This study confirms significant changes in adc in patients responding to treatment and indirect evidence from twopoint dixon mri suggests that these changes are influenced by changes in. This strategy is quite wholebody diffusion weighted mri with apparent diffusion coefficient mapping for early response monitoring in multiple myeloma. Whole body diffusion weighted mri a new view of myeloma ncbi. Multiple myeloma, magnetic resonance imaging, dynamic contrastenhanced mri, diffusion weighted imaging, response. An mri can show if normal bone marrow has been replaced by myeloma cells or by a plasmacytoma, especially in the skull, spine, and pelvis. The purpose of our study was to prospectively assess the feasibility of wholebody diffusionweighted imaging dwi for shortterm evaluation of response to treatment in multiple myeloma patients using a singleshot echoplanar imaging dwi sequence with a stejskaltanner diffusion encoding scheme and spectral fat suppression. In functional mri, only diffusionweighted imaging has been included because of the. Mri plays an important role in the management of patients with plasma cell neoplasms and has been recognized as a biomarker of malignancy in the novel criteria for the diagnosis of multiple myeloma. Assessing the relation between bone marrow signal intensity and. Whole body diffusion weighted mri in multiple myeloma. Wholebody mri, dynamic contrastenhanced mri, and diffusion. Magnetic resonance imaging mri is the standard tool to detect bm involvement bmi.
This can further enhance the sensitivity and specificity of mri in the staging of multiple myeloma patients. Since 2014, mri findings are included in the new diagnostic criteria proposed by the international myeloma working group. Combined morphological and functional mri provides optimal bone marrow assessment for staging. Assessment of early treatment response on mri in multiple. The 2016 diagnostic criteria of the international myeloma working group identify wbmri and fluorodeoxyglucose positron emission tomographycomputed tomography. The international myeloma working group imwg has issued practical recommendations on the use of mri in patients with multiple myeloma mm and in patients with asymptomatic disease, such smoldering mm and monoclonal gammopathy of undetermined significance mgus. Learn more about the symptoms, causes, diagnosis, risk factors, and treatment of multiple myeloma. Article baseline mri recommended for all newly diagnosed. A plasmacytoma is a plasma cell tumor growing in bone or soft tissue. Multiple myeloma early detection, diagnosis, and staging 1.
Bone disease is the most frequent diseasedefining clinical feature of multiple myeloma mm, with 90% of patients developing bone lesions over the course of their disease. Current role of ct and whole body mri in multiple myeloma em. Wholebody mr imaging protocols, including diffusionweighted mr imaging, are suggested as well as notes on pearls, pitfalls, and variants. Combined morphological and functional mri is of considerable value in treatment followup.
Therefore, this case report will provide a dimension to think about rare spinal fluorosis that may show unusual multiple myelomalike findings in spinal mri. An mri uses magnetic fields, not xrays, to produce detailed images of the body. Recent advances in the treatment of multiple myeloma have increased the need for accurate diagnosis of the disease. Comparison of mri in the evaluation of multiple myeloma. Diffusion weighted magnetic resonance imaging of metastatic bone disease. Myeloma patients with a diffuse mri pattern of involvement have higher iss stage, more severe anemia and hypercalcemia, and significantly higher values of. Wholebody diffusion weighted mri with apparent diffusion coefficient mapping for early response monitoring in multiple myeloma. Because of high cellularity and high nucleustocytoplasm ratio, bone marrow infiltration by multiple myeloma has relatively high signal intensity on dwi, allowing. The recently updated duriesalmon plus staging system published in 2006 highlights the many advances that have been made in the imaging of multiple myeloma, a common malignancy of plasma cells. Lack of spleen signal on diffusion weighted mri is associated with.
A diffuse mri pattern of multiple myeloma is less frequent than a focal pattern, according to most studies. Whole body diffusion weighted mri a new view of myeloma christina messiou1 and martin kaiser2 1department of radiology, the royal marsden hospital, surrey, and 2division of molecular pathology, the institute of cancer research, sutton, surrey, uk summary the recent consensus statement from the international mye. During the xvii international myeloma workshop imw in boston, us, dr bruno paiva 1 and dr francesca gay 2 both presented on the topic of measurable residual disease mrd in multiple myeloma mm in a session entitled mm. Evangelos terpos, md department of clinical therapeutics national and kapodistrian university of athens school of medicine athens, greece. The speed, coverage and high sensitivity of wb diffusion. Any information contained in this pdf file is automatically generated from digital material. Abstractwholebody mri wbmri with diffusionweighted imaging dwi can now be used to stage and restage multiple myeloma mm and lymphoma. Multiple myeloma early detection, diagnosis, and staging. Functional and molecular mri of the bone marrow in multiple.
