Frequency, distribution and clinical management of incidental findings and extramedullary plasmacytomas in whole body diffusion weighted magnetic resonance imaging in patients with multiple myeloma

Wale, Anita; Pawlyn, Charlotte; Kaiser, Martin; Messiou, Christina

doi:10.3324/haematol.2015.139816

Cited by 25 publications

(19 citation statements)

References 9 publications

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“…A report of whole body DW-MRI in healthy volunteers has shown IFs in 29% of subjects. Of these 30.6% were considered of ‘moderate significance’ and 10.2% ‘high significance’, requiring specialist review but only a minority of scans required further action [ 102 ]. In myeloma, IFs were seen in 38% (67/175) of examinations, 20% of findings were equivocal and after specialist radiologist and clinical review, only 3% of cases prompted further investigation.…”

Section: Maintaining Quality Standards Across Centres Through the Lifmentioning

confidence: 99%

Implementing diffusion-weighted MRI for body imaging in prospective multicentre trials: current considerations and future perspectives

et al. 2017

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For body imaging, diffusion-weighted MRI may be used for tumour detection, staging, prognostic information, assessing response and follow-up. Disease detection and staging involve qualitative, subjective assessment of images, whereas for prognosis, progression or response, quantitative evaluation of the apparent diffusion coefficient (ADC) is required. Validation and qualification of ADC in multicentre trials involves examination of i) technical performance to determine biomarker bias and reproducibility and ii) biological performance to interrogate a specific aspect of biology or to forecast outcome. Unfortunately, the variety of acquisition and analysis methodologies employed at different centres make ADC values non-comparable between them. This invalidates implementation in multicentre trials and limits utility of ADC as a biomarker. This article reviews the factors contributing to ADC variability in terms of data acquisition and analysis. Hardware and software considerations are discussed when implementing standardised protocols across multi-vendor platforms together with methods for quality assurance and quality control. Processes of data collection, archiving, curation, analysis, central reading and handling incidental findings are considered in the conduct of multicentre trials. Data protection and good clinical practice are essential prerequisites. Developing international consensus of procedures is critical to successful validation if ADC is to become a useful biomarker in oncology.Key Points• Standardised acquisition/analysis allows quantification of imaging biomarkers in multicentre trials.• Establishing “precision” of the measurement in the multicentre context is essential.• A repository with traceable data of known provenance promotes further research.

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Section: Maintaining Quality Standards Across Centres Through the Lifmentioning

confidence: 99%

Implementing diffusion-weighted MRI for body imaging in prospective multicentre trials: current considerations and future perspectives

et al. 2017

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“…Imaging of multiple myeloma was initially applied for classification according to the Durie & Salmon criteria published in 1975 focusing on bone destruction as a surrogate for the myeloma cell burden in addition to diagnosing complications, such as fractures or detecting potential causes for neurologic symptoms [8,9]. With the advent of whole-body MRI, imaging concentrated increasingly on the assessment of medullary and extra-medullary involvement [10]. Whereas, primarily detection and surveillance of focal-nodular medullary lesions seems to be more easily done, in case of diffuse bone marrow involvement, signal intensity changes vary considerably and overlap with those of normal bone marrow patient thus illustrating inter-individual variability, which is primarily influenced by the patient's age [11].…”

Section: Introductionmentioning

confidence: 99%

Extended Texture Analysis of Non-Enhanced Whole-Body MRI Image Data for Response Assessment in Multiple Myeloma Patients Undergoing Systemic Therapy

