Magnetic resonance imaging as a supplement for the clinical staging system of Durie and Salmon?
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.
Baur
Andrea
A
Department of Clinical Radiology, University of Munich-Grosshadern, Germany. Andrea.Baur@ikra.med.uni-muenchen.de
Stäbler
Axel
A
Nagel
Dorothea
D
Lamerz
Rolf
R
Bartl
Reiner
R
Hiller
Erhard
E
Wendtner
Clemens
C
Bachner
Fridleif
F
Reiser
Maximilian
M
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