title: Prognostic significance of increased bone marrow microcirculation in newly diagnosed multiple myeloma: results of a prospective DCE-MRI study.
abstract: OBJECTIVE
  Aim of this prospective study was to investigate prognostic significance of increased bone marrow microcirculation as detected by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for survival and local complications in patients with multiple myeloma (MM).
  
  
  METHODS
  We performed DCE-MRI of the lumbar spine in 131 patients with newly diagnosed MM and analysed data according to the Brix model to acquire amplitude A and exchange rate constant kep. In 61 patients a second MRI performed after therapy was evaluated to assess changes in vertebral height and identify vertebral fractures.
  
  
  RESULTS
  Correlation analysis revealed significant positive association between beta2-microglobulin as well as immunoparesis with DCE-MRI parameters A and kep. Additionally, A was negatively correlated with haemoglobin levels and kep was positively correlated with LDH levels. Higher baseline kep values were associated with decreased vertebral height in a second MRI (P = 0.007) and A values were associated with new vertebral fractures in the lower lumbar spine (P = 0.03 for L4). Pre-existing lytic bone lesions or remission after therapy had no impact on the occurrence of vertebral fractures. Multivariate analysis revealed that amplitude A is an independent adverse risk factor for overall survival.
  
  
  CONCLUSIONS
  DCE-MRI is a non-invasive tool with significance for systemic prognosis and vertebral complications.
  
  
  CONCLUSIONS
  • Qualitative parameters from DCE-MRI are correlated with established factors of disease activity • Increased marrow microcirculation might be a risk factor for loss of vertebral height and fractures • Amplitude A is an independent predictor for shortened overall survival.
authors.affiliation: German Cancer Research Center, Department of Radiology, Heidelberg, Germany. maximilian.merz@med.uni-heidelberg.de.|Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. maximilian.merz@med.uni-heidelberg.de.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Merz
authors.affiliation: German Cancer Research Center, Department of Radiology, Heidelberg, Germany.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Moehler
authors.affiliation: German Cancer Research Center, Department of Radiology, Heidelberg, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Ritsch
authors.affiliation: Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Bäuerle
authors.affiliation: Rinecker Proton Therapy, München, Germany.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Zechmann
authors.affiliation: Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wagner
authors.affiliation: Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Jauch
authors.affiliation: Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Hose
authors.affiliation: German Cancer Research Center, Department of Biostatistics, Heidelberg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Kunz
authors.affiliation: German Cancer Research Center, Department of Biostatistics, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hielscher
authors.affiliation: Fraunhofer MEVIS, Bremen, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Laue
authors.affiliation: Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.|National Center for Tumor Diseases, Heidelberg, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Goldschmidt
authors.affiliation: German Cancer Research Center, Department of Radiology, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Delorme
authors.affiliation: German Cancer Research Center, Department of Radiology, Heidelberg, Germany.|Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Hillengass
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000098:blood supply*; D003287:Contrast Media; D005260:Female; D005598:Fractures, Spontaneous / Q000473:pathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology*; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000473:pathology
chemical_list: D003287:Contrast Media
keywords: Angiogenesis; Dynamic contrast-enhanced MRI; Magnetic resonance imaging; Multiple myeloma; Vertebral fracture