title: Pre-treatment staging of multiple myeloma patients: comparison of whole-body diffusion weighted imaging with whole-body T1-weighted contrast-enhanced imaging.
abstract: BACKGROUND
  Multiple myeloma (MM) is a hematologic malignancy characterized by the clonal proliferation of plasma cells. Accurate staging is of pivotal importance in the management of MM. Advanced imaging techniques, such as magnetic resonance imaging (MRI), are increasingly used for the initial diagnosis and staging of MM.
  
  
  OBJECTIVE
  To compare whole-body (WB) MR diffusion-weighted imaging with background body signal suppression (DWIBS) with (WB) MR fat-suppressed T1-weighted contrast-enhanced imaging (T1-CE) in the pre-treatment staging evaluation of multiple myeloma (MM) patients.
  
  
  METHODS
  Thirty-six patients with MM were included in the study. T1-CE and DWIBS were performed using a 3 T scanner. The Durie-Salmon plus staging system was used. Kappa statistics was used to assess agreement.
  
  
  RESULTS
  For all MM stages good to very good agreement was found for both T1-CE and DWIBS. The unweighted kappa statistic indicated a moderate, good and very good agreement between T1-CE and DWIBS for stages I, II, and III, respectively. In particular, in 67% of patients the MM staging according to T1-CE was not different from DWIBS. In the remaining 33% of patients, the MM stage obtained with T1-CE was lower than that provided by DWIBS.
  
  
  CONCLUSIONS
  DWIBS and T1-CE were concordant in the majority of patients. In a minority of cases DWIBS evidenced areas of water restriction that did not correspond to contrast enhancement areas. Studies monitoring therapeutic response in relation to tumour burden and aggressiveness should be performed to assess the clinical relevance of DWIBS findings.
authors: University Hospital Policlinico Tor Vergata, Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Rome, Italy.
authors: Ettore
authors: E
authors: Squillaci
authors: University Hospital Policlinico Tor Vergata, Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Rome, Italy f.bolacchi@alice.it.
authors: Francesca
authors: F
authors: Bolacchi
authors: University Hospital Policlinico Tor Vergata, Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Rome, Italy.
authors: Simone
authors: S
authors: Altobelli
authors: Department of Internal Medicine, Hematology/Oncology Unit, Tor Vergata University, Rome, Italy.
authors: Luca
authors: L
authors: Franceschini
authors: Department of Internal Medicine, Hematology/Oncology Unit, Tor Vergata University, Rome, Italy Department of Public Health and Cellular Biology, University of Rome "Tor Vergata", Rome, Italy.
authors: Alberto
authors: A
authors: Bergamini
authors: Department of Internal Medicine, Hematology/Oncology Unit, Tor Vergata University, Rome, Italy.
authors: Maria
authors: M
authors: Cantonetti
authors: University Hospital Policlinico Tor Vergata, Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Rome, Italy.
authors: Giovanni
authors: G
authors: Simonetti
mesh_terms: D000368:Aged; D003287:Contrast Media; D003952:Diagnostic Imaging; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D011446:Prospective Studies; D051598:Whole Body Imaging
chemical_list: D003287:Contrast Media
keywords: Multiple myeloma; diffusion-weighted imaging with background body signal suppression (DWIBS); magnetic resonance imaging (MRI); whole-body MRI