Whole-body magnetic resonance imaging, including diffusion-weighted imaging, for diagnosing bone marrow involvement in malignant lymphoma

Abstract INTRODUCTION: MRI has a high sensitivity in determining changes in bone marrow induced by metastatic disease or primary neoplasms of the bone marrow. Whole-Body Magnetic Resonance Imaging (WB-MRI) is a novel imaging technique that displays nearly the complete skeletal system in one exam. We investigated the differences between conventional skeletal survey and WB-MRI and their impact on staging of patients with newly diagnosed plasma cell disease. METHOD AND MATERIALS: In 41 consecutive patients with newly diagnosed MGUS (n=5), Multiple Myeloma (n=34) or AL-Amyloidosis (n=2) conventional radiographs and WB-MRI (coronar T1 tse and T2 tirm sequences and sagittal T2 star sequences, 1,5 T MRI with parallel imaging, Siemens Avanto®) were performed. Radiographs and scans were evaluated for diffuse and focal bone marrow involvement in consent by two experienced radiologists blinded for patient name and study time. Staging was performed including clinical data according to the Salmon/Durie classification system and the Durie/Salmon PLUS classification system with inclusion of WB-MRI. RESULTS: In 24 (59%) patients there were no lesions in conventional radiography or MRI. In 17 (41 %) patients results of MRI and conventional radiography were discrepant. 4 (10%) patients had lesions only in MRI, 3 (7%) only in conventional radiography and 10 (24%) in both techniques but in different localization. In 16 (38%) patients with radiological signs of osteopenia there was no diffuse infiltration in MRI or vice versa. We systematically analysed the consequences of WB-MRI on staging of patients based on the newly proposed staging system Durie/Salmon PLUS. Replacing conventional radiographs by WB-MRI resulted in reclassification of 12 patients. 3 patients were reclassified from MGUS or stage I into stage II or III. 9 patients were downstaged from stage III or II into stage I or MGUS. CONCLUSION: WB-MRI is a valuable technique for the initial work-up of patients with Multiple Myeloma. In comparison with conventional skeletal survey there are often differing results with impact on clinical staging and influence on therapy decision. WB-MRI can give additional information in patients with unclear staging situation before onset of therapy. Further evaluation of WB-MRI within prospective studies is warranted in particular with respect to prognostic impact regarding overall prognosis as well as regarding local complications. Until then WB-MRI should be used complementary to conventional radiography or CT-techniques that provide accurate imaging of the bone.

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Clinical significance of diffusion-weighted whole body magnetic resonance imaging with background body signal suppression (DWIBS) as a staging procedure for lymphoma patients in comparison with FDG-PET

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.8084 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 8084-8084

Author(s):

T. Itoyama ◽

T. Shibuya ◽

T. Koga ◽

M. Kitagawa ◽

T. Yoshida ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Clinical Significance ◽

Fdg Pet ◽

Clinical Staging ◽

Whole Body ◽

Resonance Imaging ◽

Diffusion Weighted ◽

Signal Suppression ◽

Body Magnetic Resonance Imaging

8084 Background: FDG-PET is thought to be an important staging tool in lymphomas. However, high cost and exposure to radioactive agents are of disadvantage. Diffusion weighted whole body magnetic resonance imaging with background body signal suppression (DWIBS) is recently reported to be a new way of magnetic resonance imaging which can make FDG-PET-like imaging possible to detect tumors (Takahara et al; Radiation Medicine 22: 275–282, 2004). This study is aimed to compare accuracy and clinical significance of DWIBS to FDG - PET. Methods: We examined 19 lymphoma (Ly) patients (pts) by using both DWIBS and FDG -PET at the time of diagnosis before therapy. There were follicular Ly in 3 pts, nodal marginal zone Ly in 1, diffuse large B-cell Ly in 9 including primary stomach Ly in 2, peripheral T -cell Ly in 4, and MALT Ly of stomach (GI-MALT) in 2. DWIBS was performed with a 1.5 -Tesla system as previously reported (Ochiai et al; Nichidoku -Iho 50: 86–98, 2005). Clinical staging was made according to the Ann Arbor classification. Results: Both DWIBS and FDG -PET had positive findings in 18 of 19 pts except for a case of GI -MALT. In nodal lesions, DWIBS was positive in 16 pts at 66 sites compared to 16 pts at 68 sites with FDG -PET. DWIBS was negative in 3 pts at 5 sites in spleen, hilar and mediastinal lymphnodes where positive in FDG -PET. DWIBS was positive in 2 pts at 4 sites in iliac and inguinal lymphnodes that are negative in FDG -PET. In extranodal lesions, DWIBS was positive in 12 pts at 17 sites as compared to 12 pts at 18 sites with FDG -PET. Involvement of bone and stomach were equally identified at 8 sites. DWIBS was negative in 2 pts at 2 sites in liver and pleura with FDG -PET positive. Small skin lesions were clearly identified on DWIBS. Discordance of clinical staging was not observed between DWIBS and FDG -PET. Conclusions: Although some discrepancy was seen between DWIBS and FDG -PET, there was no disadvantage of DWIBS compared to FDG -PET. Furthermore, DWIBS has no risk of radiation exposure and is even advantageous to detect lesions with FDG -PET negative. We conclude DWIBS is a new useful tool to assess tumor spread in lymphomas. No significant financial relationships to disclose.

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The use of whole body magnetic resonance imaging in detecting bone marrow disorders - a valid alternative to imaging modalities that utilise ionising radiation

Radiographer ◽

10.1002/j.2051-3909.2005.tb00036.x ◽

2005 ◽

Vol 52 (3) ◽

pp. 17-20

Author(s):

Susanne S Hansen

Keyword(s):

Magnetic Resonance Imaging ◽

Bone Marrow ◽

Magnetic Resonance ◽

Ionising Radiation ◽

Imaging Modalities ◽

Whole Body ◽

Resonance Imaging ◽

Body Magnetic Resonance Imaging ◽

Bone Marrow Disorders

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Diffusion-weighted imaging in pediatric body magnetic resonance imaging

Pediatric Radiology ◽

10.1007/s00247-016-3573-3 ◽

2016 ◽

Vol 46 (6) ◽

pp. 847-857 ◽

Cited By ~ 11

Author(s):

Govind B. Chavhan ◽

Pablo Caro-Dominguez

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Diffusion Weighted Imaging ◽

Resonance Imaging ◽

Diffusion Weighted ◽

Body Magnetic Resonance Imaging

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Whole-body magnetic resonance imaging (WBMRI) versus whole-body computed tomography (WBCT) for myeloma imaging and staging

Skeletal Radiology ◽

10.1007/s00256-021-03799-4 ◽

2021 ◽

Author(s):

Karla M. Treitl ◽

Jens Ricke ◽

Andrea Baur-Melnyk

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Bone Marrow ◽

Magnetic Resonance ◽

Treatment Response ◽

Standard Procedure ◽

Whole Body ◽

Resonance Imaging ◽

Mortality And Morbidity ◽

Body Magnetic Resonance Imaging

AbstractMyeloma-associated bone disease (MBD) develops in about 80–90% of patients and severely affects their quality of life, as it accounts for the majority of mortality and morbidity. Imaging in multiple myeloma (MM) and MBD is of utmost importance in order to detect bone and bone marrow lesions as well as extraosseous soft-tissue masses and complications before the initiation of treatment. It is required for determination of the stage of disease and aids in the assessment of treatment response. Whole-body low-dose computed tomography (WBLDCT) is the key modality to establish the initial diagnosis of MM and is now recommended as reference standard procedure for the detection of lytic destruction in MBD. In contrast, whole-body magnetic resonance imaging (WBMRI) has higher sensitivity for the detection of focal and diffuse plasma cell infiltration patterns of the bone marrow and identifies them prior to osteolytic destruction. It is recommended for the evaluation of spinal and vertebral lesions, while functional, diffusion-weighted MRI (DWI-MRI) is a promising tool for the assessment of treatment response. This review addresses the current improvements and limitations of WBCT and WBMRI for diagnosis and staging in MM, underlining the fact that both modalities offer complementary information. It further summarizes the corresponding radiological findings and novel technological aspects of both modalities.

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