Lacognata C, Crimì F, Guolo A, Varin C, De March E, Vio S, Ponzoni A, Barilà G, Lico A, Branca A, De Biasi E, Gherlinzoni F, Scapin V, Bissoli E, Berno T, Zambello R
Radiology Section, Department of Medicine DIMED, University-Hospital of Padua, Italy.
Radiology Section, Department of Medicine DIMED, University-Hospital of Padua, Italy.
Clin Radiol. 2017 Oct;72(10):850-857. doi: 10.1016/j.crad.2017.05.004. Epub 2017 Jun 3.
To evaluate the modifications of the apparent diffusion coefficient (ADC) in myelomatous lesions before and after induction treatment and the correlation with patient response to therapy according to International Myeloma Working Group (IMWG) criteria.
A homogeneous group of 18 patients with a diagnosis of symptomatic multiple myeloma who underwent whole-body MRI with diffusion-weighted imaging (DWI-MRI) before and after bortezomib-based induction chemotherapy were evaluated prospectively. Quantitative analysis of ADC maps of myelomatous lesions was performed with the following pattern types: focal pattern, diffuse pattern (moderate and severe), and "salt and pepper" pattern. Lesions were evaluated by quantitative image analysis including measurement of the mean ADC in three measurements. Imaging results were compared to laboratory results as the clinical reference standard.
A statistically significant increase in ADC values were found in the lesions of patients that responded to treatment. Interestingly, focal lesions showed a strongly significant increase in ADC values in responders, whereas no significant variation in ADC value in non-focal lesions (diffuse pattern and "salt and peppers" pattern) between responders and non-responders group was demonstrated.
DWI-MRI could provide additional quantitative information useful in monitoring early therapy response according to ADC changes of focal lesions.
评估诱导治疗前后骨髓瘤病灶表观扩散系数（ADC）的变化，以及根据国际骨髓瘤工作组（IMWG）标准与患者治疗反应的相关性。
前瞻性评估了一组18例确诊为有症状多发性骨髓瘤的患者，这些患者在基于硼替佐米的诱导化疗前后均接受了全身磁共振成像（MRI）及扩散加权成像（DWI-MRI）检查。对骨髓瘤病灶的ADC图进行定量分析，采用以下模式类型：局灶性模式、弥漫性模式（中度和重度）和“椒盐”模式。通过定量图像分析评估病灶，包括在三次测量中测量平均ADC值。将影像学结果与实验室结果作为临床参考标准进行比较。
在对治疗有反应的患者病灶中发现ADC值有统计学意义的增加。有趣的是，局灶性病灶在有反应者中显示出ADC值有极显著增加，而在有反应者和无反应者组之间，非局灶性病灶（弥漫性模式和“椒盐”模式）的ADC值无显著差异。
DWI-MRI可根据局灶性病灶的ADC变化提供有助于监测早期治疗反应的额外定量信息。
