Whole-Body Imaging of Multiple Myeloma: Diagnostic Criteria

Filho, Alípio Gomes Ormond; Carneiro, Bruno Cerretti; Pastore, Daniel; Silva, Igor P.; Yamashita, Sâmia R.; Consolo, Flávio D.; Hungria, Vânia; Sandes, Alex Freire; Rizzatti, Edgar Gil; Nico, Marcelo Astolfi Caetano

doi:10.1148/rg.2019180096

Cited by 79 publications

(63 citation statements)

References 64 publications

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“…Images were evaluated in terms of infiltration pattern (focal, diffuse, and combined) in the comparison between WBLDCT and WBMRI, only focal involvement was considered on both techniques, due to the lower sensitivity of WBLDCT, when compared to WBMRI, in the evaluation of diffuse bone marrow infiltration, making it difficult to differentiate myeloma-related osteopenia from osteoporosis [ 7 ]. Moreover, up to date, among all known MM infiltration patterns, the focal involvement is the only one reported to affect the disease stage according to international guidelines [ 1 ].…”

Section: Methodsmentioning

confidence: 99%

“…The diagnosis of MM mainly relies on the demonstration of bone marrow plasmacytosis and/or presence of monoclonal proteins (M-proteins) in the serum or urine, and/or detection of end-organ damage (CRAB—hypercalcemia, renal failure, anemia, and bone disease), especially lytic bone lesions, based on the International Myeloma Working Group (IMWG) diagnostic criteria published in 2014 [ 1 , 4 , 5 , 6 ]. Indeed, at imaging assessment, the evidence of at least two 5-mm or larger focal lesions detected at magnetic resonance imaging (MRI) is considered to be a myeloma biomarker, while at least one 5-mm or larger osteolytic lesion at positron emission tomography (PET), whole-body low dose computed tomography (WBLDCT), or whole-skeletal x-ray is considered to be a CRAB feature [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Whole Body Low Dose Computed Tomography (WBLDCT) Can Be Comparable to Whole-Body Magnetic Resonance Imaging (WBMRI) in the Assessment of Multiple Myeloma

et al. 2021

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Aim of the study is to compare the agreement between whole-body low-dose computed tomography (WBLDCT) and magnetic resonance imaging (WBMRI) in the evaluation of bone marrow involvement in patients with multiple myeloma (MM). Patients with biopsy-proven MM, who underwent both WBLDCT and WBMRI were retrospectively enrolled. After identifying the presence of focal bone involvement (focal infiltration pattern), the whole skeleton was divided into five anatomic districts (skull, spine, sternum and ribs, pelvis, and limbs). Patients were grouped according to the number and location of the lytic lesions (<5, 5–20, and >20) and Durie and Salmon staging system. The agreement between CT and MRI regarding focal pattern, staging, lesion number, and distribution was assessed using the Cohen Kappa statistics. The majority of patients showed focal involvement. According to the distribution of the focal lesions and Durie Salmon staging, the agreement between CT and MRI was substantial or almost perfect (all κ > 0.60). The agreement increased proportionally with the number of lesions in the pelvis and spine (κ = 0.373 to κ = 0.564, and κ = 0.469–0.624), while for the skull the agreement proportionally decreased without reaching a statistically significant difference (p > 0.05). In conclusion, WBLDCT showed an almost perfect agreement in the evaluation of focal involvement, staging, lesion number, and distribution of bone involvement in comparison with WBMRI.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Whole Body Low Dose Computed Tomography (WBLDCT) Can Be Comparable to Whole-Body Magnetic Resonance Imaging (WBMRI) in the Assessment of Multiple Myeloma

et al. 2021

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“…High-risk patients in particular should receive periodic staging imaging to exclude asymptomatic progression [ 19 ]. Although patients with SMM may remain stable over extended periods of time, the progression rate to active MM is reported as 10% per year for the first 5 years and 3% per year for the following 5 years [ 20 , 21 ].…”

Section: Whole-body Computed Tomography (Wbct)mentioning

confidence: 99%

Whole-body magnetic resonance imaging (WBMRI) versus whole-body computed tomography (WBCT) for myeloma imaging and staging

2021

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Myeloma-associated bone disease (MBD) develops in about 80–90% of patients and severely affects their quality of life, as it accounts for the majority of mortality and morbidity. Imaging in multiple myeloma (MM) and MBD is of utmost importance in order to detect bone and bone marrow lesions as well as extraosseous soft-tissue masses and complications before the initiation of treatment. It is required for determination of the stage of disease and aids in the assessment of treatment response. Whole-body low-dose computed tomography (WBLDCT) is the key modality to establish the initial diagnosis of MM and is now recommended as reference standard procedure for the detection of lytic destruction in MBD. In contrast, whole-body magnetic resonance imaging (WBMRI) has higher sensitivity for the detection of focal and diffuse plasma cell infiltration patterns of the bone marrow and identifies them prior to osteolytic destruction. It is recommended for the evaluation of spinal and vertebral lesions, while functional, diffusion-weighted MRI (DWI-MRI) is a promising tool for the assessment of treatment response. This review addresses the current improvements and limitations of WBCT and WBMRI for diagnosis and staging in MM, underlining the fact that both modalities offer complementary information. It further summarizes the corresponding radiological findings and novel technological aspects of both modalities.

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“…These lesions are expansile and may show a "mini-brain" appearance on axial images. Distinction from other entities such as metastasis, lymphoma or leukemia may be challenging (148).…”

Section: Multiple Myeloma and Solitary Plasmacytomamentioning

confidence: 99%

Axial Spondyloarthritis: Mimics and Pitfalls of Imaging Assessment

2021

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Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder that predominantly involves the axial skeleton. Imaging findings of axSpA can be divided into active changes, which include bone marrow edema, synovitis, enthesitis, capsulitis, and intra-articular effusion, and structural changes, which include erosions, sclerosis, bone fatty infiltration, fat deposition in an erosion cavity, and bone bridging or ankylosis. The ability to distinguish between imaging lesions suggestive of axSpA and artifacts or lesions suggestive of other disorders is critical for the accurate diagnosis of axSpA. Diagnosis may be challenging, particularly in early-stage disease and magnetic resonance imaging (MRI) plays a key role in the detection of subtle or inflammatory changes. MRI also allows the detection of structural changes in the subchondral bone marrow that are not visible on conventional radiography and is of prognostic and monitoring value. However, bone structural changes are more accurately depicted using computed tomography. Conventional radiography, on the other hand, has limitations, but it is easily accessible and may provide insight on gross changes as well as rule out other pathological features of the axial skeleton. This review outlines the imaging evaluation of axSpA with a focus on imaging mimics and potential pitfalls when assessing the axial skeleton.

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Whole-Body Imaging of Multiple Myeloma: Diagnostic Criteria

Cited by 79 publications

References 64 publications

Whole Body Low Dose Computed Tomography (WBLDCT) Can Be Comparable to Whole-Body Magnetic Resonance Imaging (WBMRI) in the Assessment of Multiple Myeloma

Whole Body Low Dose Computed Tomography (WBLDCT) Can Be Comparable to Whole-Body Magnetic Resonance Imaging (WBMRI) in the Assessment of Multiple Myeloma

Whole-body magnetic resonance imaging (WBMRI) versus whole-body computed tomography (WBCT) for myeloma imaging and staging

Axial Spondyloarthritis: Mimics and Pitfalls of Imaging Assessment

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