- 作者：Julie C. Dutoit ; Matthias A. V ; erkerken ; Koenraad L. Verstraete
- 关键词：ASCT ; autologous stem cell transplantation ; a.U. ; arbitrary units ; A ; artery ; CR ; complete response ; DCE-MRI ; dynamic contrast enhanced MRI ; IMWG ; International Myeloma Working Group ; ISS ; international staging system ; MPNST ; malignant peripheral nerve sh
- 刊名：European Journal of Radiology
- 出版年：2013
- 出版时间：September, 2013
- 年：2013
- 卷：82
- 期：9
- 页码：1444-1452
- 全文大小：1910 K
class=""h4"">Purpose
To evaluate the significance of dynamic contrast enhanced MRI (DCE-MRI) and whole body MRI (WB-MRI) in the diagnosis, prognosis and assessment of therapy for patients with monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM).class=""h4"">Materials and methods
The retrospective study includes 219 patients providing 463 WB-MRI and DCE-MRI investigations for the subgroups MGUS (n = 70), MM active disease (n = 126; this includes 70 patients with new diagnosis of MM, according to the International Staging System (ISS): 41.4 % ISS stage I, 20.0 % ISS stage II, 7.1 % ISS stage III, 31.4 % insufficient for staging; and 56 patients with ¡®(re-)active disease¡¯: 16.07 % relapse, 32.14 % progressive disease and 51.79 % stable disease) and MM remission (n = 23; 60.87 % complete remission, 17.39 % very good partial remission and 21.74 % partial remission). Investigations of patients with hereditary multiple exostoses (n = 5), neurofibromatosis (n = 7) and healthy persons (n = 9) were added as control subjects (n = 21). WB-MRI evaluation was done by evaluating thirteen skeletal regions, providing a ¡®skeletal score¡¯. DCE-MRI images of the spine, were analyzed with regions-of-interest and time-intensity-curves (TIC).
class=""h4"">Results
All TIC parameters can significantly differentiate between the predefined subgroups (p < 0.001). One hundred days after autologous stem cell transplantation a 75 % decrease of the slope wash-in value (p < 0.001) can be seen. A cubic regression trend between ¡®skeletal score¡¯ and slope wash-in (adj.R2 = 0.412) could demonstrate a significant increase bone marrow perfusion if MM affects more than 10 skeletal regions (p < 0.001), associated with a poorer prognosis (p < 0.001).
class=""h4"">Conclusion
DCE-MRI evaluation of the spine is useful for diagnosis of MM, follow-up after stem cell transplantation and evaluation of disease activity. A combined evaluation with WB-MRI and DCE-MRI provides additional micro-vascular information on the morphologic lesions and could help categorize patients with MM in two different groups to offer useful therapeutic and prognostic advise.