scholarly journals Hepatocellular carcinoma and multiple myeloma with elevated globulin: a case report and literature review

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092039
Author(s):  
Ling Xu ◽  
Wei Yang ◽  
Ye-Fei Shu ◽  
Xiao-Feng Xu
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hepatocellular Carcinoma ◽  
Multiple Myeloma ◽  
Bone Marrow ◽  
Bone Marrow Examination ◽  
Hbv Dna ◽  
Resonance Imaging ◽  
Serum Globulin ◽  
B Virus ◽  
Immunofixation Electrophoresis

A 60-year-old male patient presented with a serum α-fetoprotein (AFP) level of 2940.5 ng/mL accompanied by a significant increase in serum globulin. Hepatitis B virus (HBV) DNA was 2.85 × 103 (normal value <1.0 × 103). B-mode ultrasound and magnetic resonance imaging showed characteristic manifestations and he was clinically diagnosed with hepatocellular carcinoma in January 2015. He received radiofrequency ablation and tenofovir disoproxil anti-HBV therapy and his serum AFP and globulin levels were significantly reduced. In March 2018, he presented at our Hematology Department with fatigue and a pale complexion. At that time, his serum AFP level was normal, with hemoglobin 61 g/L and globulin 64.7 g/L. He was diagnosed with multiple myeloma (MM) by bone marrow examination, and immunofixation electrophoresis. The patient received PCD chemotherapy (bortezomib 2.0 g/dL on days 1, 4, 8, and 11 plus cyclophosphamide 0.3 g/dL on days 1–4 plus dexamethasone 20 mg/dL on days 1–2, 4–5, 8–9, and 11–12). The patient finally died of MM complicated by disseminated intravascular coagulation.

scholarly journals Prognostic significance of magnetic resonance imaging of bone marrow in previously untreated patients with multiple myeloma

2005 ◽  
Vol 16 (11) ◽  
pp. 1824-1828 ◽  
Author(s):  
L.A. Moulopoulos ◽  
D. Gika ◽  
A. Anagnostopoulos ◽  
K. Delasalle ◽  
D. Weber ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Myeloma ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Prognostic Significance ◽  
Resonance Imaging

Impact of Whole-Body Magnetic Resonance Imaging on Staging in Patients with Newly Diagnosed Plasma Cell Disease.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5061-5061
Author(s):  
Martin Zoz ◽  
Andreas Baldauf ◽  
Anne Schipp ◽  
Jens Hillengass ◽  
Anthony D. Ho ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Myeloma ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Conventional Radiography ◽  
Whole Body ◽  
Newly Diagnosed ◽  
Resonance Imaging ◽  
Cell Disease ◽  
Body Magnetic Resonance Imaging

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.

Use of whole-body diffusion-weighted magnetic resonance imaging for the diagnosis and therapeutic response of multiple myeloma

2014 ◽  
Vol 155 (31) ◽  
pp. 1241-1245
Author(s):  
Tamás Puskás ◽  
Imre Henits
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Myeloma ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Functional Imaging ◽  
Bone Marrow Infiltration ◽  
Resonance Imaging ◽  
Diffusion Weighted ◽  
Weighted Magnetic Resonance Imaging ◽  
Weighted Sequences

Introduction: Multiple myeloma is an incurable neoplastic disorder of B cells characterized by diffuse bone marrow infiltration, circumscribed bone lesions, and soft-tissue spreading. The role of novel functional imaging techniques in multiple myeloma includes initial staging of the disease, detection and characterization of complications, and evaluation of the response to treatment. Aim: The authors present their 2 and a half-year experience with diffusion-weighted magnetic resonance imaging in staging and follow up of patients with multiple myeloma. Method: Conventional T1 weighted, T2 weighted fat suppressed and 2 b-values diffusion-weighted sequences were performed from skull base to symphysis in 27 patients suspected to have multiple myeloma. Apparent diffusion coefficient calculation was carried out in 3 cases. The final diagnosis of multiple myeloma was verified by bone-marrow biopsy. Results: In 13 cases magnetic resonance imaging revealed the suspected disease. In one patient magnetic resonance imaging failed to detect the disease because of metallic artifacts. In 6 cases diffusion-weighted sequences showed additional information about bone-marrow infiltration. Conclusions: Diffusion-weighted magnetic resonance imaging with conventional sequences is a useful and promising functional imaging modality in the early diagnosis of myeloma multiple. Orv. Hetil., 2014, 155(31), 1241–1245.

scholarly journals Whole-body magnetic resonance imaging for diagnosis and treatment monitoring in multiple myeloma

