Whole‑body diffusion‑weighted magnetic resonance imaging and apparent diffusion coefficient values as prognostic factors in multiple myeloma

Abstract

Multiple myeloma (MM) is a neoplasm of the B lymphocytes characterized by the uncontrolled proliferation of a plasmocyte clone. Magnetic resonance imaging (MRI) remains the most sensitive and specific imaging method for the detection of bone marrow infiltration, before macroscopic bone changes are visible, with evidence that the detection rate and overall performance of MRI could be enhanced by applying diffusion-weighted imaging (DWI). The aim of our research was to evaluate whether measuring apparent diffusion coefficient (ADC) values in newly diagnosed patients with MM could be a prognostic factor for the course of the disease and to ascertain whether there is any correlation with other prognostic factors in MM. A retrospective study was performed on a group of 32 patients with newly diagnosed MM that underwent at least two whole-body (WB)-MRIs; one before and one after induction therapy. Patients with advanced stage of disease showed an increased ADC value: Stage 2 vs. stage 1 (1.162 vs. 0.289, P=0.033), respectively, stage 3 vs. stage 1 (0.867 vs. 0.289, P=0.041). In addition, ADC values were inversely correlated with survival time: r=-0.641, P<0.001. According to the multivariate linear regression model, we observed that for every point of ADC value (before treatment) the survival was decreased/reduced by 14.5 months. Moreover, bortezomib therapy predicted an increase in the survival length/duration by 7.9 months. Our regression equation proved to be a good fit for the model, explaining 57.8% of survival duration (adjusted R 2 =0.578). In conclusion, the negative prognostic factors associated with WB-MRI are represented by high ADC values before treatment (for every point of ADC the survival was decreased by 14.5 months) and focal/diffuse marrow involvement.

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.…”

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

“…It has been shown that lower ADC before treatment may be associated with better treatment response (13). This theory has may become one of the reasons why MM patients with lower ADC value obtained longer PFS and OS.…”

“…However, whether the imaging information about DW-MRI can predict the prognosis of MM patients and provide hints of disease management remains to be discussed. Some studies have found that the change of ADC value could reflect the response to disease treatment before the size and number of MM bone lesion (12,13). MM patients with nonequivalent bone lesions on DW-MRI mean worse prognosis than those negative ones (14).…”

Role of whole-body diffusion-weighted imaging in evaluation of multiple myeloma

“…Yamada et al [22] found that ADC value of MM treatment responders differed more significantly than that of non-responders (0.154 ± 0.386 × 10 −3 mm 2 /s vs –0.307 ± 0.424 × 10 −3 mm 2 /s, P = .003). In addition, it has been proved that ADC value was negatively correlated with survival time (r = –0.641, P < .001) [23] . As for the treatment response of PD, the average ADC value increased after treatment, but there was no statistical significance compared with the ADC value before treatment.…”

“…In addition, it has been proved that ADC value was negatively correlated with survival time (r = –0.641, P < .001). [ 23 ] As for the treatment response of PD, the average ADC value increased after treatment, but there was no statistical significance compared with the ADC value before treatment. In 9 cases of PD, the increase of ADC value after treatment was slight in most patients, and even increased in some cases after treatment.…”