Comparison of whole-body MR imaging and conventional X-ray examination in patients with multiple myeloma and implications for therapy

Dinter, Dietmar; Neff, Wolfgang; Klaus, Johanna; Böhm, Christoph; Hastka, Jan; Weiß, Christel; Schoenberg, Stefan O.; Metzgeroth, Georgia

doi:10.1007/s00277-008-0621-6

Cited by 55 publications

(35 citation statements)

References 37 publications

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“…Osteolytic lesions are reported more frequently in the mandible as compared to the maxilla, particularly in the posterior teeth region, ramus and condylar process, presumably due to greater hematopoietic activity in these areas (13,18). As for the image findings, results of the CT provided detailed information regarding the extent of cortical involvement of the tumor, whereas MRI revealed marrow infiltration as well as diffuse patterns of infiltration that may not be adequately visualized using radiographic imaging alone (2). An ulcerated, haemorhagic tissue mass of 3 x 5 cm, arising from the maxillary left third molar to the maxillary left seventh molar, was observed in the present case.…”

Section: Discussionmentioning

confidence: 92%

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Maxillary pain is the first indication of the presence of multiple myeloma: A case report

Zhao

Sun

Wang

et al. 2013

Molecular and Clinical Oncology

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Abstract. Multiple myeloma is a primary malignancy of bone marrow characterized by the clonal proliferation of plasma cells and production of monoclonal immunoglobulin. The disease occurs more frequently in males, with the average age at diagnosis being ~60 years. The first manifestation of multiple myeloma is varied and depends on the sites and extent of involvement. The predominant clinical symptoms of multiple myeloma are associated with bone pain and renal dysfunction. Neoplastic cells usually produce large amounts of monoclonal immunoglobulin light or heavy chains that can be detected in serum or urine, while plasmacytoma may be identified on marrow biopsy. The present study reported on the case of a 69-year-old male patient presenting with a complaint of a painful lesion in the left maxilla. Physical examination, imaging, laboratory investigations and biopsy were conducted, confirming the diagnosis of multiple myeloma. The results obtained suggest that the dentist should address oral manifestations as first indications of multiple myeloma. IntroductionMultiple myeloma involves the clonal proliferation of plasma cells based in the bone marrow, with various degrees of differentiation (1). Neoplastic cells usually produce large amounts of monoclonal immunoglobulin light or heavy chains that can be detected in serum or urine (2). Although multiple myeloma is the most common primary bone cancer in adults, in ~95% of cases, it involves several bones (3).The etiology of this disease remains to be determined. However, some occupations, exposure to certain chemicals, overdose irradiation, viruses and genetic factors are considered to be etiologic factors (4).Myeloma is slightly more prevalent in males and individuals of African-American descent (5). In western countries, the disease is more prevalent in males, with a median and average age at diagnosis of 66 and ~60 years, respectively (6). By contrast, the median and average age at diagnosis is 57 and 55-65 years, respectively (7). The first manifestations that usually present at diagnosis include bone pain (58%), fatigue (32%) and weight loss (24%) (6). The diagnosis of myeloma is usually confirmed by the demonstration of a monoclonal protein (M-protein) in the serum or urine and/or lytic lesions on X-ray together with histological confirmation of a malignant proliferation of plasma cells (8). Treatment involves mainly irradiation, chemotherapy, autologous stem cell transplantation. Prognosis is determined via risk classification by the International Staging System (ISS) (9).The present study reports a case of painful ulcer-like maxillary mass with multiple myeloma, which was diagnosed based on biopsy of the oral lesion. Case reportA 69-year-old male patient presented with a chief complaint of a painful ulcerated lesion in left maxilla, for ~1 month. Although the patient was treated with antibiotics and cortisol, the lesion was non-healing and became enlarged and painful, resulting in restriction of mouth opening and a weight loss of 4 kg during the month he was ...

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Section: Discussionmentioning

confidence: 92%

“…Neoplastic cells usually produce large amounts of monoclonal immunoglobulin light or heavy chains that can be detected in serum or urine (2). Although multiple myeloma is the most common primary bone cancer in adults, in ~95% of cases, it involves several bones (3).…”

Section: Introductionmentioning

confidence: 99%

Maxillary pain is the first indication of the presence of multiple myeloma: A case report

