Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany.
Theranostics. 2019 Jul 9;9(16):4756-4763. doi: 10.7150/thno.33289. eCollection 2019.
Due to the low frequency of abnormalities affecting the spleen, this organ is often overlooked during radiological examinations. Here, we report on the unexpected finding, that the spleen signal on diffusion-weighted MRI (DW-MRI) is associated with clinical parameters in patients with plasma cell dyscrasias. : We investigated the spleen signal on DW-MRI together with clinical and molecular parameters in 295 transplant-eligible newly diagnosed Multiple Myeloma (NDMM) patients and in 72 cases with monoclonal gammopathy of undetermined significance (MGUS). : Usually, the spleen is the abdominal organ with the highest intensities on DW-MRI. Yet, significant signal loss on DW-MRI images was seen in 71 of 295 (24%) NDMM patients. This phenomenon was associated with the level of bone marrow plasmacytosis (=1x10) and International Staging System 3 (=0.0001) but not with gain(1q), and del(17p) or plasma cell gene signatures. The signal was preserved in 72 individuals with monoclonal gammopathy of undetermined significance and generally re-appeared in MM patients responding to treatment, suggesting that lack of signal reflects increased tumor burden. While absence of spleen signal in MM patients with high risk disease defined a subgroup with very poor outcome, re-appearance of the spleen signal after autologous stem cell transplantation was seen in patients with improved outcome. Our preliminary observation suggests that extramedullary hematopoiesis in the spleen is a factor that modifies the DW-MRI signal of this organ. : The DW-MRI spleen signal is a promising marker for tumor load and provides prognostic information in MM.
由于影响脾脏的异常情况频率较低，因此在放射学检查中，该器官经常被忽视。在这里，我们报告了一个意外发现，即在浆细胞异常患者中，弥散加权 MRI（DW-MRI）上的脾脏信号与临床参数有关。我们研究了 295 例适合移植的新诊断多发性骨髓瘤（NDMM）患者和 72 例单克隆丙种球蛋白血症（MGUS）的 DW-MRI 上的脾脏信号与临床和分子参数之间的关系。通常，脾脏是 DW-MRI 上信号强度最高的腹部器官。然而，在 295 例 NDMM 患者中的 71 例（24%）中，DW-MRI 图像上可见明显的信号丢失。这种现象与骨髓浆细胞增多症水平（=1x10）和国际分期系统 3（=0.0001）有关，但与获得（1q）、缺失（17p）或浆细胞基因特征无关。在 72 例单克隆丙种球蛋白血症患者中信号得到保留，且在对治疗有反应的 MM 患者中信号通常重新出现，这表明信号缺失反映了肿瘤负荷增加。虽然在高风险疾病定义的 MM 患者中缺乏脾脏信号，这是预后极差的亚组，但在自体干细胞移植后脾脏信号的重新出现见于预后改善的患者。我们的初步观察表明，脾脏中的骨髓外造血是改变该器官 DW-MRI 信号的一个因素。DW-MRI 脾脏信号是肿瘤负荷的一个有前途的标志物，可为 MM 提供预后信息。
