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

Sommer, Gregor; Klarhöfer, Markus; Lenz, Claudia; Scheffler, Klaus; Bongartz, Georg; Winter, Leopold

doi:10.1007/s00330-010-1950-0

Cited by 42 publications

(25 citation statements)

References 17 publications

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“…Our results are concordant with those of Luboldt et al [9], who found in a study of 11 patients with prostate cancer that DWI signal-to-noise ratio was higher than that for STIR (p50.007) [9]. Sommer et al [10] evaluated signal intensities in 81 myeloma patients, and found that DWI signal was higher than STIR in patients with high concentrations of M component (20 g dl -1 ), although the relationship was reversed in those patients with low concentrations of M components (,20 g dl -1 ). These results suggest that whole-body DWI technique is potentially more sensitive than conventional STIR imaging for the detection of bone disease in patients with prostate malignancy or multiple myeloma.…”

Section: Discusssionsupporting

confidence: 93%

“…spinal cord or muscle); however, as we wished to focus on the clinical challenge of lesion detection and not the biological behaviour of different tumours, we considered the lesion-to-background bone marrow ratio measurements to be sufficient. For the DWI sequence, we chose a b-value of 800, in line with others [7,10], as a compromise between obtaining lesion signal (lower values with T 2 shine-through effects) [9] and greater diffusion weighting (higher values). Other researchers have used lower b-values: Luboldt et al, b5200 [9]; Nakanishi et al, b5600 [8].…”

Section: Discusssionmentioning

confidence: 99%

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Bone metastases from prostate, breast and multiple myeloma: differences in lesion conspicuity at short-tau inversion recovery and diffusion-weighted MRI

Pearce

Philip²,

Brown³

et al. 2012

The British Journal of Radiology

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Objectives: The objective of this study was to compare the relative conspicuity of bone metastases on short-tau inversion recovery (STIR) and diffusion-weighted MRI (DWI) whole-body MR sequences for breast, prostate and myeloma malignancies. Methods: 44 whole-body MRI scans were reviewed retrospectively (coronal T 1 weighted, STIR and DWI with b5800). On each scan, up to four of the largest bone lesions were identified on T 1 weighting, and the region of interest signal intensity was measured on STIR and DWI, as well as the background signal intensity. The mean lesion signal to background ratio was calculated for each patient and then for each malignancy group. Results: In prostate cancer patients, the DWI signal/background ratio was greater than that of STIR in 22 out of 24 patients (mean DWI lesion/background ratio 3.91, mean STIR lesion/background ratio 2.31; p50.0001). In multiple myeloma, the DWI ratio was higher in 6/7 patients (DWI group mean ratio 7.59, STIR group mean ratio 3.7; p50.0366). In 13 breast cancer patients, mean STIR and DWI signal/background were similar (DWI group mean ratio 4.13, group mean STIR ratio 4.26; p50.8587). Conclusion: Bone lesion conspicuity measured by lesion/background signal intensity was higher on DWI b5800 than on STIR in patients with prostate cancer and multiple myeloma. DWI should be used in whole-body MR oncology protocols in these conditions to maximise lesion detection. Metastatic disease to bones can be the only site of distant spread in patients with prostate or breast cancer. Accurate detection of such disease dissemination can be challenging as small-volume disease confined to the marrow cavity may be missed on radionuclear bone scintigraphy or CT imaging. Whole-body (WB) MRI is increasingly used in oncological imaging as a tool to improve detection of bone metastases. Several authors report good results compared with other modalites. Baur-Melnyk et al [1] found WB MRI gave superior detection rate and staging for myeloma compared with CT, and Shortt et al [2], evaluating the same malignancy, concluded that WB MRI performed better than positron emission tomography CT. In prostate and breast patients, Gutzeit et al [3] found WB MRI to rank equally with skeletal scintigraphy for detection of bone lesions, and in some cases detected markedly more metastases. In a recent pooled meta-analysis of published studies, WB MRI showed a pooled sensitivity of 90.0% and pooled specificity of 91.8% for the detection of bone metastases [4].WB MRI imaging protocols have evolved with time as MRI scanners are now more technologically advanced. Conventional WB MRI studies have typically employed T 1 weighted (T 1 W) and short-tau inversion recovery (STIR) sequences [1,5,6]. However, more recently, diffusion-weighted sequences are increasingly being utilised [3,7]. The image contrast from diffusion-weighted MRI (DWI) is based on difference in the mobility of water protons between tissues. As the mobility of water protons is impeded more in tumour than in normal tissues, this results ...

