Whole-body MRI, dynamic contrast-enhanced MRI, and diffusion-weighted imaging for the staging of multiple myeloma

Abstract

Magnetic resonance imaging (MRI) is the most sensitive imaging technique for the detection of bone marrow infiltration, and has therefore recently been included in the new diagnostic myeloma criteria, as proposed by the International Myeloma Working Group. Nevertheless, conventional MRI only provides anatomical information and is therefore only of limited use in the response assessment of patients with multiple myeloma. The additional information from functional MRI techniques, such as diffusion-weighted imaging and dynamic contrast-enhanced MRI, can improve the detection rate of bone marrow infiltration and the assessment of response. This can further enhance the sensitivity and specificity of MRI in the staging of multiple myeloma patients. This article provides an overview of the technical aspects of conventional and functional MRI techniques with practical recommendations. It reviews the diagnostic performance, prognostic value, and role in therapy assessment in multiple myeloma and its precursor stages.

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

“…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]. Both qualitative MRI-monitoring using ancillary sequences like T1-weighted (T1w) and T2w and quantitative monitoring using functional image data derived from diffusion-weighted-imaging (DWI) have been therefore, recommended [12]. However, their interpretation is challenging as signal intensity changes are subject to temporal variability and are dependent also on the amount of red and yellow marrow and treatment-related shifts between these two components [11].…”

Musculoskeletal Imaging: Current Practice and Future Directions

“…The addition of dynamic contrast-enhanced and diffusion imaging was shown to improve the detection rate of marrow infiltration as well as the treatment response. 43 WB-MRI was also studied in solid tumors with encouraging results in many different cancers. Examples include the bony and nodal staging of prostate cancer, 44 detection of metastatic disease in breast cancer, and in the evaluation of bone involvement in non-small cell lung cancer when combined with DWI.…”

Whole body MRI in multiple myeloma: Optimising image acquisition and read times

“…A strategy to improve value of WB-MRI would be to choose sequences which provide sufficient diagnostic information in a reasonable time and remove sequences which do not add any additional diagnostic information. Recent studies have reported the utility of faster sequences in whole body protocols for MM such as Dixon MRI and diffusion weighted imaging [5,[11][12][13]. These sequences have shorter acquisition times than conventional spin echo sequences and can provide additional functional information such as disease activity or bone marrow composition.…”

“…These image types provide anatomical information comparable to conventional spin echo sequences but also allow the assessment of water and fat content of bone marrow and myeloma lesions. Dixon imaging is also recommended as a core component of imaging protocols and considered important in reducing false positive lesions on DWI [13]. Gadolinium-enhanced sequences have also been shown to be useful in the assessment of MM [14], and can be included into acquisition protocols [13].…”