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

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

doi:10.1148/radiol.13131529

Cited by 177 publications

(172 citation statements)

References 33 publications

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“…A significant difference in the specificity and accuracy was observed between the two steps for reader 2 and an added value of 84 % (16/19) in indeterminate lesions for reader 2. We observed excellent interobserver agreement in the measurement of ADC, consistent with a recent report by Giles et al [23]. There has been no consensus on which DWI parameters are optimal for evaluating soft tissue tumours.…”

Section: Discussionsupporting

confidence: 91%

Differentiation of malignant from benign soft tissue tumours: use of additive qualitative and quantitative diffusion-weighted MR imaging to standard MR imaging at 3.0 T

et al. 2015

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Objectives To determine the added value of diffusionweighted imaging (DWI) to standard magnetic resonance imaging (MRI) to differentiate malignant from benign soft tissue tumours at 3.0 T. Methods 3.0 T MR images including DWI in 63 patients who underwent surgery for soft tissue tumours were retrospectively analyzed. Two readers independently interpreted MRI for the presence of malignancy in two steps: standard MRI alone, standard MRI and DWI with qualitative and quantitative analysis combined. Results There were 34 malignant and 29 non-malignant soft tissue tumours. In qualitative analysis, hyperintensity relative to skeletal muscle was more frequent in malignant than benign tumours on DWI (P=0.003). In quantitative analysis, ADCs of malignant tumours were significantly lower than those of nonmalignant tumours (P≤0.002): 759±385 vs. 1188±423 μm 2 / sec minimum ADC value, 941±440 vs. 1310±440 μm 2 /sec average ADC value. The mean sensitivity, specificity and accuracy of both readers were 96 %, 72 %, and 85 % on standard MRI alone and 97 %, 90 %, and 94 % on standard MRI with DWI.Conclusions The addition of DWI to standard MRI improves the diagnostic accuracy for differentiation of malignant from benign soft tissue tumours at 3.0 T. Key Points • DWI has added value for differentiating malignant from benign soft tissue tumours. • Addition of DWI to standard MRI at 3.0 T improves the diagnostic accuracy. • Measurements of both ADC min within solid portion and ADC av are helpful.

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Section: Discussionsupporting

confidence: 91%

Differentiation of malignant from benign soft tissue tumours: use of additive qualitative and quantitative diffusion-weighted MR imaging to standard MR imaging at 3.0 T

et al. 2015

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“…Conversely, it was able to reveal a faster normalization of the imaging findings in patients achieving a complete response or a very good partial response [44]. Also, a preliminary WBDW MRI study for the assessment of treatment response, carried out in a limited number of MM patients, indicates that WBDW is a repeatable and quantifiable imaging technique [45]. However, no comparative reports of the diagnostic performance between FDG PET/CT and WBDW in the same patients before and after therapy are so far available.…”

Section: Response To Therapy and Prognostic Evaluation In Overt MMmentioning

confidence: 93%

18F-FDG PET/CT: a review of diagnostic and prognostic features in multiple myeloma and related disorders

et al. 2014

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Conventional radiographic skeletal survey has been for many years the gold standard to detect the occurrence of osteolytic lesions in patients with multiple myeloma (MM). However, the introduction of more sensitive imaging procedures has resulted in an updated anatomic and functional Durie and Salmon "plus" staging system and has remarkably changed the diagnostic and prognostic approach to this tumor. It is now established that (18)fluorine-fluorodeoxyglucose ((18)F-FDG) positron-emission tomography (PET) combined with low-dose computed tomography (CT), shortly designated PET/CT, exhibits a higher screening and diagnostic sensitivity and specificity over the skeleton X-ray. In patients with monoclonal gammopathy of undetermined significance and in those with smoldering MM, PET/CT is consistently unable to detect focal and/or diffuse marrow abnormalities. Conversely, based on a systematic review of 18 studies comprising almost 800 MM patients, PET/CT was able to detect MM osteolytic lesions with a sensitivity of approximately 80-90% and a specificity of 80-100%. Importantly, a poor degree of concordance has also been emphasized between PET/CT and whole-body magnetic resonance imaging (WB-MRI) in that when both techniques were applied to the same patients, double-positive results were recorded in approximately 30% of the cases, but in the majority of them, a higher number of lesions were revealed with PET/CT than with MRI. Double-negative results, on the other hand, were found in about 22% of the patients. Because PET/CT is able to identify tumor foci throughout the body, it can be usefully applied to the study of solitary bone plasmacytoma and extra-medullary plasmacytoma: In both conditions, the detection of additional, previously overlooked sites of skeletal involvement would falsify the diagnosis of single-district disease, upstage the tumor, and therefore require a different therapeutic approach. In addition, although PET/CT is poorly sensitive to diffuse bone marrow infiltration, it can anticipate a site of impending fracture throughout the body and can discriminate old from new pathologic fractures. MRI should, however, be preferred when vertebral bodies are suspected to be involved and the risk of vertebral fracture is to be assessed. PET/CT is a sensitive and reliable procedure to evaluate the response to chemotherapy and/or radiotherapy, which is shown by a remarkable reduction and sometimes total disappearance of FDG accumulation in the involved bony structures, although these structures remain morphologically abnormal. Conversely, an increased focal uptake of FDG in apparent remission patients often precedes clinically overt relapse. PET/CT should be preferred to other imaging techniques to assess the remission status after autologous stem cell transplantation. In patients with primary and remission-induced non-secretory MM, the use of PET/CT may help to early detect single or multiple districts of focal non-secretory relapse. Osteonecrosis of the jaw, its location, and extent in MM patients receiving b...

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“…Despite promising results concerning the application of ADC as MRI biomarker for monitoring response in various soft tissue and skeletal tumours (Punwani et al , 2010; Giles et al , 2014), generalization of ADC remains challenging (Koh et al , 2011). ADC quantitation could be affected by several factors, such as number and choices of b values, mathematical model for data fitting, software for data analysis and choices of applied sequence parameters (Koh et al , 2011; Celik, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, functional MRI techniques, such as contrast enhanced (CE) (Lin et al , 2010), DW imaging (DWI) (Hillengass et al , 2011) and fat‐water imaging (Takasu et al , 2012), have become widely available on clinical MRI scanners, providing an opportunity to explore these techniques for response assessment. By detecting intra‐ and extracellular water flux, DWI provides a measure of tissue cellularity and changes in apparent diffusion coefficient (ADC) have been associated with treatment response (Hillengass et al , 2011; Giles et al , 2014). CE imaging is used to highlight abnormal vasculature, allowing detection of alterations of vasculature following therapy (Lin et al , 2010).…”

mentioning

confidence: 99%

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

Cited by 177 publications

References 33 publications

Differentiation of malignant from benign soft tissue tumours: use of additive qualitative and quantitative diffusion-weighted MR imaging to standard MR imaging at 3.0 T

Differentiation of malignant from benign soft tissue tumours: use of additive qualitative and quantitative diffusion-weighted MR imaging to standard MR imaging at 3.0 T

18F-FDG PET/CT: a review of diagnostic and prognostic features in multiple myeloma and related disorders

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

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