Increased microcirculation detected by dynamic contrast‐enhanced magnetic resonance imaging is of prognostic significance in asymptomatic myeloma

Abstract

This prospective study aimed to investigate the prognostic significance of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) as a non-invasive imaging technique delivering the quantitative parameters amplitude A (reflecting blood volume) and exchange rate constant kep (reflecting vascular permeability) in patients with asymptomatic monoclonal plasma cell diseases. We analysed DCE-MRI parameters in 33 healthy controls and 148 patients with monoclonal gammopathy of undetermined significance (MGUS) or smouldering multiple myeloma (SMM) according to the 2003 IMWG guidelines. All individuals underwent standardized DCE-MRI of the lumbar spine. Regions of interest were drawn manually on T1-weighted images encompassing the bone marrow of each of the 5 lumbar vertebrae sparing the vertebral vessel. Prognostic significance for median of amplitude A (univariate: P < 0·001, hazard ratio (HR) 2·42, multivariate P = 0·02, HR 2·7) and exchange rate constant kep (univariate P = 0·03, HR 1·92, multivariate P = 0·46, HR 1·5) for time to progression of 79 patients with SMM was found. Patients with amplitude A above the optimal cut-off point of 0·89 arbitrary units had a 2-year progression rate into symptomatic disease of 80%. In conclusion, DCE-MRI parameters are of prognostic significance for time to progression in patients with SMM but not in individuals with MGUS.

Cancer Stem Cell Marker DCLK1 Correlates with Tumorigenic Immune Infiltrates in the Colon and Gastric Adenocarcinoma Microenvironments

“…Pearson correlations were calculated with the cor.test package in R and correlation plots were prepared with ggpubr and corrplot packages in R. For correlations only p values < 0.0001 were considered statistically significant, and the strength of the correlation was described as follows: 0.00-0.19 "very weak", 0.20-0.39 "weak", 0.40-0.59 "moderate", 0.60-0.79 "strong", 0.80-1.0 "very strong" [94]. Kaplan-Meier and Cox regression analyses were performed and visualized using the survival and survminer packages in R. The optimal cutpoint for these analyses was generated by the function "surv_cutpoint" which originates in the "maxstat" R package [95,96].…”

Functional and molecular MRI of the bone marrow in multiple myeloma

“…It has the advantage of evaluating a large volume of the bone marrow, overcoming the sampling bias of trephine biopsies. 2 For DCE-MRI in myeloma patients, a fat-suppressed T 1 weighted ultrafast gradient echo sequence of the thoracolumbar or lumbar spine (more rarely of the pelvis) is usually acquired. Semi-quantitative perfusion parameters can be extracted from TICs, by drawing ROIs.…”

“…Diffusion-weighted imaging (DWI) and dynamic contrast enhanced (DCE) MRI permit noninvasive evaluation of tumor-specific characteristics related to cellularity and angiogenesis and can thus improve diagnosis, prognostication, treatment planning and response assessment. [1][2][3] Both diffusion and perfusion quantification can be provided from intravoxel incoherent motion (IVIM) modelling. 4 Whole body MRI (WBMRI) has been recently recommended as a first line imaging modality by the International Myeloma Working Group.…”

Volumetry based biomarker speed of growth: Quantifying the change of total tumor volume in whole-body magnetic resonance imaging over time improves risk stratification of smoldering multiple myeloma patients

“…MRI has proven to be a suitable tool for risk stratification of SMM patients, using abnormal bone marrow pattern [ 7 , 8 ], count of FLs [ 5 , 6 , 9 , 10 ], development of MRI findings [ 6 ] or even parameters from dynamic contrast enhancement MRI (DCE-MRI) as criteria to isolate high-risk groups [ 11 ]. Additionally, it was shown that volumetry is the superior method of quantifying tumor burden [ 12 , 13 ] and that volumetry can contribute to proper risk stratification in lung cancer screening [ 14 , 15 ].…”