The Apparent Diffusion Coefficient of Diffusion-Weighted Whole-Body Magnetic Resonance Imaging Affects the Survival of Multiple Myeloma Independently

Abstract

BackgroundDiffusion-weighted whole-body MRI (DW-MRI) is increasingly used to evaluate bone diseases of multiple myeloma (MM), but there is lack of quantitative indicator for DW-MRI to reflect the prognosis of MM. Apparent diffusion coefficient (ADC) values in DW-MRI has potential correlations between some indexes of MM, but the influence of ADC on MM survival needs to be further verified.MethodsA total of 381 newly diagnosed MM patients were enrolled in the study to analyze the effect of ADC values in DW-MRI on progression-free survival (PFS) and overall survival (OS). The Kaplan–Meier method was used to perform univariate survival analysis, and the Cox proportional hazards model was used for multivariate analysis. In addition to the ADC value, genetic and serological indexes were also included.ResultsThe survivals were observed in univariate ADC stratification with median PFS of 52.0, 45.0, 34.0, and 26.0 months (the unit of ADC value was 10−3 mm2/s; the ADC ranges were ADC < 0.4886, 0.4886 ≤ ADC < 0.6545, 0.6545 ≤ ADC < 0.7750, and ADC ≥ 0.7750; 95% CI, 43.759–62.241, 46.336–53.664, 39.753–46.247, and 27.812–32.188). The OS were 81.0, 61.0, 47.0, and 36.0 months (p < 0.001; 95% CI, 71.356–82.644, 67.630–70.370, 57.031–60.969, and 36.107–43.893). In Cox proportional hazards model, the ADC value was considered to be an independent risk factor affecting PFS and OS of MM (both p < 0.001).ConclusionsThis study supports that ADC in DW-MRI may independently stratify MM patients and better predict their prognosis. The combined use of DW-MRI and other parameters allows more accurate evaluation of MM survival.Trial Registrationhttp://www.chictr.org.cn/showproj.aspx?proj=49012, ChiCTR2000029587.

Quantitative Analysis of Whole‐Body MRI for Accessing the Degree of Diffuse Infiltration Patterns and Identifying High Risk Cases of Newly Diagnosed Multiple Myeloma

“…31 Several studies have shown a prognostic value for the ADC value in multiple myeloma, as an independent prognostic predictor of PFS and OS. [32][33][34] However, this work indicated ADC was not an independent prognostic factor of HRMM by multivariate analysis. This might be because various factors affect the ADC value, including the number of yellow bone marrow cells, cell size, cell structure, and/or perfusion effects.…”

“…Several studies have shown a prognostic value for the ADC value in multiple myeloma, as an independent prognostic predictor of PFS and OS 32–34 . However, this work indicated ADC was not an independent prognostic factor of HRMM by multivariate analysis.…”

The Current Research Status of Imaging Assessment of Bone Disease in Multiple Myeloma

“…Studies have shown that DW-MRI can detect more focal lesions compared to conventional radiography and has a high concordance with the bone marrow plasma cell infiltration rate [36], [38]. Additionally, changes in ADC values post-treatment have been correlated with response to chemotherapy, with responders showing a significant increase in ADC values, indicating a reduction in cellularity and a positive treatment effect [39], [44].…”

Deep Learning for Automatic Bone Marrow Apparent Diffusion Coefficient Measurements From Whole-Body Magnetic Resonance Imaging in Patients With Multiple Myeloma

“…Diffusion-weighted imaging (DWI) as part of whole-body magnetic resonance imaging (wb-MRI) is of great clinical value in imaging of MM patients 3,4 and is increasingly recommended for both initial workup and follow-up imaging 5–8 . Diffusion-weighted imaging allows assessment of the semiquantitative apparent diffusion coefficient (ADC), which has been shown to correlate with histology 9,10 and to differ significantly between the different stages of monoclonal plasma cell disorders, 9–11 between different classes of therapy response, 9,12–21 and to be of predictive value for progression-free survival and overall survival 22,23 . The texture of the bone marrow is very heterogenous, and there is a large volume of bone marrow in which a region of interest (ROI) can be placed when the ADC is manually measured by radiologists.…”

“…[5][6][7][8] Diffusion-weighted imaging allows assessment of the semiquantitative apparent diffusion coefficient (ADC), which has been shown to correlate with histology 9,10 and to differ significantly between the different stages of monoclonal plasma cell disorders, [9][10][11] between different classes of therapy response, 9,[12][13][14][15][16][17][18][19][20][21] and to be of predictive value for progression-free survival and overall survival. 22,23 The texture of the bone marrow is very heterogenous, and there is a large volume of bone marrow in which a region of interest (ROI) can be placed when the ADC is manually measured by radiologists. Consequently, the test-retest repeatability and interrater reproducibility using ROI-based ADC measurements in the bone marrow have been reported to be relatively low, especially in comparison to other tissues.…”