Scudla V, Herman M, Minarík J, Pika T, Hrbek J, Bacovský J, Heinzová V
III. Interní klinika Lékarské fakulty UP a FN Olomouc.
Vnitr Lek. 2011 Jan;57(1):52-60.
The aim of the study was to assess the contribution of the whole body MRI (WB-MRI) in the diagnostics of monoclonal gammopathy of undetermined significance (MGUS) and initial, asymptomatic form of multiple myeloma (MM), as well as the evaluation of practical usefulness of the Durie-Salmon Plus staging system (D-S Plus).
The analyzed 86-patient cohort consisted of 28 patients with MGUS and 54 patients with newly diagnosed multiple myeloma and 4 patients with solitary plasmocytoma (SP). WB-MRI was evaluated using Magnetom Avanto 1.5 T with the use of virtual whole body coil with sequential acquisition on 7 levels and 2 sequentions--T2 STIR and T1. Based on the number of lesions and the degree of diffuse involvement we assessed the D-S Plus stage, and compared it to the results of standard staging systems according to Durie Salmon (D-S) and International Staging System (ISS). Statistical estimation was done using the Cohen kappa test and McNemara-Bowker test at p < 0.05.
In the group of 28 individuals with MGUS, there were 17 (61%) patients fulfilling the IMWG criteria and/orWB-MRI criteria of incipient MM. In 4/17 (23%) patients we described a more advanced stage when comparing D-S Plus to D-S. Nine out of fourteen (64%) patients with MGUS transforming into MM with negative radiological assessment had positive findings on WB-MRI. The character of WB-MRI findings lead in 9/17 (53%) of the patients to the initiation of induction treatment. Stratification according to D-S Plus divided the 54 newly diagnosed patients with MM into stage 1 (16.7%), stage 2 (33.3%) and stage 3 (50%). In 22% there was a shift into a higher stage using DS-Plus in comparison with D-S, in 9% of the patients the shift lead to downstaging. When comparing the results of ISS vs D-S Plus we found that the system based on WB-MRI showed in 41% of the patients higher stage and only in 9% of the patients lower stage. In 13% of MM patients we described extramedulary masses of the tumor, especially in paraspinal region. In 1 of the 4 SP patients the WB-MRI changed the diagnosis into multifocal plasmocytoma.
WB-MRI is a very contributive imaging method with substantially higher resolution than conventional radiography. It is able to evaluate the grade and the extent of myeloma bone disease. It improves the diagnostic approach in the differentiation of stable MGUS from the phase of malignant transformation into MM. The D-S Plus system proved to be contributive and is competent to become a routine part of diagnostic and stratification algorithms in MGUS and MM.
本研究旨在评估全身磁共振成像（WB-MRI）在意义未明的单克隆丙种球蛋白病（MGUS）及初始无症状性多发性骨髓瘤（MM）诊断中的作用，以及评估Durie-Salmon Plus分期系统（D-S Plus）的实际应用价值。
分析的86例患者队列包括28例MGUS患者、54例新诊断的多发性骨髓瘤患者和4例孤立性浆细胞瘤（SP）患者。使用Magnetom Avanto 1.5 T磁共振成像仪，采用虚拟全身线圈，在7个层面进行序列采集，包括T2 STIR和T1两个序列，对WB-MRI进行评估。根据病变数量和弥漫性受累程度评估D-S Plus分期，并与Durie Salmon（D-S）标准分期系统和国际分期系统（ISS）的结果进行比较。采用Cohen kappa检验和McNemara-Bowker检验进行统计学评估，p<0.05。
在28例MGUS患者组中，有17例（61%）患者符合国际骨髓瘤工作组（IMWG）标准和/或早期MM的WB-MRI标准。将D-S Plus与D-S进行比较时，4/17例（23%）患者的分期更晚。14例MGUS转化为MM且放射学评估为阴性的患者中，9例（64%）在WB-MRI上有阳性发现。WB-MRI检查结果使9/17例（53%）患者开始进行诱导治疗。根据D-S Plus分期，54例新诊断的MM患者分为1期（16.7%）、2期（33.3%）和3期（50%）。与D-S相比，22%的患者使用D-S Plus分期时分期升高，9%的患者分期降低。比较ISS与D-S Plus的结果时，发现基于WB-MRI的系统在41%的患者中显示分期更高，仅在9%的患者中显示分期更低。13%的MM患者存在髓外肿瘤肿块，尤其是椎旁区域。4例SP患者中有1例，WB-MRI将诊断改为多灶性浆细胞瘤。
WB-MRI是一种非常有价值的成像方法，分辨率明显高于传统放射学检查。它能够评估骨髓瘤骨病的分级和范围。在区分稳定的MGUS与向MM恶性转化阶段方面，它改善了诊断方法。D-S Plus系统被证明是有价值的，有能力成为MGUS和MM诊断及分层算法的常规组成部分。
