title: Increased microcirculation detected by dynamic contrast-enhanced magnetic resonance imaging is of prognostic significance in asymptomatic myeloma.
abstract: This prospective study aimed to investigate the prognostic significance of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) as a non-invasive imaging technique delivering the quantitative parameters amplitude A (reflecting blood volume) and exchange rate constant kep (reflecting vascular permeability) in patients with asymptomatic monoclonal plasma cell diseases. We analysed DCE-MRI parameters in 33 healthy controls and 148 patients with monoclonal gammopathy of undetermined significance (MGUS) or smouldering multiple myeloma (SMM) according to the 2003 IMWG guidelines. All individuals underwent standardized DCE-MRI of the lumbar spine. Regions of interest were drawn manually on T1-weighted images encompassing the bone marrow of each of the 5 lumbar vertebrae sparing the vertebral vessel. Prognostic significance for median of amplitude A (univariate: P < 0·001, hazard ratio (HR) 2·42, multivariate P = 0·02, HR 2·7) and exchange rate constant kep (univariate P = 0·03, HR 1·92, multivariate P = 0·46, HR 1·5) for time to progression of 79 patients with SMM was found. Patients with amplitude A above the optimal cut-off point of 0·89 arbitrary units had a 2-year progression rate into symptomatic disease of 80%. In conclusion, DCE-MRI parameters are of prognostic significance for time to progression in patients with SMM but not in individuals with MGUS.
authors.affiliation: Department of Haematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.|Department of Radiology, German Cancer Research Centre, Heidelberg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Hillengass
authors.affiliation: Department of Radiology, German Cancer Research Centre, Heidelberg, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Ritsch
authors.affiliation: Department of Haematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.|Department of Radiology, German Cancer Research Centre, Heidelberg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Merz
authors.affiliation: Department of Haematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wagner
authors.affiliation: Department of Biostatistics, German Cancer Research Centre, Heidelberg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Kunz
authors.affiliation: Department of Biostatistics, German Cancer Research Centre, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hielscher
authors.affiliation: Fraunhofer Institute for Medical Image Computing MEVIS, Bremen, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Laue
authors.affiliation: Institute of Radiology, University Medical Centre Erlangen, Erlangen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Bäuerle
authors.affiliation: Diagnostisches Brustzentrum Heidelberg, Heidelberg, Germany.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Zechmann
authors.affiliation: Department of Haematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Ho
authors.affiliation: Department of Radiology, German Cancer Research Centre, Heidelberg, Germany.
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schlemmer
authors.affiliation: Department of Haematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.|National Centre for Tumor Diseases, Heidelberg, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Goldschmidt
authors.affiliation: InVentiv Health Clinical, Neu-Isenburg, Germany.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Moehler
authors.affiliation: Department of Radiology, German Cancer Research Centre, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Delorme
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000098:blood supply / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000000981:diagnostic imaging* / Q000473:pathology; D009101:Multiple Myeloma / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult
keywords: Smouldering multiple myeloma; dynamic contrast-enhanced magnetic resonance imaging; monoclonal gammopathy of undetermined significance; prognosis; risk factor