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Section: Discusssionsupporting

confidence: 93%

Section: Discusssionmentioning

confidence: 99%

Bone metastases from prostate, breast and multiple myeloma: differences in lesion conspicuity at short-tau inversion recovery and diffusion-weighted MRI

Pearce

Philip²,

Brown³

et al. 2012

The British Journal of Radiology

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“…ADC values of focal myeloma lesions have also been inversely correlated with serum paraprotein concentrations (31), and a significant positive correlation was demonstrated between ADC and bone marrow cellularity (7).…”

Section: Discussionmentioning

confidence: 96%

Whole-Body Diffusion-weighted MR Imaging for Assessment of Treatment Response in Myeloma

Giles

Messiou²,

Collins³

et al. 2014

Radiology

181

142

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FRCP, FRCP Nandita M. deSouza, MD, FRCP, FRCR Purpose:To determine the feasibility of whole-body diffusionweighted (DW) magnetic resonance (MR) imaging for assessment of treatment response in myeloma. Materials and Methods:This prospective single-institution study was HIPAAcompliant with local research ethics committee approval. Written informed consent was obtained from each subject. Eight healthy volunteers (cohort 1a) and seven myeloma patients (cohort 1b) were imaged twice to assess repeatability of quantitative apparent diffusion coefficient (ADC) estimates. Thirty-four additional myeloma patients (cohort 2) underwent whole-body DW imaging before treatment; 26 completed a posttreatment imaging. Wholebody DW data were compared before and after treatment by using qualitative (ie, observer scores) and quantitative (ie, whole-body segmentation of marrow ADC) methods. Serum paraproteins and/or light chains or bone marrow biopsy defined response. Results:Whole-body DW imaging scores were significantly different between observers (P , .001), but change in scores between observers after treatment was not (P = .49). Sensitivity and specificity for detecting response according to observer scores were 86% (18 of 21 patients) and 80% (4 of 5 patients) for both observers. ADC measurement was repeatable: mean coefficient of variation was 3.8% in healthy volunteers and 2.8% in myeloma patients. Pretreatment ADC in cohort 2 was significantly different from that in cohort 1a (P = .03), but not from that in cohort 1b (P = .2). Mean ADC increased in 95% (19 of 20) of responding patients and decreased in all (five of five) nonresponders (P = .002). A 3.3% increase in ADC helped identify response with 90% sensitivity and 100% specificity; an 8% increase (greater than repeatability of cohort 1b) resulted in 70% sensitivity and 100% specificity. There was a significant negative correlation between change in ADC and change in laboratory markers of response (r = 20.614; P = .001). Conclusion:Preliminary work demonstrates whole-body DW imaging is a repeatable, quantifiable technique for assessment of treatment response in myeloma.q RSNA, 2014 1

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“…DWIBS is a promising MR sequence that may quantitatively evaluate tissue cellularity by measuring random movements of water molecules using the apparent diffusion coefficient map, which may potentially serve as a radiological biomarker of tumor-related hypercellularity (8). This characteristic has suggested the possible clinical applicability of DWIBS in intra-individual disease monitoring during follow-up of MM patients (9,10). To date, there are no published studies comparing DWIBS to T1-CE sequence in the diagnostic work-up of MM patients.…”

Section: Introductionmentioning

confidence: 99%

Pre-treatment staging of multiple myeloma patients: comparison of whole-body diffusion weighted imaging with whole-body T1-weighted contrast-enhanced imaging

et al. 2015

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Background: Multiple myeloma (MM) is a hematologic malignancy characterized by the clonal proliferation of plasma cells. Accurate staging is of pivotal importance in the management of MM. Advanced imaging techniques, such as magnetic resonance imaging (MRI), are increasingly used for the initial diagnosis and staging of MM. Purpose: To compare whole-body (WB) MR diffusion-weighted imaging with background body signal suppression (DWIBS) with (WB) MR fat-suppressed T1-weighted contrast-enhanced imaging (T1-CE) in the pre-treatment staging evaluation of multiple myeloma (MM) patients. Material and Methods: Thirty-six patients with MM were included in the study. T1-CE and DWIBS were performed using a 3 T scanner. The Durie-Salmon plus staging system was used. Kappa statistics was used to assess agreement. Results: For all MM stages good to very good agreement was found for both T1-CE and DWIBS. The unweighted kappa statistic indicated a moderate, good and very good agreement between T1-CE and DWIBS for stages I, II, and III, respectively. In particular, in 67% of patients the MM staging according to T1-CE was not different from DWIBS. In the remaining 33% of patients, the MM stage obtained with T1-CE was lower than that provided by DWIBS. Conclusion: DWIBS and T1-CE were concordant in the majority of patients. In a minority of cases DWIBS evidenced areas of water restriction that did not correspond to contrast enhancement areas. Studies monitoring therapeutic response in relation to tumour burden and aggressiveness should be performed to assess the clinical relevance of DWIBS findings.

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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

Cited by 42 publications

References 17 publications

Bone metastases from prostate, breast and multiple myeloma: differences in lesion conspicuity at short-tau inversion recovery and diffusion-weighted MRI

Bone metastases from prostate, breast and multiple myeloma: differences in lesion conspicuity at short-tau inversion recovery and diffusion-weighted MRI

Whole-Body Diffusion-weighted MR Imaging for Assessment of Treatment Response in Myeloma

Pre-treatment staging of multiple myeloma patients: comparison of whole-body diffusion weighted imaging with whole-body T1-weighted contrast-enhanced imaging

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