This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.pISSN 1598 -2998 , eISSN 2005 http://dx. Original ArticlePurpose The aim of this study is to determine the diagnostic and prognostic role of baseline spinal magnetic resonance imaging (MRI) in patients with multiple myeloma. Materials and MethodsWe enrolled patients newly diagnosed with multiple myeloma from 2004-2011 at a single center. Abnormal MRI findings that were not detected in radiographs have been analyzed and categorized as malignant compression fractures or extramedullary plasmacytoma. The bone marrow (BM) infiltration patterns on MRI have been classified into five categories. ResultsA total of 113 patients with a median age of 65 years (range, 40 to 89 years) were enrolled in the study. Malignant compression fractures not detected in the bone survey were found in 26 patients (23.0%), including three patients (2.6%) with no related symptoms or signs. Extramedullary plasmacytoma was detected in 22 patients (19.5%), including 15 (13.3%) with epidural extension of the tumor. Of these 22 patients, 11 (50.0%) had no relevant symptoms or signs. The presence of malignant compression fractures did not influence overall survival; whereas non-epidural extramedullary plasmacytoma was associated with poor overall survival in the multivariate analysis (hazard ratio, 3.205; 95% confidence interval [CI], 1.430 to 9.845; p=0.042). During the follow-up for a median of 21 months (range, 1 to 91 months), overall survival with the mixed BM infiltrative pattern (median, 24.0 months; 95% CI, 22.9 to 25.1 months) was shorter than those with other patterns (median 56 months; 95% CI, 48.9 to 63.1 months; p=0.030). ConclusionThese results indicate that spine MRI at the time of diagnosis is useful for detecting skeletal lesions and predicting the prognosis in patients with multiple myeloma.

Background: Iron deficiency anemia (IDA) is common in patients with partial or total gastrectomy; however, clinical features and appropriate therapy in these patients have not been well described. We compared clinical features and outcomes in IDA patients with and without gastrectomy. Methods: We retrospectively analyzed clinical features at the time of diagnosis and response to iron therapy in IDA patients with partial or total gastrectomy (gastrectomy group) and in age- and gender-matched IDA patients without gastrectomy (control group) who were diagnosed between 2002 and 2010 at Chungnam National University Hospital. Results: A total of 2,072 patients were diagnosed with IDA during the study period. Thirty-seven and 40 patients were enrolled in the gastrectomy and control groups, respectively. The median ages were 58.8 years (range, 19–84 years) and 52.7 years (range, 25–84 years), respectively. At initial presentation, the hemoglobin levels, mean corpuscular volume (MCV), mean corpuscular hemoglobin levels, mean corpuscular hemoglobin concentration, serum iron levels, total iron binding capacity, ferritin levels as well as endoscopic findings did not differ between the two groups. After 2 weeks, 6 weeks, and 3 months of oral iron therapy, hemoglobin levels were significantly lower in the gastrectomy group than in the control group (8.3 vs. 9.6 g/dL, P=0.012; 9.7 vs. 12.0 g/dL, P=0.000; 11.9 vs. 13.3 g/dL, P=0.016, respectively). After 2 weeks and 6 weeks of treatment, the increase in the hemoglobin level and that in the MCV were significantly slower in the gastrectomy group than in the control group (hemoglobin: 0.6 vs. 2.3 g/dL, P=0.000; 2.1 vs. 4.7 g/dL, P=0.000, respectively) (MCV: 2.6 vs. 6.2 fL, P=0.005; 7.2 vs. 12.7 fL, P=0.008). Parenteral iron was required in nine (23.4%) patients in the gastrectomy group, but not in the control group. The follow-up duration was much longer in the gastrectomy group (23.2 vs. 5.2 months, P=0.008), and 11 (29.7%) patients in this group needed long-term maintenance iron therapy. To normalize hemoglobin levels, longer treatment was required in the gastrectomy group (0.8 vs. 2.8 months, respectively; P=0.013). Conclusion: The response to oral iron therapy in IDA patients with gastrectomy is slower than in those without gastrectomy. Parenteral iron therapy is needed in one-fourth of these patients to normalize hemoglobin levels. Disclosures No relevant conflicts of interest to declare.