Pre-treatment staging of multiple myeloma patients: comparison of whole-body diffusion weighted imaging with whole-body T1-weighted contrast-enhanced imaging

Abstract

Background: Multiple myeloma (MM) is a hematologic malignancy characterized by the clonal proliferation of plasma cells. Accurate staging is of pivotal importance in the management of MM. Advanced imaging techniques, such as magnetic resonance imaging (MRI), are increasingly used for the initial diagnosis and staging of MM. Purpose: To compare whole-body (WB) MR diffusion-weighted imaging with background body signal suppression (DWIBS) with (WB) MR fat-suppressed T1-weighted contrast-enhanced imaging (T1-CE) in the pre-treatment staging evaluation of multiple myeloma (MM) patients. Material and Methods: Thirty-six patients with MM were included in the study. T1-CE and DWIBS were performed using a 3 T scanner. The Durie-Salmon plus staging system was used. Kappa statistics was used to assess agreement. Results: For all MM stages good to very good agreement was found for both T1-CE and DWIBS. The unweighted kappa statistic indicated a moderate, good and very good agreement between T1-CE and DWIBS for stages I, II, and III, respectively. In particular, in 67% of patients the MM staging according to T1-CE was not different from DWIBS. In the remaining 33% of patients, the MM stage obtained with T1-CE was lower than that provided by DWIBS. Conclusion: DWIBS and T1-CE were concordant in the majority of patients. In a minority of cases DWIBS evidenced areas of water restriction that did not correspond to contrast enhancement areas. Studies monitoring therapeutic response in relation to tumour burden and aggressiveness should be performed to assess the clinical relevance of DWIBS findings.

The Role of18F-FDG PET/CT in Multiple Myeloma Staging according to IMPeTUs: Comparison of the Durie–Salmon Plus and Other Staging Systems

“…In recent years, new imaging techniques, such as PET or MRI, play an increasingly important role in staging of MM. The impact of MRI on staging patients according to DS Plus has been analyzed in many studies [ 12 – 14 ]. Although 18 F-FDG PET/CT has been proved to be prognostically valuable in staging different groups [ 15 – 17 ], only few studies have been reported on DS Plus based on 18 F-FDG PET/CT [ 18 ].…”

Applications of PET‐MRI in musculoskeletal disease

“…Importantly MRI depicts marrow infiltration and replacement, while radiographs and CT illustrate osseous destruction, and because of this MRI has superior detection of bone marrow involvement compared with LDWBCT or PET/CT, with a specific advantage in the diffuse patterns of involvement . Incorporation of DWI results in superior lesion conspicuity compared with conventional STIR and contrast‐enhanced MRI, and ADC values can be used with excellent accuracy (90% sensitivity and 93% specificity) to differentiate diseased and normal marrow . Quantitative ADC analysis has shown particular value in determining diffuse involvement; a bone marrow ADC greater than 0.548 × 10 −3 mm 2 /s has been shown to be 100% sensitive and 98% specific for diagnosing a diffuse marrow pattern …”

Whole-Body MR Imaging: Musculoskeletal Applications

“…It is not necessary for bone evaluation in the vast majority of patients (46). Several authors have used gadolinium-based contrast agent injection in a global approach to disease staging in MM and lymphoma (47), but this may not be necessary if whole-body DWI is performed (48).…”