title: Intravoxel Incoherent Motion Diffusion-weighted Imaging of Multiple Myeloma Lesions: Correlation with Whole-Body Dynamic Contrast Agent-enhanced MR Imaging.
abstract: OBJECTIVE
  To correlate intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) parameters with the enhancement patterns of bone marrow and focal lesion obtained on whole-body (WB) dynamic contrast agent-enhanced (DCE) magnetic resonance (MR) images in patients with stage-III multiple myeloma (MM) before and after systemic therapy.
  
  
  METHODS
  Twenty-seven patients with MM were retrospectively included in this institutional review board-approved study. Requirement for written informed consent was waived. All patients underwent WB DCE MR imaging before treatment and 18 patients underwent repeat MR imaging 3 months after treatment. A transverse IVIM DWI sequence with 10 b values (0, 10, 20, 30, 50, 80, 100, 200, 400, and 800 sec/mm(2)) was acquired within bone marrow and focal lesions. The IVIM parameters (perfusion fraction [f], molecular diffusion coefficient [D], and perfusion-related D [D*]) and apparent diffusion coefficient (ADC) were extracted for both focal lesions and bone marrow and correlated with focal lesions and maximal bone marrow enhancement (BMEmax) (Spearman correlation coefficient) at baseline and at follow-up (Wilcoxon signed-rank test).
  
  
  RESULTS
  D and ADC values positively correlated with BMEmax (r = 0.7, P < .001; and r = 0.455, P = .0435, respectively). Patients with increased BMEmax showed significantly increased ADC and D within bone marrow versus patients who did not have increased BMEmax (ADC, 0.67 × 10(-3) mm(2)/sec vs 0.54 × 10(-3) mm(2)/sec, P = .03; D, 0.58 × 10(-3) mm(2)/sec vs 0.42 × 10(-3) mm(2)/sec, P < .001). Within focal lesions, f was the maximum in lesions that showed enhancement followed by washout. After treatment in good responders, the significant decrease in maximal enhancement value of focal lesions (baseline vs after treatment, 213.9% ± 78.7 [standard deviation] vs 131% ± 53.6, respectively; P < .001) was accompanied by a significant decrease in f (baseline vs after treatment, 11% ± 3.8 vs 5.8% ± 4.7, respectively; P < .001).
  
  
  CONCLUSIONS
  Diffuse bone marrow involvement is associated with increased D. Hypervascular focal lesions with high maximal enhancement value of focal lesions also show high f value. Likewise, the decreased maximal enhancement value of focal lesions after treatment is accompanied by decreased f.
authors.affiliation: From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.).
authors.forename: Camille
authors.initials: C
authors.lastname: Bourillon
authors.affiliation: From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.).
authors.forename: Alain
authors.initials: A
authors.lastname: Rahmouni
authors.affiliation: From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.).
authors.forename: Chieh
authors.initials: C
authors.lastname: Lin
authors.affiliation: From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.).
authors.forename: Karim
authors.initials: K
authors.lastname: Belhadj
authors.affiliation: From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.).
authors.forename: Pauline
authors.initials: P
authors.lastname: Beaussart
authors.affiliation: From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.).
authors.forename: Alexandre
authors.initials: A
authors.lastname: Vignaud
authors.affiliation: From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.).
authors.forename: Pierre
authors.initials: P
authors.lastname: Zerbib
authors.affiliation: From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.).
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pigneur
authors.affiliation: From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.).
authors.forename: Charles-André
authors.initials: CA
authors.lastname: Cuenod
authors.affiliation: From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.).
authors.forename: Hocine
authors.initials: H
authors.lastname: Bessalem
authors.affiliation: From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.).
authors.forename: Madeleine
authors.initials: M
authors.lastname: Cavet
authors.affiliation: From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.).
authors.forename: Amal
authors.initials: A
authors.lastname: Boutekadjirt
authors.affiliation: From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.).
authors.forename: Corinne
authors.initials: C
authors.lastname: Haioun
authors.affiliation: From the Department of Medical Imaging, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil Cedex, F-94010, France (C.B., A.R., P.B., P.Z., F.P., H.B., M.C., A.B., A.L.); Université Paris Descartes, Paris, France (C.B., C.A.C., A.L.); Faculty of Medicine, Université Paris Est Creteil, Creteil, France (A.R., M.C., C.H.); Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C.L.); Lymphomproliferative Unit, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France (K.B., C.H.); I2BM, CEA, Saclay, France (A.V.); Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.); and INSERM U 955, Equipe 18, Creteil, France (A.L.).
authors.forename: Alain
authors.initials: A
authors.lastname: Luciani
mesh_terms: D000328:Adult; D000368:Aged; D001853:Bone Marrow; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000628:therapy; D015588:Observer Variation; D012189:Retrospective Studies