Assessment of early treatment response on MRI in multiple myeloma: Comparative study of whole-body diffusion-weighted and lumbar spinal MRI

Abstract

Objectives To compare remission status at completion of chemotherapy for multiple myeloma (MM) with changes in total diffusion volume (tDV) calculated from whole-body diffusion-weighted imaging (WB-DWI) and fat fraction (FF) of lumbar bone marrow (BM) by modified Dixon Quant (mDixon Quant) soon after induction of chemotherapy, and to assess the predictive value of MRI. Methods Fifty patients (mean age, 66.9 ± 10.5 years) with symptomatic myeloma were examined before and after two cycles of chemotherapy. From WB-DWI data, tDV was obtained with the threshold for positive BM involvement. Mean FF was calculated from lumbar BM using the mDixon Quant sequence. At the completion of chemotherapy, patients were categorized into a CR/very good PR (VGPR) group (n = 15; mean age, 67.6 ± 10.3 years) and a PR, SD or PD group (n = 35; mean age, 69.1 ± 8.6 years). ROC curves were plotted to assess performance in predicting achievement of CR/VGPR. Results At second examination, serum M protein, β 2-microglobulin, and tDV were significantly decreased and hemoglobin, mean ADC, and FF were significantly increased in the CR/ VGPR group and serum M protein was significantly increased in the PR/SD/PD group. The general linear model demonstrated that percentage changes in FF and M protein contributed significantly to achieving CR/VGPR (P = 0.02, P = 0.04, respectively). AUCs of ROC curves were 0.964 for FF and 0.847 for M protein.

Correlations between apparent diffusion coefficient values of WB-DWI and clinical parameters in multiple myeloma

“…MRI-based texture features are expected to be used as an auxiliary tool to evaluate the prognosis of MM patients. In addition, this study has shown that the average ADC of patients in the CR/VGPR group increases significantly after induction chemotherapy [ 41 ]. However, Park et al [ 42 ] considered that MR imaging was useful in the evaluation of PD (sensitivity 94.7%, specificity 84.2%), but the evaluation of CR was not satisfactory (sensitivity 4.5%, specificity 98.1%), which also involved the information of the ADC map.…”

Comparison of [18F]FDG PET/CT and MRI for Treatment Response Assessment in Multiple Myeloma: A Meta-Analysis

“…In addition, [ 18 F]FDG PET-CT could be considered a high-performance imaging procedure for diagnosis of diffuse infiltration [ 43 ]. Nowadays, many studies on WBDWI have focused on the detection of BM lesions in newly diagnosed MM [ 40 , 44 ], and there are few studies assessed the correlation with IMWG response criteria in post-treatment evaluation [ 38 ]. A study that was not included in the quantitative evaluation of the present meta-analysis, due to the small number of cases, compared the ability of WBDWI and FDG PET/CT to evaluate treatment response in eight cases of MM.…”

Correlations Between Apparent Diffusion Coefficient Values of WB-DWI and Clinical Parameters in Multiple Myeloma

“…[37] In addition, this study has shown that the average ADC of patients in the CR / VGPR group increased signi cantly after induction chemotherapy. [38] However, Park et al [39] consider that MR imaging is useful in the evaluation of PD (sensitivity 94.7%, speci city 84.2%), but the evaluation of CR is not satisfactory (sensitivity 4.5%, speci city 98.1%), which also involves the information of the ADC map. When the baseline ADC value was 0.808 × 10 -3 mm 2 / s, ADC had the speci city of 68.05% and sensitivity of 54.09% in predicting the increase in ADC after treatment.…”