Conventional mri diagnoses multiple myeloma by assessing the infiltration pattern. Abstractwholebody mri wb mri with diffusion weighted imaging dwi can now be used to stage and restage multiple myeloma mm and lymphoma. The system also provides a means abbreviations adc apparent diffusion coefficient, dw diffusion weighted, fdg fluorodeoxyglucose, myrads myeloma response assessment and diagnosis system summary this myeloma response assessment and diagnosis system, or myrads, consensus on wholebody mri in myeloma proposes a. Guidelines for acquisition, interpretation, and reporting.
Magnetic resonance imaging mri is increasingly being used in the diagnostic workup of patients with multiple myeloma. Diffusion weighted imaging evaluates bone marrow composition and cellularity in multiple myeloma. Bone disease is the most frequent feature of multiple myeloma mm, occurring in approximately two thirds of patients at diagnosis and in nearly all patients during their disease. Wholebody diffusionweighted mri for evaluation of response. Mri is likely to have a significant impact on management decisions and pathways for patients with multiple myeloma. Objectives to compare remission status at completion of chemotherapy for multiple myeloma mm with changes in total diffusion volume tdv calculated from wholebody diffusion weighted imaging wbdwi and fat fraction ff of lumbar bone marrow bm by modified dixon quant mdixon quant soon after induction of chemotherapy, and to assess the predictive value of mri. Dec 14, 2017 irosamond, it should go without saying that i agree with multibilly. Multiple myeloma is a monoclonal gammopathy and is the most common primary malignant bone neoplasm in adults. The aim of this report by the bone group of the imwg is to provide practical recommendations for the acquisition, interpretation and reporting of wbldct in patients with multiple myeloma and other. Discriminating depth of response to therapy in multiple. Some early cancers may have signs and symptoms that can be noticed, but that is not always the case.
Guidelines for acquisition, interpretation, and reporting of. Acknowledging the increasingly important role of wholebody mri for directing patient care in myeloma, a multidisciplinary, international, and expert panel of radiologists, medical physicists, and hematologists with specific expertise in wholebody mri in myeloma convened to discuss the technical performance standards, merits, and limitations of currently available imaging methods. The system also provides a means abbreviations adc apparent diffusion coefficient, dw diffusion weighted, fdg fluorodeoxyglucose, myrads myeloma response assessment and diagnosis system summary this myeloma response assessment and diagnosis system, or myrads, consensus on wholebody mri in myeloma proposes a core. Feb 09, 2018 diffusion weighted mri in multiple myeloma. Functional and molecular mri techniques play an increasing role in the management of patients with multiple myeloma. Since petct data have been acquired after publication of the most recent guidelines for the definition of multiple myeloma, only mri focal lesions have been defined as a myelomadefining event, leading to the imwg recommendation to treat these patients. The fulima study is a twocenter study at odense university hospital and vejle hospital, denmark. A number of recent studies have underlined the added value of dwi in the management of patients with mm.
In this article, we shall focus primarily on the more sensitive and specific wholebody imaging techniques, including wholebody computed tomography, wholebody magnetic resonance imaging. Functional imaging in multiple myeloma petct and diffusion. This study confirms significant changes in adc in patients responding to treatment and indirect evidence from twopoint dixon mri suggests. Although conventional radiography has traditionally been the standard of care, its low sensitivity in detecting osteolytic. My myeloma center does two different mris on different machines. Multiple myeloma, low dose whole body ct, whole body mri, diffusionweighted mri. May 10, 2016 diffusion weighted imaging evaluates bone marrow composition and cellularity in multiple myeloma. Mri into the management pathway for patients with multiple myeloma. Nov 21, 2016 therefore, this case report will provide a dimension to think about rare spinal fluorosis that may show unusual multiple myeloma like findings in spinal mri. Functional and molecular mri techniques such as diffusionweighted. Detection of avascular necrosis on routine diffusion weighted whole body mri in patients with multiple myeloma article pdf available in british journal of radiology 921097.
