title: Association between magnetic resonance imaging patterns and baseline disease features in multiple myeloma: analyzing surrogates of tumour mass and biology.
abstract: OBJECTIVE
  To assess associations between bone marrow infiltration patterns and localization in magnetic resonance imaging (MRI) and baseline clinical/prognostic parameters in multiple myeloma (MM).
  
  
  METHODS
  We compared baseline MM parameters, MRI patterns and localization of focal lesions to the mineralized bone in 206 newly diagnosed MM patients.
  
  
  RESULTS
  A high tumour mass (represented by International Staging System stage III) was significantly associated with severe diffuse infiltration (p = 0.015) and a higher number of focal lesions (p = 0.006). Elevated creatinine (p = 0.003), anaemia (p < 0.001) and high LDH (p = 0.001) correlated with severe diffuse infiltration. A salt and pepper diffuse pattern had a favourable prognosis. A higher degree of destruction of mineralized bone (assessed by X-ray or computed tomography) was associated with an increasing number of focal lesions on MRI (p < 0.001). Adverse cytogenetics (del17p/gain1q21/t(4;14)) were associated with diffuse infiltration (p = 0.008). The presence of intraosseous focal lesions exceeding the mineralized bone had a borderline significant impact on prognosis.
  
  
  CONCLUSIONS
  Diffuse bone marrow infiltration on MRI correlates with adverse cytogenetics, lowered haemoglobin values and high tumour burden in newly diagnosed MM whereas an increasing number of focal lesions correlates with a higher degree of bone destruction. Focal lesions exceeding the cortical bone did not adversely affect the prognosis.
  
  
  CONCLUSIONS
  • Diffuse MRI correlates with adverse cytogenetics, lowered haemoglobin and high tumour burden. • Higher numbers of MRI focal lesions correlate with increasing degree of bone destruction. • Focal lesions exceeding the cortical bone borderline significantly influence survival. • Moderate/severe diffuse infiltration and more than 23 focal lesions adversely affect survival.
authors.affiliation: Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. elias.mai@med.uni-heidelberg.de.
authors.forename: Elias K
authors.identifier: http://orcid.org/0000-0002-6226-1252
authors.initials: EK
authors.lastname: Mai
authors.affiliation: Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hielscher
authors.affiliation: Clinic of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Jost K
authors.initials: JK
authors.lastname: Kloth
authors.affiliation: Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Merz
authors.affiliation: Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: Sofia
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Hillengass
authors.affiliation: Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wagner
authors.affiliation: Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Hose
authors.affiliation: Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: M S
authors.initials: MS
authors.lastname: Raab
authors.affiliation: Institute of Human Genetics, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Jauch
authors.affiliation: Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Delorme
authors.affiliation: Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.|National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Goldschmidt
authors.affiliation: Clinic of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Marc-André
authors.initials: MA
authors.lastname: Weber
authors.affiliation: Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.|Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Hillengass
mesh_terms: D000368:Aged; D001853:Bone Marrow / Q000000981:diagnostic imaging / Q000473:pathology; D019046:Bone Marrow Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009101:Multiple Myeloma / Q000000981:diagnostic imaging* / Q000473:pathology*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Bone marrow; Magnetic resonance imaging; Multiple myeloma; Plasma cells; Prognosis