Zhao

Sun

Wang

et al. 2013

Molecular and Clinical Oncology

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“…In contrast to simple X-ray, novel imaging methods such as MRI and 18 F-fluorodeoxuglucose (FDG) positron emission tomography (PET) provide ‘functional' information regarding lesions, as well as morphologic and anatomic details [17,18,19]. As reported in the literature, an X-ray is less sensitive than other imaging modalities at detecting both medullary and extramedullary lesions as well as at identifying bone marrow (BM) involvement [20,21,22,23,24]; therefore, it serves as a less accurate modality for staging MM [25,26,27,28,29]. In addition to staging at the time of initial diagnosis, newer imaging techniques allow for improved understanding of the prognosis of a disease [17,30,31,32,33].…”

Section: Introductionmentioning

confidence: 99%

Positive Correlation between Baseline PET or PET/CT Findings and Clinical Parameters in Multiple Myeloma Patients

Park

Lee²,

Chang

et al. 2013

Acta Haematol

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Recently, positron emission tomography (PET) has been incorporated into a series of prospective studies as a predictor of outcomes in multiple myeloma (MM), and the number of ¹⁸F-fluorodeoxuglucose (FDG)-avid focal lesions (FLs) and the intensity of tumor metabolism have been designated as important surrogate markers for predicting prognosis. Here, we compared initial clinical characteristics of MM patients with baseline PET parameters: the number of FLs and the maximum standardized uptake value (SUV_max). A total of 59 patients diagnosed with MM between August 2004 and February 2012 were reviewed. At diagnosis, 23 patients (40.0%) had ≤3 FLs, 11 patients (18.6%) 4-9 FLs, and 25 patients (42.4%) ≥10 FLs. The median SUV_max was 5.3 (range 0-24.3), and 40 patients (67.8%) showed a SUV_max >4. No clinical characteristics were significantly different between groups with a SUV_max ≤4 and a SUV_max >4. However, there were significant differences in several clinical indices between the FLs ≤3 and FLs >3 groups; elevated β₂-microglobulin, elevated lactate dehydrogenase, anemia and more advanced disease by the Durie-Salmon stage corresponded to FLs >3 at baseline PET. Adverse baseline PET findings are positively correlated with prognostically relevant clinical parameters. Regarding PET parameters, FLs are more likely to be well correlated with disease aggressiveness and pathophysiology compared to SUV_max.

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“…It provides important complementary information as, for example, osteoporosis may be a sign of tumour infiltration, but is difficult to distinguish from senile osteoporosis on conventional radiographs. Also an extramedullary tumour extension could be missed on x-ray images, but is easily detected by means of MRI [2]. Whole-body MRI is therefore recommended at least in MM patients with normal conventional radiography and in all patients with an apparent solitary plasmocytoma of the bone [3].…”

Section: Introductionmentioning

confidence: 99%

Signal characteristics of focal bone marrow lesions in patients with multiple myeloma using whole body T1w-TSE, T2w-STIR and diffusion-weighted imaging with background suppression

et al. 2010

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Objective This study analyses the diagnostic potential of Diffusion-Weighted Imaging with Background Suppression (DWIBS) in the detection of focal bone marrow lesions from multiple myeloma. The signal and contrast properties of DWIBS are evaluated in correlation with the serum concentration of M-component (MC) and compared with established T1-and T2-weighted sequences. Methods Data from 103 consecutive studies in 81 patients are analysed retrospectively. Signal intensities and apparent Diffusion Coefficients (ADC) of 79 focal lesions in the lumbar spine or pelvis of 38 patients are determined and contrast-to-noise-ratio (CNR) is calculated. Data from patients with low (<20 g/L) and high (>20 g/dL) MC are evaluated separately. Results Signal intensities of focal myeloma lesions on T2w-STIR vary significantly depending on the MC, which leads to a loss in CNR in patients with high MC. No signal variation is observed for T1w-TSE and DWIBS. The CNR values provided by DWIBS in patients with high MC are slightly higher than those of T2w-STIR. ADC values in patients with low MC are significantly higher than in patients with high MC.Conclusion Whole-body DWIBS has the potential to improve the conspicuity of focal myeloma lesions and provides additional biological information by ADC quantification.

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Comparison of whole-body MR imaging and conventional X-ray examination in patients with multiple myeloma and implications for therapy

Cited by 55 publications

References 37 publications

Maxillary pain is the first indication of the presence of multiple myeloma: A case report

Maxillary pain is the first indication of the presence of multiple myeloma: A case report

Positive Correlation between Baseline PET or PET/CT Findings and Clinical Parameters in Multiple Myeloma Patients

Signal characteristics of focal bone marrow lesions in patients with multiple myeloma using whole body T1w-TSE, T2w-STIR and diffusion-weighted imaging with background suppression

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