Ekert

Hinterleitner

Baumgärtner

et al. 2020

Cancers

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Identifying MRI-based radiomics features capable to assess response to systemic treatment in multiple myeloma (MM) patients. Retrospective analysis of whole-body MR-image data in 67 consecutive stage III MM patients (40 men; mean age, 60.4 years). Bone marrow involvement was evaluated using a standardized MR-imaging protocol consisting of T1w-, short-tau inversion recovery- (STIR-) and diffusion-weighted-imaging (DWI) sequences. Ninety-two radiomics features were evaluated, both in focally and diffusely involved bone marrow. Volumes of interest (VOI) were used. Response to treatment was classified according to International Myeloma Working Group (IMWG) criteria in complete response (CR), very-good and/or partial response (VGPR + PR), and non-response (stable disease (SD) and progressive disease (PD)). According to the IMWG-criteria, response categories were CR (n = 35), VGPR + PR (n = 19), and non-responders (n = 13). On apparent diffusion coefficient (ADC)-maps, gray-level small size matrix small area emphasis (Gray Level Size Zone (GLSZM) small area emphasis (SAE)) significantly correlated with CR (p < 0.001), whereas GLSZM non-uniformity normalized (NUN) significantly (p < 0.008) with VGPR/PR in focal medullary lesions (FL), whereas in diffuse involvement, 1st order root mean squared significantly (p < 0.001) correlated with CR, whereas for VGPR/PR Log (gray-level run-length matrix (GLRLM) Short Run High Gray Level Emphasis) proved significant (p < 0.003). On T1w, GLRLM NUN significantly (p < 0.002) correlated with CR in FL, whereas gray-level co-occurrence matric (GLCM) informational measure of correlation (Imc1) significantly (p < 0.04) correlated with VGPR/PR. For diffuse myeloma involvement, neighboring gray-tone difference matrix (NGTDM) contrast and 1st order skewness were significantly associated with CR and VGPR/PR (p < 0.001 for both). On STIR-images, CR correlated with gray-level co-occurrence matrix (GLCM) Informational Measure of Correlation (IMC) 1 (p < 0.001) in FL and 1st order mean absolute deviation in diffusely involved bone marrow (p < 0.001). VGPR/PR correlated at best in FL with GSZLM size zone NUN (p < 0.019) and in all other involved medullary areas with GLSZM large area low gray level emphasis (p < 0.001). GLSZM large area low gray level emphasis also significantly correlated with the degree of bone marrow infiltration assessed histologically (p = 0.006). GLCM IMC 1 proved significant throughout T1w/STIR sequences, whereas GLSZM NUN in STIR and ADC. MRI-based texture features proved significant to assess clinical and hematological response (CR, VPGR, and PR) in multiple myeloma patients undergoing systemic treatment.

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“…It is interesting to note that although the frequency of incidental findings is high in patients with myeloma undergoing whole body MRI (70 in 175 examinations). 17 Wale et al reported that only 3% of whole body MRI scans in patients with myeloma resulted in the need for further investigation. Most incidental findings were not significant, however, as AVN can be a significant cause of morbidity for patients with myeloma routine review of the femoral heads on whole body MRI is recommended.…”

Section: Discussionmentioning

confidence: 99%

Detection of avascular necrosis on routine diffusion-weighted whole body MRI in patients with multiple myeloma

Ahmed

Sriskandarajah

Burd

et al. 2019

The British Journal of Radiology

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Objective: Current therapies for multiple myeloma, which include corticosteroids, increase risk of avascular necrosis. The aim of this study was to assess incidental detection of femoral head avascular necrosis on routine whole body MRI including diffusion weighted MRI. Methods: All whole body MRI studies, performed on patients with known multiple myeloma between 1 January 2010 to 1 May 2017 were assessed for features of avascular necrosis. Results: 650 whole body MR scans were analysed. 15 patients (6.6%) had typical MR features of avascular necrosis: 2/15 (13.3%) had femoral head collapse, 4/15 (26.7%) had bilateral avascular necrosis and 9/15 (60%) were asymptomatic. Conclusion: This is the first report of avascular necrosis detected on routine whole body MRI in patients with multiple myeloma. Targeted review of femoral heads in multiple myeloma patients undergoing whole body MR is recommended, including in patients without symptoms. Advances in knowledge: Whole body MR which includes diffusion-weighted MRI is extremely sensitive for evaluation of bone marrow. Although whole body MRI is primarily used for evaluation of multiple myeloma disease burden, it also presents an unique opportunity to evaluate the femoral heads for signs of avascular necrosis which can predate symptoms.

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Frequency, distribution and clinical management of incidental findings and extramedullary plasmacytomas in whole body diffusion weighted magnetic resonance imaging in patients with multiple myeloma

Cited by 25 publications

References 9 publications

Implementing diffusion-weighted MRI for body imaging in prospective multicentre trials: current considerations and future perspectives

Implementing diffusion-weighted MRI for body imaging in prospective multicentre trials: current considerations and future perspectives

Extended Texture Analysis of Non-Enhanced Whole-Body MRI Image Data for Response Assessment in Multiple Myeloma Patients Undergoing Systemic Therapy

Detection of avascular necrosis on routine diffusion-weighted whole body MRI in patients with multiple myeloma

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