FRCP, FRCP Nandita M. deSouza, MD, FRCP, FRCR Purpose:To determine the feasibility of whole-body diffusionweighted (DW) magnetic resonance (MR) imaging for assessment of treatment response in myeloma. Materials and Methods:This prospective single-institution study was HIPAAcompliant with local research ethics committee approval. Written informed consent was obtained from each subject. Eight healthy volunteers (cohort 1a) and seven myeloma patients (cohort 1b) were imaged twice to assess repeatability of quantitative apparent diffusion coefficient (ADC) estimates. Thirty-four additional myeloma patients (cohort 2) underwent whole-body DW imaging before treatment; 26 completed a posttreatment imaging. Wholebody DW data were compared before and after treatment by using qualitative (ie, observer scores) and quantitative (ie, whole-body segmentation of marrow ADC) methods. Serum paraproteins and/or light chains or bone marrow biopsy defined response. Results:Whole-body DW imaging scores were significantly different between observers (P , .001), but change in scores between observers after treatment was not (P = .49). Sensitivity and specificity for detecting response according to observer scores were 86% (18 of 21 patients) and 80% (4 of 5 patients) for both observers. ADC measurement was repeatable: mean coefficient of variation was 3.8% in healthy volunteers and 2.8% in myeloma patients. Pretreatment ADC in cohort 2 was significantly different from that in cohort 1a (P = .03), but not from that in cohort 1b (P = .2). Mean ADC increased in 95% (19 of 20) of responding patients and decreased in all (five of five) nonresponders (P = .002). A 3.3% increase in ADC helped identify response with 90% sensitivity and 100% specificity; an 8% increase (greater than repeatability of cohort 1b) resulted in 70% sensitivity and 100% specificity. There was a significant negative correlation between change in ADC and change in laboratory markers of response (r = 20.614; P = .001). Conclusion:Preliminary work demonstrates whole-body DW imaging is a repeatable, quantifiable technique for assessment of treatment response in myeloma.q RSNA, 2014 1
Objective: To establish whether T 2 relaxation and apparent diffusion coefficient (ADC) in normal prostate and tumour are related and to investigate the effects of glandular compression from an enlarged transition zone (TZ) on peripheral zone (PZ) T 2 and ADC by correlating them with the peripheral zone fractional volume (PZFV).Methods: 48 consecutive patients prospectively underwent multiecho T 2 weighted (T 2 W) (echo times 20, 40, 60, 80, 100 ms) and diffusion-weighted (b50, 100, 300, 500, 800 s mm 22 ) endorectal MRI. In 43 evaluable patients, single slice whole PZ, TZ and tumour (focal hypointense signal on T 2 W images in a biopsy-positive octant) regions of interest were transferred to T 2 and ADC maps by slice matching. T 2 and ADC values were correlated, and PZ values were correlated with PZFV.
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