title: Assessing myeloma bone disease with whole-body diffusion-weighted imaging: comparison with x-ray skeletal survey by region and relationship with laboratory estimates of disease burden.
abstract: OBJECTIVE
  To estimate and compare the extent of myeloma bone disease by skeletal region using whole-body diffusion-weighted imaging (WB-DWI) and skeletal survey (SS) and record interobserver agreement, and to investigate differences in imaging assessments of disease extent and apparent diffusion coefficient (ADC) between patients with pathological high versus low disease burden.
  
  
  METHODS
  Twenty patients with relapsed myeloma underwent WB-DWI and SS. Lesions were scored by number and size for each skeletal region by two independent observers using WB-DWI and SS. Observer scores, ADC, and ADC-defined volume of tumour-infiltrated marrow were compared between patients with high and low disease burden (assessed by serum paraproteins and marrow biopsy).
  
  
  RESULTS
  Observer scores were higher on WB-DWI than SS in every region (p<0.05) except the skull, with greater interobserver reliability in rating the whole skeleton (WB-DWI: ICC = 0.74, 95% CI: 0.443-0.886; SS: ICC = 0.44, 95% CI: 0.002-0.730) and individual body regions. WB-DWI scores were not significantly higher in patients with high versus low disease burden (observer 1: mean ± SD: 48.8 ± 7, 38.6 ± 14.5, observer 2: mean ± SD: 37.3 ± 13.5, 30.4 ± 15.5; p = 0.06, p = 0.35).
  
  
  CONCLUSIONS
  WB-DWI demonstrated more lesions than SS in all regions except the skull with greater interobserver agreement. Sensitivity is not a limiting factor when considering WB-DWI in the management pathway of patients with myeloma.
authors: MRI Department, Royal Marsden Hospital, Sutton, Surrey, UK. Electronic address: sharon.giles@rmh.nhs.uk.
authors: S L
authors: SL
authors: Giles
authors: Clinical Magnetic Resonance Unit, Institute of Cancer Research, Sutton, Surrey, UK.
authors: N M
authors: NM
authors: deSouza
authors: Clinical Magnetic Resonance Unit, Institute of Cancer Research, Sutton, Surrey, UK.
authors: D J
authors: DJ
authors: Collins
authors: MRI Department, Royal Marsden Hospital, Sutton, Surrey, UK.
authors: V A
authors: VA
authors: Morgan
authors: Haemato-oncology Department, Royal Marsden Hospital, Sutton, Surrey, UK.
authors: S
authors: S
authors: West
authors: Haemato-oncology Department, Royal Marsden Hospital, Sutton, Surrey, UK; Molecular Pathology, Institute of Cancer Research, Sutton, Surrey, UK.
authors: F E
authors: FE
authors: Davies
authors: Haemato-oncology Department, Royal Marsden Hospital, Sutton, Surrey, UK; Molecular Pathology, Institute of Cancer Research, Sutton, Surrey, UK.
authors: G J
authors: GJ
authors: Morgan
authors: MRI Department, Royal Marsden Hospital, Sutton, Surrey, UK.
authors: C
authors: C
authors: Messiou
mesh_terms: D000368:Aged; D001847:Bone Diseases / Q000175:diagnosis*; D017281:Cost of Illness; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D005598:Fractures, Spontaneous / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis*; D015588:Observer Variation; D011446:Prospective Studies; D051598:Whole Body Imaging / Q000379:methods