title: Serum levels of carboxy-terminal telopeptide of type-I collagen are elevated in patients with multiple myeloma showing skeletal manifestations in magnetic resonance imaging but lacking lytic bone lesions in conventional radiography.
abstract: OBJECTIVE
  Skeletal involvement is a hallmark of multiple myeloma. Increased bone resorption can even be present in patients lacking osteolyses in conventional radiography. Magnetic resonance imaging (MRI) of the spine was established as a more sensitive technique to depict bone abnormalities. Type-I collagen degradation product carboxyterminal telopeptide of type-I collagen (ICTP) was introduced as a novel biochemical parameter reflecting the bone resorption activity in myeloma. The aim of this study was to evaluate whether increased ICTP serum levels predict abnormal MRI patterns in myeloma patients.
  
  
  METHODS
  MRI of the spine was performed in 32 untreated patients with multiple myeloma, who had no skeletal abnormalities in conventional radiographies. Simultaneously, ICTP was measured in serum by a competitive radioimmunoassay at corresponding time points.
  
  
  RESULTS
  Serum ICTP was significantly (P = 0.002) elevated in patients with abnormal bone MRI compared with those patients with normal MRI findings. The sensitivity of ICTP for depiction of MRI abnormalities was 79%; the positive and negative predictive values were 85 and 84%, respectively. Compared with ICTP, the parameters of disease activity, beta2-microglobulin and C-reactive protein, had a much lower sensitivity for abnormal MRI (29 and 64%, respectively).
  
  
  CONCLUSIONS
  In myeloma patients without osteolytic lesions in conventional radiography, abnormal skeletal MRI is accompanied by an increase in serum levels of ICTP. Our data show that ICTP can be used as an inexpensive parameter to identify myeloma patients with normal skeletal survey who have a high probability of skeletal involvement and deserve more accurate diagnostic evaluation using MRI.
authors.affiliation: Department of Hematology, Universitätsklinikum Charité, Humboldt-Universität, 10098 Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Jakob
authors.forename: Ivana
authors.initials: I
authors.lastname: Zavrski
authors.forename: Ulrike
authors.initials: U
authors.lastname: Heider
authors.forename: Matthias
authors.initials: M
authors.lastname: Bollow
authors.forename: Carsten-Oliver
authors.initials: CO
authors.lastname: Schulz
authors.forename: Claudia
authors.initials: C
authors.lastname: Fleissner
authors.forename: Jan
authors.initials: J
authors.lastname: Eucker
authors.forename: Rainer
authors.initials: R
authors.lastname: Michael
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.forename: Kurt
authors.initials: K
authors.lastname: Possinger
authors.forename: Orhan
authors.initials: O
authors.lastname: Sezer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001859:Bone Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D024042:Collagen Type I / Q000097:blood* / Q000737:chemistry*; D005260:Female; D006801:Humans; D007118:Immunoassay; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology; D010446:Peptide Fragments / Q000097:blood* / Q000737:chemistry; D010455:Peptides; D011347:Procollagen / Q000097:blood* / Q000737:chemistry; D017434:Protein Structure, Tertiary; D011859:Radiography; D012680:Sensitivity and Specificity
chemical_list: D024042:Collagen Type I; D010446:Peptide Fragments; D010455:Peptides; D011347:Procollagen; C052929:collagen type I trimeric cross-linked peptide