Whole-body MRI in the detection of bone marrow infiltration in patients with plasma cell neoplasms in comparison to the radiological skeletal survey

Ghanem, Nadir; Lohrmann, Christian; Engelhardt, Monika; Pache, Gregor; Uhl, Markus; Saueressig, Ulrich; Kotter, Elmar; Langer, Mathias

doi:10.1007/s00330-005-0055-7

Cited by 120 publications

(36 citation statements)

References 31 publications

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“…For example, the introduction of a rolling-table platform with integrated surface coils has eliminated previously time-consuming changes in position of both patient and coils, and sequences such as breath-hold gradient echo and whole-body turbo STIR have substantially shortened scan time-in some cases to a total scan time of less than 15 min-while also providing good spatial resolution [56][57][58]. Given its high sensitivity in the detection of Fig.…”

Section: Complementary Mr Techniques Under Developmentmentioning

confidence: 99%

“…The amount of residual viable tumor cannot be assessed by visual inspection of the MR image or gross specimen. Histopathologic analysis using the Huvos method determined that 40% of the remaining lesion was necrotic, indicating a poor (grade I) chemotherapeutic response marrow lesions and excellent soft tissue contrast, WBMRI is under investigation as a screening and staging modality in oncology patients [56][57][58][59][60][61]. For example, WBMRI appears to be both more sensitive and specific than radiographic skeletal survey in assessing the extent of multiple myeloma, which is critical in determining the appropriate therapy [58,59].…”

Section: Complementary Mr Techniques Under Developmentmentioning

confidence: 99%

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Magnetic resonance imaging of bone marrow in oncology, Part 2

Hwang

Panicek

2007

Skeletal Radiol

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Magnetic resonance imaging plays an integral role in the detection and characterization of marrow lesions, planning for biopsy or surgery, and post-treatment followup. To evaluate findings in bone marrow on MR imaging, it is essential to understand the normal composition and distribution of bone marrow and the changes in marrow that occur with age, as well as the basis for the MR signals from marrow and the factors that affect those signals; these points have been reviewed and illustrated in part 1 of this two-part article. Part 2 will emphasize the practical application of MR imaging to facilitate differentiation of normal marrow, tumor, and treatment-related marrow changes in oncology patients, and will review complementary MR techniques under development.

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Section: Complementary Mr Techniques Under Developmentmentioning

confidence: 99%

Section: Complementary Mr Techniques Under Developmentmentioning

confidence: 99%

Magnetic resonance imaging of bone marrow in oncology, Part 2

Hwang

Panicek

2007

Skeletal Radiol

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“…7 Although PR has been an integral part of imaging for the last 25 years, osteolytic lesions can only be detected on plain films if more than 50% of bone loss is evident. 8 For this reason, CT is most often recommended because it is more sensitive to depict destruction of mineralized bone and imminent osseous instability, especially in the vertebral column. However, myeloma infiltrates inside cancellous bone are difficult to detect as long as stimulation of osteoclast activity has not yet taken place to a major extent and the bone trabeculae are still preserved.…”

mentioning

confidence: 99%

“…8,[12][13][14] MRI has a sensitivity of 68%, a specificity of 83%, a positive predictive value of 88% and is superior to PET-CT. 15 Furthermore, the development of fast sequences allows MRI to be performed as a whole-body protocol (wb-MRI), replacing the use of spinal MRI alone. 16 Focal lesions and diffuse tumor cell infiltration detected by wb-MRI have been demonstrated to be of prognostic significance for predicting progression free and overall survival in monoclonal plasma cell diseases.…”

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confidence: 99%

Appearance of monoclonal plasma cell diseases in whole‐body magnetic resonance imaging and correlation with parameters of disease activity

Kloth

Hillengaß

Listl

et al. 2014

Intl Journal of Cancer

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The aim of our study was to assess in which way different infiltration patterns of monoclonal plasma cell diseases in wholebody (wb) magnetic resonance imaging (MRI) are associated with clinical stages, plasma cell content in bone marrow samples and established serum markers of disease activity. Institutional review board approval was obtained. We performed wb-MRI in 547 consecutive, unselected and untreated patients with monoclonal gammopathy of undetermined significance (MGUS, n 5 138), smoldering myeloma (SMM, n 5 157) and multiple myeloma (MM, n 5 252) on two 1.5 T MRI-scanners with body array coils. The studies were evaluated in consensus by two experienced radiologists blinded to the diagnosis. We observed focal lesions in 23.9% (MGUS), 34.4% (SMM) and 81.3% (MM), respectively. A diffuse infiltration pattern was detected in 38.4%, 45.9% and 71%, respectively. The differences between all infiltration patterns were significant (p < 0.0001). The presence of focal lesions and the presence of a diffuse bone marrow infiltration was associated with an increased plasma cell percentage in bone marrow samples (median 22% vs. 14%, 26% vs. 10%, both p < 0.0001) and monoclonal protein concentration (median 18 g/dl vs. 13 g/dl, p 5 0.003, 20 g/dl vs. 11 g/dl, p < 0.0001). Further categorization of the diffuse infiltration patterns in wb-MRI into "salt-and-pepper," moderate and severe identified significant associations with M-protein (median g/dl for S1P/moderate/severe 23/18/25, p 5 0.04), plasma cell percentage in the bone marrow (median 25%/24%/40%, p 5 0.02), and age (median years 67/60/57, p < 0.0001). Bone marrow infiltration in wb-MRI is significantly different between the various stages of plasma cell disease and correlates well with established markers of disease activity.Monoclonal plasma cell diseases like multiple myeloma (MM), monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma (SMM) are a group of hematologic premalignant or malignant disorders associated with monoclonal proliferation of plasma cells mainly in the bone marrow.1,2 Although MGUS, being the most common disorder of plasma cells and occurring in 2% of persons older than 50 years, has an overall annual risk of progression of only 1% per year, the rate of transformation of SMM to MM or systemic amyloidosis (AL) has been shown to be 10% per year in the first 5 years. [3][4][5][6] In the aforementioned monoclonal plasma cell disorders, the bone marrow involvement may be present in different patterns: diffuse bone marrow infiltration and focal lesions. Diffuse bone marrow infiltration is characterized by malignant plasma cells, mixed up with normal bone marrow cells, still preserving the cancellous bone structure. Focal lesions are circumscribed solid foci of plasma cells with the potential of destruction of the cancellous and cortical bone.To image these changes, plain radiographs (PRs), computed tomography (CT) and magnetic resonance imaging (MRI) are currently in routine use. 7 Although PR has been an integral part of...

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“…51 When whole-body examination was performed, including the appendicular skeleton, MRI had a higher detection rate than WBXR. 57 A comparison of axial MRI versus whole body MRI revealed that~1 0% of patients had lesions exclusively outside of the axial skeleton. 58 A systematic review of imaging techniques in the diagnosis of myeloma bone disease compared MRI with WBXR and/or CT.…”

Section: Imagingmentioning

confidence: 99%