title: Dynamic contrast-enhanced magnetic resonance imaging for assessment of antiangiogenic treatment effects in multiple myeloma.
abstract: OBJECTIVE
  To noninvasively assess bone marrow microcirculation before and after therapy in patients with newly diagnosed multiple myeloma with dynamic contrast-enhanced MRI (DCE-MRI).
  
  
  METHODS
  Ninety-six patients received DCE-MRI before and after primary treatment for newly diagnosed multiple myeloma. For the 91 evaluable patients, treatment consisted of high-dose therapy (HDT) with autologous stem cell transplantation (ASCT) in 82 patients and chemotherapy without ASCT in 9 patients. In addition, 33 healthy volunteers were imaged as the control group. Analysis of DCE-MRI was performed according to the two-compartment model by Brix to quantify amplitude A (associated with blood volume) and exchange rate constant kep (reflecting vessel permeability and perfusion).
  
  
  RESULTS
  Nonresponders showed significantly higher A-values before the start of therapy compared with responders (P = 0.02). In both responders and nonresponders to therapy, A-values dropped significantly (P = 0.004 and <0.001, respectively) after primary therapy, whereas lower values for kep were found only in responders (P < 0.001). Depth of remission was significantly correlated to decreased bone marrow microcirculation: Patients in near complete response (nCR) or complete remission (CR) after treatment showed significantly lower values for A compared with patients not achieving nCR+CR. The application of HDT or novel agents had no significant effect on DCE-MRI parameters after therapy, although patients treated with novel agents more often achieved nCR+CR (42%/12.5%; P < 0.002). Higher kep-values at second MRI were positively correlated to shorter overall survival (HR 3.53; 95% confidence intervals, 1.21-10.33; P = 0.02).
  
  
  CONCLUSIONS
  Parameters from DCE-MRI are correlated to remission after primary therapy and outcome in newly diagnosed multiple myeloma.
authors.affiliation: Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany. Department of Radiology, German Cancer Research Center, Heidelberg, Germany. maximilian.merz@med.uni-heidelberg.de.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Merz
authors.affiliation: Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Ritsch
authors.affiliation: Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Kunz
authors.affiliation: Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wagner
authors.affiliation: Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sauer
authors.affiliation: Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Hose
authors.affiliation: Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Moehler
authors.affiliation: Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Delorme
authors.affiliation: Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany. National Center for Tumor Diseases, Heidelberg, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Goldschmidt
authors.affiliation: Rinecker Proton Therapy Center, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Zechmann
authors.affiliation: Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany. Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Hillengass
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D001853:Bone Marrow / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009101:Multiple Myeloma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D011859:Radiography; D012074:Remission Induction
chemical_list: D020533:Angiogenesis Inhibitors