Diffuse MRI marrow pattern correlates with increased angiogenesis, advanced disease features and poor prognosis in newly diagnosed myeloma treated with novel agents

Diffuse pattern of bone marrow involvement on magnetic resonance imaging is associated with high risk cytogenetics and poor outcome in newly diagnosed, symptomatic patients with multiple myeloma: A single center experience on 228 patients

“…This result is described for the first time and is in accordance with a recent observation of the Heidelberg group in 87 untreated myeloma patients where the gain of 1q21 and the deletions of 17p and 13q significantly correlated with at least one abnormal finding in bone marrow dynamic contrastenhanced MRI, that is, aberrant ''focal'' microcirculation pattern, increase in median microcirculation parameter amplitude A or exchange rate constant kep, suggesting that these chromosomal abnormalities trigger the angiogenic cascade in MM [14]. Indeed, our group has described that patients with diffuse MRI pattern have increased microvessel density in their trephine biopsies and adverse myeloma features [5]. In this study, we confirm that a diffuse MRI pattern correlated with adverse disease characteristics, such as ISS-3 stage, elevated LDH, severe anemia, and poor prognosis.…”

“…MR images were analyzed for pattern of myelomatous involvement. The pattern of marrow involvement on MR images was characterized as: (1) normal when there was no evidence of abnormal signal intensity; (2) focal, which consisted of localized areas of abnormal marrow; the lesions are darker than yellow marrow and slightly darker than or isointense to red marrow on T1-weighted images, while on T2-weighted images focal lesions are brighter than both red and yellow marrow, and on enhanced T1-weighted images they enhance to various degrees; (3) diffuse, in which normal bone marrow signal intensity is completely absent; the intervertebral disks appear brighter than or isointense to the diseased marrow; there is a diffuse decrease in the bone marrow signal intensity of the marrow on T1-weighted images, a variable increase in the signal intensity of abnormal marrow on T2-weighted images, and after the administration of intravenous contrast, the abnormal marrow enhances and the intervertebral disks appear darker than the enhanced spine; and finally (4) variegated which consists of innumerable small foci of disease on a background of intact marrow, with small dark lesions on T1-weighted images which become bright on T2-weighted image and enhance after the administration of intravenous contrast [3][4][5].…”

“…4). Discussion MRI pattern of marrow involvement and specific cytogenetic abnormalities have been associated with prognosis in newly diagnosed patients with symptomatic myeloma [4][5][6][7][8][9]. However, there are very limited data in the literature for the correlation between MRI patterns and cytogenetic aberrations in myeloma patients.…”

“…Because of the small number of patients with variegated pattern in this study and because we have already observed that patients with variegated pattern have similar prognosis with patients with diffuse pattern [4,5], we have grouped and analyzed these two patterns together. As depicted in Table I, patients with diffuse and variegated patterns had more often severe anemia (51%), extensive marrow infiltration (>40% of bone marrow infiltration by myeloma cells in 88%), higher incidence of increased serum LDH 300 IU/l (15%), and ISS-3 stage (45%) compared to patients with focal and normal MRI patterns.…”

“…MRI recognizes four patterns of marrow infiltration in myeloma: focal, diffuse, variegated, and normal [3]. A diffuse MRI marrow pattern has been associated with poor prognosis in myeloma patients treated with either conventional chemotherapy or novel agent-based therapies [4,5]. In the era of novel anti-myeloma drugs, it becomes necessary to recognize patients with high risk disease who may benefit from more aggressive treatment.…”