Magnetic resonance imaging in multiple myeloma: diagnostic and clinical implications.
OBJECTIVE
Magnetic resonance imaging (MRI) permits the detection of diffuse and focal bone marrow infiltration in the absence of osteopenia or focal osteolysis on standard metastatic bone surveys (MBSs).


METHODS
Both baseline MBS and MRI were available in 611 of 668 myeloma patients who were treated uniformly with a tandem autologous transplantation-based protocol and were evaluated to determine their respective merits for disease staging, response assessment, and outcome prediction.


RESULTS
MRI detected focal lesions (FLs) in 74% and MBS in 56% of imaged anatomic sites; 52% of 267 patients with normal MBS results and 20% of 160 with normal MRI results had FL on MRI and MBS, respectively. MRI- but not MBS-defined FL independently affected survival. Cytogenetic abnormalities (CAs) and more than seven FLs on MRI (MRI-FLs) distinguished three risk groups: 5-year survival was 76% in the absence of both more than seven MRI-FLs and CA (n = 276), 61% in the presence of one MRI-FL (n = 262), and 37% in the presence of both unfavorable parameters (n = 67). MRI-FL correlated with low albumin and elevated levels of C-reactive protein, lactate dehydrogenase, and creatinine, but did not correlate with age, beta-2-microglobulin, and CA. Resolution of MRI-FL, occurring in 60% of cases and not seen with MBS-defined FL, conferred superior survival.


CONCLUSIONS
MRI is a more powerful tool for detection of FLs than is MBS. MRI-FL number had independent prognostic implications; additionally, MRI-FL resolution identified a subgroup with superior survival. We therefore recommend that, in addition to MBS, MRI be used routinely for staging, prognosis, and response assessment in myeloma.
Walker
Ronald
R
Department of Radiology, Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Barlogie
Bart
B
Haessler
Jeffrey
J
Tricot
Guido
G
Anaissie
Elias
E
Shaughnessy
John D
JD
Epstein
Joshua
J
van Hemert
Rudy
R
Erdem
Eren
E
Hoering
Antje
A
Crowley
John
J
Ferris
Ernest
E
Hollmig
Klaus
K
van Rhee
Frits
F
Zangari
Maurizio
M
Pineda-Roman
Mauricio
M
Mohiuddin
Abid
A
Yaccoby
Shmuel
S
Sawyer
Jeffrey
J
Angtuaco
Edgardo J
EJ
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001853:Bone Marrow / Q000000981:diagnostic imaging / Q000473:pathology*; D016026:Bone Marrow Transplantation; D002869:Chromosome Aberrations; D020732:Cytogenetic Analysis; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000628:therapy; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D018570:Risk Assessment; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome