Prognostic significance of focal lesions and diffuse infiltration on MRI for multiple myeloma: a meta-analysis.
OBJECTIVE
MRI of bone marrow of the axial skeleton is recommended for evaluation of multiple myeloma. The impact of bone marrow involvement pattern on MRI for determining progression-free survival (PFS) and overall survival (OS) is not yet clear.


METHODS
We performed a meta-analysis of research on the prognostic significance of MRI patterns for OS and PFS using a random effects model. Databases searched without language restriction were MEDLINE, EMBASE, and the Cochrane Library (January 1976 to April 2014). Manual searches were also conducted.


RESULTS
Of 10,953 citations identified in the original search, 10 cohort studies for a total of 2015 patients met the inclusion criteria. Nine of the 10 included studies are from three research groups. Pooled hazard ratios were 1.80 (95 % confidence interval [CI] 1.32-2.46; P < 0.001) for OS and 2.30 (95 % CI 1.65-3.20; P < 0.001) for PFS for focal lesions on MRI; and 1.70 (95 % CI 1.30-2.21; P < 0.001) for OS and 1.74 (95 % CI 1.07-2.85; P = 0.03) for PFS for diffuse infiltration on MRI. No significant heterogeneity was observed among studies.


CONCLUSIONS
This meta-analysis demonstrated an association between focal lesions and diffuse infiltration and poor prognosis in this population.


CONCLUSIONS
• MRI findings of multiple myeloma include normal, focal, variegated and diffuse infiltration • Focal lesions and diffuse infiltration on MRI were poor prognostic factors • Bone marrow involvement pattern on MRI can help physicians assess prognosis.
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
So-Yeon
SY
Lee
Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea. Hjk3870@daum.net.
Hyun-Jung
HJ
Kim
Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Yu Ri
YR
Shin
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Hee-Jin
HJ
Park
Division of Hematology and Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Yun-Gyoo
YG
Lee
Division of Hematology and Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Suk Joong
SJ
Oh
D000368:Aged; D001855:Bone Marrow Diseases / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models
Bone marrow; MRI; Meta-analysis; Multiple myeloma; Prognosis