title: Bone marrow microcirculation analysis in multiple myeloma by contrast-enhanced dynamic magnetic resonance imaging.
abstract: The aim of our study was to investigate the quantitative microcirculation parameters amplitude A (hypothetical intravascular volume) and exchange rate constant k(21) (hypothetical vascular permeability) by contrast-enhanced dynamic magnetic resonance imaging (dMRI) as markers of angiogenesis in multiple myeloma (MM). Therefore lumbar spine and spina iliaca superior posterior of 16 normal controls and 41 patients with active MM were assessed using a dMRI protocol with a pump controlled bolus infusion of Gadolinium-DTPA. Pharmacokinetic parameters, amplitude A and exchange rate constant k(21) were calculated according to a 2-compartment model. Color-coded parameter images were generated from pharmacokinetic data analysis and superimposed onto the conventional MR images. Amplitude A and k(21) parameters were significantly increased in patients with MM compared with controls (p = 0.001; median A(ctr), 0.2 [range, 0.09-0.4]; median A(MM), 0.93 [range, 0.2-2.2]; median k(21ctr), 0.09 min(-1) [range, 0.03-0.9]; median k(21MM), 4.58 [range, 0.22-23.8]). Within the group of MM patients the pattern of color-coded parameter images were found to be either of "diffuse" (n = 13, 31%) or "focal" (n = 28, 69%) type of distribution of microcirculation. Comparison of amplitude A in patients with "focal" vs. "diffuse" pattern of the pharmacokinetic maps revealed a significant increase in the median of amplitude A in the "focal" group. Amplitude A values allowed a classification of patients according to severe osteolytic bone involvement (p = 0.023) with the best cutoff value of 0.7 for amplitude A. Downmodulation of amplitude A was observed in a MM patient treated with standard VAD chemotherapy. Our data demonstrate that dMRI is a novel imaging technique for the detection and monitoring of MM bone lesions. It provides independent evidence for angiogenesis in MM.
authors.affiliation: Department of Hematology/Oncology/Rheumatology, University of Heidelberg, Heidelberg, Germany. Thomas_Moehler@med.uni-heidelberg.de
authors.forename: T M
authors.initials: TM
authors.lastname: Moehler
authors.forename: H
authors.initials: H
authors.lastname: Hawighorst
authors.forename: K
authors.initials: K
authors.lastname: Neben
authors.forename: G
authors.initials: G
authors.lastname: Egerer
authors.forename: J
authors.initials: J
authors.lastname: Hillengass
authors.forename: R
authors.initials: R
authors.lastname: Max
authors.forename: A
authors.initials: A
authors.lastname: Benner
authors.forename: A D
authors.initials: AD
authors.lastname: Ho
authors.forename: G
authors.initials: G
authors.lastname: van Kaick
authors.forename: H
authors.initials: H
authors.lastname: Goldschmidt
mesh_terms: D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000098:blood supply* / Q000473:pathology; D016022:Case-Control Studies; D003287:Contrast Media / Q000494:pharmacology; D005260:Female; D019786:Gadolinium DTPA / Q000493:pharmacokinetics; D006801:Humans; D007150:Immunohistochemistry; D008161:Lumbosacral Region / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology*; D012984:Software; D013997:Time Factors
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA