Contrast enhancement and quantitative signal analysis in MR imaging of multiple myeloma: assessment of focal and diffuse growth patterns in marrow correlated with biopsies and survival rates.

Stäbler, Axel; Baur, Andrea; Bartl, Reiner; Munker, R.; Lamerz, R.; Reiser, M.

doi:10.2214/ajr.167.4.8819407

Cited by 163 publications

(104 citation statements)

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“…A diffusely abnormal pattern of bone marrow also correlated with more marked alterations in other clinical parameters of disease activity such as serum calcium, t32 microglobulin and hemoglobin levels, indicating more severe disease than found in patients with a focally abnormal MRI pattern of bone marrow [8]. Stabler et al [1] evaluated five types of infiltration patterns and confirmed the prognostic value of MRI in staging of, and in planning treatment for, multiple myeloma. They also reported a correlation between the pattern of infiltration and the degree of contrast enhancement: A greater than 40% increase in signal intensity compared with baseline after contrast administration correlated with diffuse tumor infiltration of marrow.…”

Section: Lymphoproliferative Diseasesmentioning

confidence: 92%

“…However, very early in the disease, tumor cells may not completely replace fat cells in marrow and thus the resultant marrow signals can be normal on T1-and T2-weighted spin echo (SE) images. In multiple myeloma, the amount of marrow fat can even increase initially because the tumor cells produce biochemical factors that inhibit hematopoiesis [1]. When more extensive, lymphoproliferative tumors in marrow are low in signal intensity on T1-weighted SE images and high in signal intensity on T2-weighted SE images.…”

Section: Lymphoproliferative Diseasesmentioning

confidence: 99%

“…Due to the lack of associated osteoblastic activity, nuclear bone scans and radiographs are often normal in multiple myeloma, making MRI the most sensitive imaging method for lesion detection. Studies have shown that MRI findings correlate with treatment response and survival [1,6,7]. Independent studies by Moulopoulos et al [6] and Vande Berg et al [7] suggested that patients with stage I disease who had normal-appearing bone marrow on MRI had a longer progression-free interval, and patients with bone marrow involvement evident on MRI had more rapid progression of the disease.…”

Section: Lymphoproliferative Diseasesmentioning

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: Lymphoproliferative Diseasesmentioning

confidence: 92%

Section: Lymphoproliferative Diseasesmentioning

confidence: 99%

Section: Lymphoproliferative Diseasesmentioning

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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“…22 According to literature, this pattern corresponds to an only low-grade diffuse infiltration of bone marrow intermingled with focal fat islets (with a hyperintense signal on T1-weighted images). 23 Generally low signal intensity of the bone marrow on T1-weighted images in combination with a general increased signal intensity on T2-weighted images were rated as diffuse infiltration pattern and subcategorized as "moderate" (hyperintense on T1-weighting compared to the intervertebral What's new? Plasma-cell disorders such as multiple myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS) may produce different cellular patterns in the bone marrow.…”

Section: Image Analysismentioning

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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“…Plasmacytomas can occur in various locations. Studies have shown that the MRI findings correlate with treatment response and survival (14).…”

Section: Plasmacytomamentioning

confidence: 99%

MRI of bone marrow abnormalities in hematological malignancies

Silva

Hayashi²,

Yonenaga³

et al. 2013

Diagn Interv Radiol

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Magnetic resonance imaging (MRI) is essential for evaluating bone marrow. Bone marrow undergoes constant modification and its appearance on MRI changes in response. Knowledge of the types of changes and their origins is essential for analysis of MRI findings of bone marrow infiltration with hematological malignancies. This pictorial review describes the MRI pulse sequences used for imaging of bone marrow, and illustrates bone marrow changes due hematological malignancies, including changes following treatment. Magnetic resonance imaging (MRI) is the only imaging method that enables direct visualization of the bone marrow with high anatomical resolution and excellent soft tissue contrast. The MRI appearance of bone marrow depends on the amounts and proportions of yellow and red marrow, which change with age and environmental factors. Red marrow contains about 40% fat, 40% water, and 20% proteins, and a proportion of 60% hematopoietic cells to 40% fat cells (1). Yellow marrow has a sparse vascular supply, and contains mainly fat (80%) and a small proportion of water (15%), with 95% fat cells. Conversion from red to yellow marrow is generally completed by 25-30 years of age. In adults, red marrow represents only half the marrow content and it is located predominantly in the axial skeleton and proximal limbs (2). MRI sequences used for bone marrow imaging T1-weighted imagingT1-weighted spin-echo sequences are the most useful for evaluating bone marrow. Lipid protons have short T1 relaxation times, so the fatty marrow appears hyperintense on T1-weighted images, similar to subcutaneous fat. Red marrow has an intermediate T1 relaxation time, with a lower signal than subcutaneous fat, but a higher one than intervertebral disc or muscle (1). T2-weighted imaging with fat suppressionT2-weighted fast spin-echo sequences can also be used to evaluate bone marrow and are the sequences used most commonly in a clinical setting. Fat suppression is required to differentiate red and yellow marrow. On fat-suppressed T2-weighted fast spin-echo sequences, the signal intensity of red marrow is higher than that of yellow marrow (1), giving better bone marrow contrast than non-fat-suppressed sequences. Short tau inversion recovery (STIR) sequenceThis technique is used to cancel the fat signal of the marrow with a 180° inversion pulse and yields high tissue contrast. The STIR sequence generally produces more homogeneous fat suppression than T2-weighted fast spin-echo sequences, but the main drawback of this sequence is that it cancels every signal close to that of fat. Gadolinium-enhanced T1-weighted imagingGadolinium-enhanced T1-weighted images might be helpful for detecting some marrow lesions. Gadolinium enhancement of the normal bone marrow in adults is generally imperceptible on T1-weighted spinFrom the Department of Radiology

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Contrast enhancement and quantitative signal analysis in MR imaging of multiple myeloma: assessment of focal and diffuse growth patterns in marrow correlated with biopsies and survival rates.

Cited by 163 publications

References 0 publications

Magnetic resonance imaging of bone marrow in oncology, Part 2

Magnetic resonance imaging of bone marrow in oncology, Part 2

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

MRI of bone marrow abnormalities in hematological malignancies

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