title: Magnetic resonance imaging as a supplement for the clinical staging system of Durie and Salmon?
abstract: BACKGROUND
  This study evaluated the prognostic value of a three-grade staging system of spinal involvement using magnetic resonance imaging (MRI) in patients with multiple myeloma and determined its usefulness as an independent parameter in the staging system of Durie and Salmon.
  
  
  METHODS
  Seventy-seven previously untreated patients with multiple myeloma underwent MRI of the thoracic and lumbar spine with unenhanced T1-weighted spin echo and short-tau inversion time inversion recovery sequences. The patients were evaluated according to their infiltration patterns and the extent of bone marrow involvement was staged using a three-grade scale: Stage I, no focal or diffuse infiltration; Stage II, 1-10 foci or mild diffuse infiltration; Stage III, more than 10 foci or strong diffuse infiltration.
  
  
  RESULTS
  The infiltration patterns had no significant effect on survival. Of 77 patients, 25 would have been understaged using the standard staging system of Durie and Salmon without the findings of MRI and 8 patients would have been understaged if the staging was based only on MRI. The combination of the staging system of Durie and Salmon and MRI was highly significant with respect to survival (P < 0.0001, log rank analysis). MRI staging I-III was independent of the staging system of Durie and Salmon (Cox regression model).
  
  
  CONCLUSIONS
  A three-grade staging of spinal MRI provides a significant prognostic tool for patients with multiple myeloma. The authors propose including it in the staging system of Durie and Salmon.
authors.affiliation: Department of Clinical Radiology, University of Munich-Grosshadern, Germany. Andrea.Baur@ikra.med.uni-muenchen.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Baur
authors.forename: Axel
authors.initials: A
authors.lastname: Stäbler
authors.forename: Dorothea
authors.initials: D
authors.lastname: Nagel
authors.forename: Rolf
authors.initials: R
authors.lastname: Lamerz
authors.forename: Reiner
authors.initials: R
authors.lastname: Bartl
authors.forename: Erhard
authors.initials: E
authors.lastname: Hiller
authors.forename: Clemens
authors.initials: C
authors.lastname: Wendtner
authors.forename: Fridleif
authors.initials: F
authors.lastname: Bachner
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
mesh_terms: D000368:Aged; D001853:Bone Marrow / Q000473:pathology; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods*; D013904:Thoracic Vertebrae / Q000473:pathology