TY - JOUR
T1 - Magnetic resonance imaging in multiple myeloma
T2 - Diagnostic and clinical implications
AU - Walker, Ronald
AU - Barlogie, Bart
AU - Haessler, Jeffrey
AU - Tricot, Guido
AU - Anaissie, Elias
AU - Shaughnessy, John D.
AU - Epstein, Joshua
AU - Van Hemert, Rudy
AU - Erdem, Eren
AU - Hoering, Antje
AU - Crowley, John
AU - Ferris, Ernest
AU - Hollmig, Klaus
AU - Van Rhee, Frits
AU - Zangari, Maurizio
AU - Pineda-Roman, Mauricio
AU - Mohiuddin, Abid
AU - Yaccoby, Shmuel
AU - Sawyer, Jeffrey
AU - Angtuaco, Edgardo J.
PY - 2007/3/20
Y1 - 2007/3/20
N2 - Purpose: Magnetic resonance imaging (MRI) permits the detection of diffuse and focal bone marrow infiltration in the absence of osteopenia or focal osteolysis on standard metastatic bone surveys (MBSs). Patients and Methods: Both baseline MBS and MRI were available in 611 of 668 myeloma patients who were treated uniformly with a tandem autologous transplantation-based protocol and were evaluated to determine their respective merits for disease staging, response assessment, and outcome prediction. Results: MRI detected focal lesions (FLs) in 74% and MBS in 56% of imaged anatomic sites; 52% of 267 patients with normal MBS results and 20% of 160 with normal MRI results had FL on MRI and MBS, respectively. MRI- but not MBS-defined FL independently affected survival. Cytogenetic abnormalities (CAs) and more than seven FLs on MRI (MRI-FLs) distinguished three risk groups: 5-year survival was 76% in the absence of both more than seven MRI-FLs and CA (n = 276), 61 % in the presence of one MRI-FL (n = 262), and 37% in the presence of both unfavorable parameters (n = 67). MRI-FL correlated with low albumin and elevated levels of C-reactive protein, lactate dehydrogenase, and creatinine, but did not correlate with age, beta-2-microglobulin, and CA. Resolution of MRI-FL, occurring in 60% of cases and not seen with MBS-defined FL, conferred superior survival. Conclusion: MRI is a more powerful tool for detection of FLs than is MBS. MRI-FL number had independent prognostic implications; additionally, MRI-FL resolution identified a subgroup with superior survival. We therefore recommend that, in addition to MBS, MRI be used routinely for staging, prognosis, and response assessment in myeloma.
AB - Purpose: Magnetic resonance imaging (MRI) permits the detection of diffuse and focal bone marrow infiltration in the absence of osteopenia or focal osteolysis on standard metastatic bone surveys (MBSs). Patients and Methods: Both baseline MBS and MRI were available in 611 of 668 myeloma patients who were treated uniformly with a tandem autologous transplantation-based protocol and were evaluated to determine their respective merits for disease staging, response assessment, and outcome prediction. Results: MRI detected focal lesions (FLs) in 74% and MBS in 56% of imaged anatomic sites; 52% of 267 patients with normal MBS results and 20% of 160 with normal MRI results had FL on MRI and MBS, respectively. MRI- but not MBS-defined FL independently affected survival. Cytogenetic abnormalities (CAs) and more than seven FLs on MRI (MRI-FLs) distinguished three risk groups: 5-year survival was 76% in the absence of both more than seven MRI-FLs and CA (n = 276), 61 % in the presence of one MRI-FL (n = 262), and 37% in the presence of both unfavorable parameters (n = 67). MRI-FL correlated with low albumin and elevated levels of C-reactive protein, lactate dehydrogenase, and creatinine, but did not correlate with age, beta-2-microglobulin, and CA. Resolution of MRI-FL, occurring in 60% of cases and not seen with MBS-defined FL, conferred superior survival. Conclusion: MRI is a more powerful tool for detection of FLs than is MBS. MRI-FL number had independent prognostic implications; additionally, MRI-FL resolution identified a subgroup with superior survival. We therefore recommend that, in addition to MBS, MRI be used routinely for staging, prognosis, and response assessment in myeloma.
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U2 - 10.1200/JCO.2006.08.5803
DO - 10.1200/JCO.2006.08.5803
M3 - Article
C2 - 17296972
AN - SCOPUS:34047195753
SN - 0732-183X
VL - 25
SP - 1121
EP - 1128
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 9
ER -