagnosis is imperative to improve clinical outcomes for patients, by both improving overall survival and reducing the morbidity associated with myeloma-related end-organ damage. This can be challenging in primary care, as myeloma can be difficult to diagnose. It may present in a number of non-specific ways that overlap with a multitude of other conditions. Tests that indicate myeloma are readily available in primary care. This article will describe the pathology of myeloma, the range and timing of diagnostic tests, guide interpretation of results, and outline the diagnostic subcategories of plasma cell disorders. Two cases looking at different aspects and complications of myeloma diagnosis are discussed with the aim of raising awareness and potential pitfalls in diagnosis. Useful resources to aid clinicians are signposted.

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Imaging in myeloma with focus on advanced imaging techniques

Cited by 26 publications

References 59 publications

Lack of Spleen Signal on Diffusion Weighted MRI is associated with High Tumor Burden and Poor Prognosis in Multiple Myeloma: A Link to Extramedullary Hematopoiesis?

Lack of Spleen Signal on Diffusion Weighted MRI is associated with High Tumor Burden and Poor Prognosis in Multiple Myeloma: A Link to Extramedullary Hematopoiesis?

An Uncommon Etiology for Pleural Effusion with Rib Lesion in a 78-year-old Woman: A Case Report

Early detection of myeloma

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