title: Whole body magnetic resonance imaging in newly diagnosed multiple myeloma: early changes in lesional signal fat fraction predict disease response.
abstract: Cross-sectional imaging techniques are being increasingly used for disease evaluation in patients with multiple myeloma. Whole body magnetic resonance imaging (WB-MRI) scanning is superior to plain radiography in baseline assessment of patients but changes following treatment have not been systematically explored. We carried out paired WB-MRI scans in 21 newly diagnosed patients prior to, and 8-weeks after, starting chemotherapy, and analysed stringently selected focal lesions (FLs) for parametric changes. A total of 323 FLs were evaluated, median 20 per patient. At 8 weeks, there was a reduction in estimated tumour volume (eTV), and an increase in signal fat fraction (sFF) and apparent diffusion coefficient (ADC) in the group as a whole (P < 0·001). Patients who achieved complete/very good partial response (CR/VGPR) to induction had a significantly greater increase in sFF compared to those achieving ≤ partial response (PR; P = 0·001). When analysed on a per-patient basis, all patients achieving CR/VGPR had a significant sFF increase in their FL's, in contrast to patients achieving ≤PR. sFF changes in patients reaching maximal response within 100 days (fast responders) were greater compared to slow responders (P = 0·001). Receiver Operator Characteristic analysis indicated that sFF changes at 8 weeks were the best biomarker (area under the Curve 0·95) for an inferior response (≤PR). We conclude that early lesional sFF changes may provide important information on depth of response, and are worthy of further prospective study.
authors.affiliation: Centre for Medical Imaging, University College London, London, UK.
authors.forename: Arash
authors.identifier: http://orcid.org/0000-0002-5143-746X
authors.initials: A
authors.lastname: Latifoltojar
authors.affiliation: Centre for Medical Imaging, University College London, London, UK.|Department of Clinical Radiology, University College London Hospitals, London, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Hall-Craggs
authors.affiliation: Department of Haematology, University College London Hospitals, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Rabin
authors.affiliation: Department of Haematology, University College London Hospitals, London, UK.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Popat
authors.affiliation: Department of Medical Physics, University College London Hospitals, London, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Bainbridge
authors.affiliation: Centre for Medical Imaging, University College London, London, UK.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Dikaios
authors.affiliation: Department of Medical Physics, University College London Hospitals, London, UK.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Sokolska
authors.affiliation: Department of Haematology, University College London Hospitals, London, UK.
authors.forename: Ali
authors.initials: A
authors.lastname: Rismani
authors.affiliation: Department of Haematology, University College London Hospitals, London, UK.
authors.forename: Shirley
authors.initials: S
authors.lastname: D'Sa
authors.affiliation: Centre for Medical Imaging, University College London, London, UK.|Department of Clinical Radiology, University College London Hospitals, London, UK.
authors.forename: Shonit
authors.initials: S
authors.lastname: Punwani
authors.affiliation: UCL Cancer Institute, Haematology, University College London, London, UK.
authors.forename: Kwee
authors.initials: K
authors.lastname: Yong
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D051598:Whole Body Imaging / Q000379:methods*
chemical_list: D015415:Biomarkers
keywords: bortezomib; magnetic resonance imaging; multiple myeloma; treatment response; whole body