Imaging of the right lower extremity was performed on a 3t mr system. The full text of this article is available in pdf format. May 10, 2016 magnetic resonance imaging mri is increasingly being used in the diagnostic workup of patients with multiple myeloma. However, evidence for the value of wbmri in the evaluation of treatment response remains. Assessing response of myeloma bone disease with diffusion. Recommendations for acquisition, interpretation and reporting.
The multiple myeloma like mri findings suggestive of neoplastic bone marrow infiltration and proliferative changes in the spine of fluorosis patients are very unusual, and. It is associated with increased tumor burden and a poorer prognosis 2. C and d, diffusionweighted imaging panels at level of left thigh c and below left hip joint d. Functional and molecular mri of the bone marrow in. Current concepts in tumor imaging with wholebody mri with. Editor we read with interest the cme masterclass on multiple myeloma. Practice changing mri recommendations in multiple myeloma. The standard mri looking for bone involvement, and a diffusion weighted blood supply dwbs looking for focal or plasma cell concentration i think they look for homogeneous good vs. This article provides an overview of the technical aspects of conventional and functional mri techniques with practical recommendations. Pdf whole body diffusion weighted mri a new view of. Preliminary results marius horger 1, katja weisel 2, wilhelm horger 3, ali mroue 1, michael fenchel 1 and matthias lichy 1. Furthermore, detection of minimal residual disease is important for prognosis determination and treatment planning, and it has.
Patients with smouldering myeloma presenting with more than one unequivocal focal lesion in the bone marrow on mri are considered having. International myeloma working group consensus recommendations. Summary extramedullary multiple myeloma emm is a rare but clinically and radiologically underestimated entity that is associated with poor prognosis. For this reason, imaging plays a major role in the management of disease in patients with mm. Bone disease impairs patients quality of life and represents a major. Preliminary results marius horger1 katja weisel2 wilhelm horger3 ali mroue1 michael. Wholebody diffusionweighted mri with apparent diffusion.
Role of wholebody mri for treatment response assessment. Management of relapsed refractory multiple myeloma with. A coronal t2weighted tirm trte 300038ms, b sagittal t2weighted tirm trte 300038, c axial t1weighted tse, and d axial t2weighted tse with dixon fat suppression trte 260090 were acquired. Pdf whole body diffusion weighted mri a new view of myeloma.
The multiple myelomalike mri findings suggestive of neoplastic bone marrow infiltration and proliferative changes in the spine of fluorosis patients are very unusual, and. The primary objective is to identify the optimal imaging technique for studies in multiple myeloma with focus on petct and mri. This consensus proposes a core clinical protocol for wholebody mri and an extended protocol for advanced. New recommendations on the use of mri in the management of multiple myeloma and related disorders are practice changing for one set of patients. Diffusion weighted magnetic resonance imaging dw mri is able to distinguish diffuse from normal mri pattern of marrow involvement in patients with multiple myeloma. Patients with smouldering myeloma presenting with more. Patients with more than one lesion 5mm on mri should be considered as having symptomatic disease requiring therapy. Objectives to compare remission status at completion of chemotherapy for multiple myeloma mm with changes in total diffusion volume tdv calculated from wholebody diffusionweighted imaging wbdwi and fat fraction ff of lumbar bone marrow bm by modified dixon quant mdixon quant soon after induction of chemotherapy, and to assess the predictive value of mri. Diffusionweighted magnetic resonance imaging dwmri is able to distinguish diffuse from normal mri pattern of marrow involvement in patients with multiple myeloma. Diffusionweighted imaging dwi and dynamic contrast enhanced dce mri permit noninvasive evaluation of tumorspecific characteristics related to cellularity and angiogenesis and can thus improve diagnosis, prognostication, treatment planning and response assessment. Radiologists and oncologists from korea are recommending that newly diagnosed patients with multiple myeloma always have a baseline spine mri exam.
