title: Value of whole body MRI and dynamic contrast enhanced MRI in the diagnosis, follow-up and evaluation of disease activity and extent in multiple myeloma.
abstract: OBJECTIVE
  To evaluate the significance of dynamic contrast enhanced MRI (DCE-MRI) and whole body MRI (WB-MRI) in the diagnosis, prognosis and assessment of therapy for patients with monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM).
  
  
  METHODS
  The retrospective study includes 219 patients providing 463 WB-MRI and DCE-MRI investigations for the subgroups MGUS (n=70), MM active disease (n=126; this includes 70 patients with new diagnosis of MM, according to the International Staging System (ISS): 41.4% ISS stage I, 20.0% ISS stage II, 7.1% ISS stage III, 31.4% insufficient for staging; and 56 patients with '(re-)active disease': 16.07% relapse, 32.14% progressive disease and 51.79% stable disease) and MM remission (n=23; 60.87% complete remission, 17.39% very good partial remission and 21.74% partial remission). Investigations of patients with hereditary multiple exostoses (n=5), neurofibromatosis (n=7) and healthy persons (n=9) were added as control subjects (n=21). WB-MRI evaluation was done by evaluating thirteen skeletal regions, providing a 'skeletal score'. DCE-MRI images of the spine, were analyzed with regions-of-interest and time-intensity-curves (TIC).
  
  
  RESULTS
  All TIC parameters can significantly differentiate between the predefined subgroups (p<0.001). One hundred days after autologous stem cell transplantation a 75% decrease of the slope wash-in value (p<0.001) can be seen. A cubic regression trend between 'skeletal score' and slope wash-in (adj.R(2)=0.412) could demonstrate a significant increase bone marrow perfusion if MM affects more than 10 skeletal regions (p<0.001), associated with a poorer prognosis (p<0.001).
  
  
  CONCLUSIONS
  DCE-MRI evaluation of the spine is useful for diagnosis of MM, follow-up after stem cell transplantation and evaluation of disease activity. A combined evaluation with WB-MRI and DCE-MRI provides additional micro-vascular information on the morphologic lesions and could help categorize patients with MM in two different groups to offer useful therapeutic and prognostic advise.
authors.affiliation: Department of Radiology, MR-1K12, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium. Julie.Dutoit@UGent.be
authors.forename: Julie C
authors.initials: JC
authors.lastname: Dutoit
authors.forename: Matthias A
authors.initials: MA
authors.lastname: Vanderkerken
authors.forename: Koenraad L
authors.initials: KL
authors.lastname: Verstraete
mesh_terms: D001530:Belgium / Q000453:epidemiology; D015897:Comorbidity; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D009361:Neoplasm Invasiveness; D010265:Paraproteinemias / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D033581:Stem Cell Transplantation / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D051598:Whole Body Imaging / Q000706:statistics & numerical data*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: A; ASCT; CR; DCE-MRI; Dynamic contrast enhanced; IMWG; ISS; International Myeloma Working Group; M; MGUS; MM; MPNST; MRI; MVD; Magnetic resonance imaging; Multiple myeloma; NF; PD; PET; PR; ROC; ROI; SD; SI; Stem cell transplantation; T; TIC; TVA; V; VGPR; WB-MRI; WI; WO; Whole body imaging; a.U.; arbitrary units; artery; autologous stem cell transplantation; complete response; dynamic contrast enhanced MRI; international staging system; magnetic resonance imaging; malignant peripheral nerve sheath tumor; micro vascular density; monoclonal gammopathy of undetermined significance; multiple myeloma; muscle; neurofibromatosis; partial response; positron-emission tomography; progressive disease; receiver operating characteristics; region of interest; sMM; signal intensity; smouldering multiple myeloma; stable disease; time; time-intensity curve; total vascular area; vertebra; very good partial response; wash-in; wash-out; whole body-MRI