Prognostic significance of whole-body MRI in patients with monoclonal gammopathy of undetermined significance

Hillengaß, Jens; Ma, Weber; Kilk, Kerstin; Listl, Karin; Wagner-Gund, Barbara; Hillengaß, Michaela; Hielscher, Thomas; Farid, Alyaa; Neben, Kai; Delorme, Stefan; Landgren, Ola; Goldschmidt, Hartmut

doi:10.1038/leu.2013.244

Cited by 65 publications

(38 citation statements)

References 32 publications

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“…A main advantage of MRI cited in the literature is the improved detection of diffuse bone marrow infiltration by myeloma cells (18). MRI allows for imaging of the bone cavity content and can detect changes in marrow density and identify marrow infiltration patterns before development of any bone destruction in patients with MGUS (19,20). Diffuse involvement of the bone marrow by multiple myeloma is better detected by WB-MRI, leading to upstaging in cases where diffuse bone loss could be misinterpreted as senile osteoporosis by WBLDCT (9).…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Whole-Body Low-Dose Computed Tomography and Advanced Imaging Techniques for Multiple Myeloma Bone Disease

Pianko

Terpos

Roodman

et al. 2014

Clinical Cancer Research

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Detection of lytic bone lesions is crucial in the workup for multiple myeloma and very often dictates the decision to start treatment. Conventional radiography, despite decades of use, is often insufficient for detection of bone disease in multiple myeloma. Modern imaging techniques such as MRI, PET, and CT offer superior detection of myeloma bone disease and extramedullary manifestations of plasma cell dyscrasias. Novel whole-body low-dose computed tomography (WBLDCT) protocols allow for collection of superior image detail of the skeleton at doses of radiation similar to those used for conventional planar radiography. Several studies have shown that WBLDCT has a superior detection rate for lytic bone lesions compared with whole-body X-ray (WBXR), potentially leading to restaging and changes in therapy. MRI and PET provide imaging data important for assessing disease activity and prognostication. Because of several advantages over WBXR, WBLDCT is already the standard imaging technique for use in patients with multiple myeloma in many European institutions. However, the radiographic skeletal survey or WBXR is still the initial study of choice used to screen for myeloma bone disease in many institutions. In this review, we aim to explore the changing landscape of imaging for myeloma bone disease through use of modern imaging techniques. Clin Cancer Res; 20(23); 5888-97. Ó2014 AACR.

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Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Whole-Body Low-Dose Computed Tomography and Advanced Imaging Techniques for Multiple Myeloma Bone Disease

Pianko

Terpos

Roodman

et al. 2014

Clinical Cancer Research

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“…1 Prognostic significance of whole-body MRI, M-protein level and age for the initiation of treatment, overall and progression-free survival has already been published for a part of the patient population (132 of 138 patients classified as MGUS). 20 …”

Section: Patient Populationmentioning

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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“…Some studies comparing WB-MRI and PET/CT showed that whole body MRI has higher sensitivity and specificity over PET/CT, which is more sensitive in the detection of extramedullary plasmocytoma 1,3,4,20,21 . MRI is able to distinguish tumorous and benign structural changes, and even to differentiate incipient MBD in the form of "pepper and salt" involvement from osteoporosis.…”

Section: 2413-16mentioning

confidence: 99%

Prospective comparison of conventional radiography, low-dose computed tomography and magnetic resonance imaging in monoclonal gammopathies

Minařík¹,

Krhovská²,

Pika³

et al. 2016

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims. We carried out a prospective study in order to identify the best imaging approach for patients with newly diagnosed multiple myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS). Methods. We assessed the extent of myeloma bone disease (MBD) in 112 individuals -84 patients with MM and 28 individuals with MGUS. For the detection of osteolytic involvement we used whole-body magnetic resonance imaging (WB-MRI), low-dose computed tomography (LD-CT) and conventional radiography (CR). Each method assessed the presence of osteolytic involvement, compressive fractures and extramedullary involvement in the following regions: skull, spine and chest, pelvis and humerus and femur. We compared the difference in the number and extent of osteolytic involvement, especially the findings in CR negative patients. Results. Conventional radiography showed no superiority in any of the evaluated regions, and failed in the detection of extramedullary massess and spine involvement. WB-MRI was best at imaging the spine including extramedullary involvement, however, detection of osteolytic lesions of the skull was limited in comparison with both CR and LD-CT. Both WB-MRI and LD-CT were comparable in imaging of lesions of pelvis, humerus, femur and the presence of extramedullary masses. LD-CT showed superiority in detection of skull lesions but lower sensitivity in spine compared to WB-MRI. Conclusions. Our results confirm that relying solely on CR in the diagnostics of MM is insufficient. We suggest that the most suitable method for primary assessment of osteolytic involvement in monoclonal gammopathies should include either whole-body MRI together with CR of the skull or, with an equivalent sensitivity, whole body LD-CT.

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Prognostic significance of whole-body MRI in patients with monoclonal gammopathy of undetermined significance

Cited by 65 publications

References 32 publications

Whole-Body Low-Dose Computed Tomography and Advanced Imaging Techniques for Multiple Myeloma Bone Disease

Whole-Body Low-Dose Computed Tomography and Advanced Imaging Techniques for Multiple Myeloma Bone Disease

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

Prospective comparison of conventional radiography, low-dose computed tomography and magnetic resonance imaging in monoclonal gammopathies

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