Diffusionweighted mri in mm patients int myeloma fn. From top to bottom, lowest, middle, and highest b values and corresponding apparent diffusion coefficient adc maps are shown. Jul 11, 2014 the fulima study is a twocenter study at odense university hospital and vejle hospital, denmark. In this article, we shall focus primarily on the more sensitive and specific wholebody imaging techniques, including wholebody computed tomography, wholebody magnetic resonance imaging, and positron. Patients may present with bone pain or with symptoms that are often nonspecific, such as nausea. Adc values in active myeloma are significantly higher than marrow in remission, indicating the potential for diffusion weighted mri to quantify the transition from active disease to remission and vice versa.
Wholebody mri wbmri including diffusionweighted image dwi have been widely used in patients with multiple myeloma. The purpose of this study is to compare the utility of whole body mri wbmri with diffusionweighted imaging dwi and simultaneous 18ffdg petmri with time of flight tof pet acquisition to identify and characterize osseous lesions in patients with multiple myeloma. My myeloma center does two different mri s on different machines. Multiple myeloma is the second most common type of blood cancer after leukemia. The purpose of this study is to compare the utility of whole body mri wbmri with diffusion weighted imaging dwi and simultaneous 18ffdg pet mri with time of flight tof pet acquisition to identify and characterize osseous lesions in patients with multiple myeloma.
Sep 27, 2019 during the xvii international myeloma workshop imw in boston, us, dr bruno paiva 1 and dr francesca gay 2 both presented on the topic of measurable residual disease mrd in multiple myeloma mm in a session entitled mm. Not only does a baseline spine mri detect skeletal lesions, it can help predict the prognosis of patients, according to a study published in july issue of cancer research and treatment. Frontiers multiple myelomalike spinal mri findings in. This strategy is quite wholebody diffusionweighted mri with apparent diffusion coefficient mapping for early response monitoring in multiple myeloma. This study aimed to measure apparent diffusion coefficient adc in chinese patients with newly diagnosed multiple myeloma by wholebody diffusionweighted magnetic resonance imaging wbdwi mri and assess the diagnostic accuracy of adc in the discrimination of deep response to induction chemotherapy. To determine the feasibility of wholebody diffusionweighted imaging wbdwi mri for evaluation of response in patients with multiple myeloma mm following bortezomibbased therapy and to explore the direction of apparent diffusion coefficient adc changes upon treatment. Adc values in active myeloma are significantly higher than marrow in remission, indicating the potential for diffusionweighted mri to quantify the transition from active disease to remission and vice versa. Pdf detection of avascular necrosis on routine diffusion. To determine the feasibility of wholebody diffusion weighted imaging wbdwi mri for evaluation of response in patients with multiple myeloma mm following bortezomibbased therapy and to explore the direction of apparent diffusion coefficient adc changes upon treatment. Recommendations for acquisition, interpretation and. Liver involvement by multiple myeloma presenting as.
Wholebody mri, dynamic contrastenhanced mri, and diffusionweighted imaging for the staging of. Irosamond, it should go without saying that i agree with multibilly. This article provides a summary of these talks, covering when and how to measure mrd, and investigating what role mrd may play in. Wb magnetic resonance imaging mri into the management pathway for patients with multiple myeloma. Pdf guidelines for acquisition, interpretation, and reporting of. The detection of bone and bone marrow lesions is crucial in the investigation of multiple myeloma and often dictates the decision to start treatment.
Whole body diffusion weighted mri a new view of myeloma. Patients with smouldering myeloma presenting with more than one unequivocal focal lesion in the bone marrow on mri are considered having symptomatic. Whole body diffusion weighted magnetic resonance imaging wb dw. Multiple myeloma cancer of the bone marrow 75,000 100,000 patients in the us at any one time over,500 new cases diagnosed each year in the us male to female ratio is 3. Multiple myeloma, magnetic resonance imaging, dynamic contrast enhanced mri, diffusion weighted imaging, response. Optimising diffusion weighted mri for imaging metastatic and myeloma bone disease. The use of wholebody mri in multiple myeloma rcp journals.
198 1052 1351 961 277 452 800 429 59 154 190 999 302 683 1039 89 344 1362 1458 1307 273 971 108 1486 998 1280 292 974 199 1243 932 1477 381 677 1372 1318 1352