Frequency, distribution and clinical management of incidental findings and extramedullary plasmacytomas in whole body diffusion weighted magnetic resonance imaging in patients with multiple myeloma

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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Role of Magnetic Resonance Imaging in the Management of Patients With Multiple Myeloma: A Consensus Statement

Journal of Clinical Oncology ◽

10.1200/jco.2014.57.9961 ◽

2015 ◽

Vol 33 (6) ◽

pp. 657-664 ◽

Cited By ~ 202

Author(s):

Meletios A. Dimopoulos ◽

Jens Hillengass ◽

Saad Usmani ◽

Elena Zamagni ◽

Suzanne Lentzsch ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Myeloma ◽

Magnetic Resonance ◽

Bone Destruction ◽

Whole Body ◽

Focal Lesion ◽

Resonance Imaging ◽

Pelvic Mri ◽

Symptomatic Disease ◽

Osteoporotic Vertebral Fractures

Purpose The aim of International Myeloma Working Group was to develop practical recommendations for the use of magnetic resonance imaging (MRI) in multiple myeloma (MM). Methods An interdisciplinary panel of clinical experts on MM and myeloma bone disease developed recommendations for the value of MRI based on data published through March 2014. Recommendations MRI has high sensitivity for the early detection of marrow infiltration by myeloma cells compared with other radiographic methods. Thus, MRI detects bone involvement in patients with myeloma much earlier than the myeloma-related bone destruction, with no radiation exposure. It is the gold standard for the imaging of axial skeleton, for the evaluation of painful lesions, and for distinguishing benign versus malignant osteoporotic vertebral fractures. MRI has the ability to detect spinal cord or nerve compression and presence of soft tissue masses, and it is recommended for the workup of solitary bone plasmacytoma. Regarding smoldering or asymptomatic myeloma, all patients should undergo whole-body MRI (WB-MRI; or spine and pelvic MRI if WB-MRI is not available), and if they have > one focal lesion of a diameter > 5 mm, they should be considered to have symptomatic disease that requires therapy. In cases of equivocal small lesions, a second MRI should be performed after 3 to 6 months, and if there is progression on MRI, the patient should be treated as having symptomatic myeloma. MRI at diagnosis of symptomatic patients and after treatment (mainly after autologous stem-cell transplantation) provides prognostic information; however, to date, this does not change treatment selection.

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