Department of Radiology, MR-1K12, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium.
Eur J Radiol. 2013 Sep;82(9):1444-52. doi: 10.1016/j.ejrad.2013.04.012. Epub 2013 May 28.
To evaluate the significance of dynamic contrast enhanced MRI (DCE-MRI) and whole body MRI (WB-MRI) in the diagnosis, prognosis and assessment of therapy for patients with monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM).
The retrospective study includes 219 patients providing 463 WB-MRI and DCE-MRI investigations for the subgroups MGUS (n=70), MM active disease (n=126; this includes 70 patients with new diagnosis of MM, according to the International Staging System (ISS): 41.4% ISS stage I, 20.0% ISS stage II, 7.1% ISS stage III, 31.4% insufficient for staging; and 56 patients with '(re-)active disease': 16.07% relapse, 32.14% progressive disease and 51.79% stable disease) and MM remission (n=23; 60.87% complete remission, 17.39% very good partial remission and 21.74% partial remission). Investigations of patients with hereditary multiple exostoses (n=5), neurofibromatosis (n=7) and healthy persons (n=9) were added as control subjects (n=21). WB-MRI evaluation was done by evaluating thirteen skeletal regions, providing a 'skeletal score'. DCE-MRI images of the spine, were analyzed with regions-of-interest and time-intensity-curves (TIC).
All TIC parameters can significantly differentiate between the predefined subgroups (p<0.001). One hundred days after autologous stem cell transplantation a 75% decrease of the slope wash-in value (p<0.001) can be seen. A cubic regression trend between 'skeletal score' and slope wash-in (adj.R(2)=0.412) could demonstrate a significant increase bone marrow perfusion if MM affects more than 10 skeletal regions (p<0.001), associated with a poorer prognosis (p<0.001).
DCE-MRI evaluation of the spine is useful for diagnosis of MM, follow-up after stem cell transplantation and evaluation of disease activity. A combined evaluation with WB-MRI and DCE-MRI provides additional micro-vascular information on the morphologic lesions and could help categorize patients with MM in two different groups to offer useful therapeutic and prognostic advise.
评估动态对比增强磁共振成像（DCE-MRI）和全身磁共振成像（WB-MRI）在单克隆丙种球蛋白病（MGUS）和多发性骨髓瘤（MM）患者的诊断、预后和疗效评估中的意义。
本回顾性研究纳入 219 例患者，共进行了 463 次 WB-MRI 和 DCE-MRI 检查，分为 MGUS 亚组（n=70）、MM 活动期疾病（n=126；包括新诊断的 MM 患者 70 例，根据国际分期系统（ISS）：ISS 分期 I 期 41.4%、ISS 分期 II 期 20.0%、ISS 分期 III 期 7.1%、ISS 分期不足 31.4%；以及 56 例“（再）活动性疾病”：复发 16.07%、进展性疾病 32.14%、稳定疾病 51.79%）和 MM 缓解期（n=23；完全缓解 60.87%、非常好的部分缓解 17.39%、部分缓解 21.74%）。还纳入遗传性多发性外生骨疣（n=5）、神经纤维瘤病（n=7）和健康人（n=9）作为对照（n=21）。对 13 个骨骼区域进行 WB-MRI 评估，提供“骨骼评分”。对脊柱 DCE-MRI 图像进行感兴趣区和时间-强度曲线（TIC）分析。
所有 TIC 参数均能在预设的亚组间进行显著区分（p<0.001）。自体干细胞移植后 100 天，斜率达峰时间值的下降幅度为 75%（p<0.001）。脊柱 DCE-MRI 的斜率达峰时间值与“骨骼评分”之间存在立方回归趋势（adj.R²=0.412），如果 MM 累及 10 个以上骨骼区域，骨髓灌注明显增加（p<0.001），且预后较差（p<0.001）。
脊柱 DCE-MRI 评估对 MM 的诊断、干细胞移植后的随访和疾病活动度的评估均有帮助。WB-MRI 和 DCE-MRI 的联合评估可提供形态学病变的额外微血管信息，并可将 MM 患者分为两个不同的组，为提供有价值的治疗和预后建议提供帮助。
