title: Lumbar bone marrow microcirculation measurements from dynamic contrast-enhanced magnetic resonance imaging is a predictor of event-free survival in progressive multiple myeloma.
abstract: OBJECTIVE
  Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with high temporal resolution enables the detection of microcirculation variables amplitude A and exchange rate constant k(ep). In this study, the prognostic value of the DCE-MRI variables for overall survival and event-free survival in patients with progressive multiple myeloma was investigated.
  
  
  METHODS
  Between 1999 and 2001, 65 patients with progressive or relapse of multiple myeloma requiring therapy were investigated with DCE-MRI of the lumbar spine before start of therapy. The contrast uptake was quantified using a two-compartment model with the output variables amplitude A and exchange rate constant k(ep) reflecting bone marrow microcirculation. The estimated median follow-up was 56 months. Event-free survival and overall survival were investigated for DCE-MRI variables and for established prognosis variables (beta(2)-microglobulin, lactate dehydrogenase, albumin, and age).
  
  
  RESULTS
  Using a multivariate Cox regression model, beta(2)-microglobulin and amplitude A of DCE-MRI were identified as statistically significant prognostic variable of event-free survival with Ps of 0.01 and 0.02, respectively. A statistical correlation of DCE-MRI variables with overall survival could not be found. The multivariate analysis of beta(2)-microglobulin, age, lactate dehydrogenase, and albumin revealed beta(2)-microglobulin as statistically significant prognostic factor for overall survival in this group of patients (P < 0.001).
  
  
  CONCLUSIONS
  This analysis identifies contrast-enhanced DCE-MRI variable amplitude A reflecting increased bone marrow microcirculation and angiogenesis as a novel and possibly useful prognostic factor in patients with multiple myeloma. Prospective studies are currently done to further investigate this functional variable for prognosis and stratification of myeloma patients.
authors.affiliation: Department of Hematology, Oncology, and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Jens.Hillengass@med.uni-heidelberg.de
authors.forename: Jens
authors.initials: J
authors.lastname: Hillengass
authors.forename: Klaus
authors.initials: K
authors.lastname: Wasser
authors.forename: Stefan
authors.initials: S
authors.lastname: Delorme
authors.forename: Fabian
authors.initials: F
authors.lastname: Kiessling
authors.forename: Christian
authors.initials: C
authors.lastname: Zechmann
authors.forename: Axel
authors.initials: A
authors.lastname: Benner
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Kauczor
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Ho
authors.forename: Hartmut
authors.initials: H
authors.lastname: Goldschmidt
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Moehler
mesh_terms: D000368:Aged; D001854:Bone Marrow Cells / Q000378:metabolism*; D003287:Contrast Media / Q000494:pharmacology*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007700:Kinetics; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality* / Q000473:pathology*; D015999:Multivariate Analysis; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media