Department of Diagnostic Radiology, Eberhard-KarlsUniversity, Hoppe-Seyler-Strasse 3, Tuebingen 72076, Germany.
AJR Am J Roentgenol. 2011 Jun;196(6):W790-5. doi: 10.2214/AJR.10.5979.
The purpose of our study was to prospectively assess the feasibility of whole-body diffusion-weighted imaging (DWI) for short-term evaluation of response to treatment in multiple myeloma patients using a single-shot echo-planar imaging DWI sequence with a Stejskal-Tanner diffusion encoding scheme and spectral fat suppression.
Twelve consecutive patients (nine men and three women; mean age, 61.4 years; age range, 54-79 years) underwent whole-body DWI (b = 50, 400, and 800 s/mm(2)) both at baseline and 3 weeks (mean, 23 days) after onset of therapy. Bone marrow and extramedullary manifestations were evaluated by quantitative image analysis using measurements of the mean apparent diffusion coefficient (ADC). These parameters were correlated with myeloma response according to standard criteria and were evaluated parallel to MRI and continuously for more than 6 months afterward.
Fifty-three myeloma lesions, 50 medullary (28 axial and 22 appendicular skeleton) and three extramedullary, were analyzed. Eleven patients were classified as responders and one as a nonresponder. DWI results accurately (100%) correlated with disease course according to standard clinical and laboratory criteria. All involved lesions showed restricted diffusion at baseline. ADC quantification yielded an increase of 63.9% (range, 8.7-211.3%) in responders and a decrease of 7.8% in the sole nonresponding patient during therapy. In parallel, M-gradient measurement showed a mean decrease of 45.1% (range, 19.6-88.8%) in responders and an increase of 21.8% in the nonresponder. Amplitude of response measured by the course of ADC values proved higher in the appendicular skeleton (99.8%) compared with the axial skeleton (54.3%) (p = 0.037).
Whole-body DWI with ADC analysis represents a feasible diagnostic tool for assessment of short-term treatment response in myeloma patients.
本研究旨在前瞻性评估单次激发回波平面成像弥散加权成像（DWI）序列结合 Stejskal-Tanner 弥散编码方案和频谱脂肪抑制技术在多发性骨髓瘤患者中的短期疗效评估中的可行性。
12 例连续患者（9 名男性，3 名女性；平均年龄 61.4 岁；年龄范围 54-79 岁）在治疗开始后 3 周（平均 23 天）进行全身 DWI（b 值为 50、400 和 800 s/mm2）检查。通过定量图像分析测量平均表观扩散系数（ADC）评估骨髓和骨髓外表现。这些参数与根据标准标准的骨髓瘤反应相关，并与 MRI 平行评估，超过 6 个月后持续评估。
分析了 53 个骨髓瘤病变，50 个骨髓（28 个轴向和 22 个四肢骨骼）和 3 个骨髓外病变。11 例患者被归类为反应者，1 例为非反应者。DWI 结果与标准临床和实验室标准的疾病过程准确（100%）相关。所有病变在基线时均显示受限扩散。ADC 定量分析显示，在治疗过程中，反应者的 ADC 值增加了 63.9%（范围 8.7-211.3%），而唯一的非反应者的 ADC 值下降了 7.8%。同时，M-梯度测量显示反应者的平均下降了 45.1%（范围 19.6-88.8%），而非反应者的增加了 21.8%。通过 ADC 值的变化来衡量的反应幅度在四肢骨骼（99.8%）明显高于轴向骨骼（54.3%）（p=0.037）。
全身 ADC 分析弥散加权成像代表了一种可行的诊断工具，可用于评估骨髓瘤患者的短期治疗反应。
