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

Abstract

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.

Magnetic Resonance Imaging of Bone Marrow and its Results as a Criterion for Administration of Maintenance Therapy After Auto-HSCT in Multiple Myeloma Patients

“…МРТ -широко распространенный метод исследования, не связанный с лучевой нагрузкой и требующий меньших временных и финансовых затрат, чем ПЭТ/КТ. В последние годы активно изучаются возможности новых режимов МРТ, в частности режим диффузионно-взвешенного изображения [19,20], использование которого позволяет определить не только объем опухоли, но и активность выявленных изменений МР-сигнала от костного мозга.…”

“…Магнитно-резонансная томография (МРТ) -высокочувствительный метод определения поражения костного мозга при ММ [19][20][21][22][23][24]. В ряде исследований отмечалось негативное влияние на показатели выживаемости больных ММ измененного МР-сигнала от костного мозга [25][26][27]…”

Imaging in myeloma with focus on advanced imaging techniques

“…52 A recent study reported that early signal fat fraction changes 8 weeks post-chemotherapy was a biomarker for inferior response. 60 Responders had a significant increase in signal fat fraction as the normal fat signal returned, whilst non-responders had no significant change.…”

Role of whole-body MRI for treatment response assessment in multiple myeloma: comparison between clinical response and imaging response

“…However, the consensus statement itself was evidence level D (panel consensus). Indeed, there have been only a few small studies evaluating the diagnostic performance of WB-MRI in response assessment [19][20][21][22][23], and, surprisingly, no study has evaluated the role of WB-MRI in differentiating progressive disease (PD) from non-PD, which is one of the most important issues in clinical oncology.…”