2020 ◽  
Vol 65 (4) ◽  
pp. 431-443
Author(s):  
N. S. Lutsik ◽  
L. P. Mendeleeva ◽  
M. V. Solovev ◽  
S. M. Kulikov ◽  
Yu. A. Chabaeva ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Myeloma ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Whole Body ◽  
Relative Reduction ◽  
Resonance Imaging ◽  
Whole Body Mri ◽  
Adc Values ◽  
Antitumour Response

Introduction. Whole-body diffusion-weighted magnetic resonance imaging (MRI) is an informative method for bone marrow infiltration diagnosis in patients with multiple myeloma (MM) and post-monitoring in autologous haematopoietic stem cell transplantation (auto-HSCT).Aim: to study bone marrow lesions in MM patients using whole-body MRI prior to and after chemotherapy with subsequent auto-HSCT.Materials and methods. Forty patients with MM were included in a prospective study of whole-body MRI before and after high-dose chemotherapy with auto-HSCT. All patients had whole-body MRI prior to and at +100 day of auto-HSCT. Antitumour response was assessed after induction and at +100 day. The number and volume of bone marrow lesions prior to and at +100 day of auto-HSCT were determined, along with apparent diffusion coefficient (ADC) in the lesions.Results. We observed a significant reduction of 29 % in the number of lesions, 40 % — in their volume and 33 % — in ADC. A significant correlation was revealed between relative reduction in the number and volume of foci (r = 0.52, p = 0.0017). A correlation was found between relative reduction in the foci number and ADC (r = 0.47, p = 0.016). Patients with lesions > 7 cm3 in MRI data exhibited a lesser reduction in the foci number and volume and ADC values after auto-HSCT compared to patients with lesions < 7 cm3.Conclusion. Whole-body MRI with diffusion-weighted imaging and subsequent estimation of the number and volume of lesions and their ADC values prior to and after auto-HSCT add power to assessing antitumour response in MM patients with auto-HSCT.

Clinical and Prognostic Relevance of Magnetic Resonance Imaging of the Spine in Newly Diagnosed Multiple Myeloma Patients Receiving Autologous Stem Cell Transplantation.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4728-4728
Author(s):  
Patrizia Tosi ◽  
Elena Zamagni ◽  
Paola Tacchetti ◽  
Eugenio Salizzoni ◽  
Giulia Perrone ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Myeloma ◽  
Bone Marrow ◽  
Stem Cell ◽  
Magnetic Resonance ◽  
Bone Marrow Involvement ◽  
Newly Diagnosed ◽  
Resonance Imaging ◽  
Negative Pattern ◽  
Focal Pattern

Abstract Magnetic resonance imaging (MRI) of the spine has demonstrated to be a useful tool for correct staging of multiple myeloma (MM), as it is more sensitive than plain x-rays in detecting vertebral lesions. Furthermore, different patterns of bone marrow involvement (focal, diffuse or normal) can be depicted, and this could contribute to better define the prognosis in newly diagnosed patients. In the present study we prospectively evaluated the clinical and prognostic role of spinal MRI in 120 newly diagnosed MM patients (68M, 52F, median age = 56yrs) that subsequently received high-dose chemotherapy and autologous stem cell transplantion, either single (n=28) or double (n=92). Pattern of marrow involvement was focal in 72 cases (60%), diffuse in 29 (24%) and negative in 19 (16%). Patients with a diffuse pattern showed a significantly higher bone marrow plasma cell infiltration (p=0.05) and beta2 microglobulin values (p= 0.04) as compared to patients with a focal pattern; stage III disease according to ISS was observed in 29%, 8% and 1% of patients with a diffuse, focal or negative pattern, respectively. Response rate to treatment program was similar in the three groups of patients, with a stringently defined CR obtained in 34% of patients with a focal pattern, 29% in those with a diffuse pattern and 35% in patients with a negative MRI. Median progression-free survival showed a trend in favor of patients with a negative MRI (54 months) as compared to those with a focal or diffuse pattern (42 and 38 months, respectively). A focal pattern of bone marrow involvement was associated with a significantly higher probability of experiencing an overt vertebral lesion (73% vs 48% in patients with diffuse pattern, p=0.03), including either a compression fracture or a vertebral mass. Consistently with this finding, also extra-spinal bone lesions were more common in patients with a focal pattern (66%) as compared to patients with a diffuse or negative pattern (42% and 6% respectively) (p=0.05). Serum crosslaps were significantly increased in patients with a focal pattern (7032 pmol/L±635SE vs 5431pmol/L±812SE in those with a diffuse pattern, p=0.04). According to our data, a diffuse pattern of bone marrow involvement could be predictive of a more aggressive disease, even though these data needs to be confirmed in a larger series of patients. A focal pattern of bone marrow involvement at diagnosis could help to identify MM patients more prone to develop skeletal complications, so that a careful monitoring and bisphosphonate therapy should be recommended.

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