多发性骨髓瘤 MRI 早期治疗反应评估：全身弥散加权和腰椎 MRI 的对比研究。

Assessment of early treatment response on MRI in multiple myeloma: Comparative study of whole-body diffusion-weighted and lumbar spinal MRI.

机构信息

Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.

Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.

出版信息

PLoS One. 2020 Feb 27;15(2):e0229607. doi: 10.1371/journal.pone.0229607. eCollection 2020.

OBJECTIVES

To compare remission status at completion of chemotherapy for multiple myeloma (MM) with changes in total diffusion volume (tDV) calculated from whole-body diffusion-weighted imaging (WB-DWI) and fat fraction (FF) of lumbar bone marrow (BM) by modified Dixon Quant (mDixon Quant) soon after induction of chemotherapy, and to assess the predictive value of MRI.

METHODS

Fifty patients (mean age, 66.9 ± 10.5 years) with symptomatic myeloma were examined before and after two cycles of chemotherapy. From WB-DWI data, tDV was obtained with the threshold for positive BM involvement. Mean FF was calculated from lumbar BM using the mDixon Quant sequence. At the completion of chemotherapy, patients were categorized into a CR/very good PR (VGPR) group (n = 15; mean age, 67.6 ± 10.3 years) and a PR, SD or PD group (n = 35; mean age, 69.1 ± 8.6 years). ROC curves were plotted to assess performance in predicting achievement of CR/VGPR.

RESULTS

At second examination, serum M protein, β2-microglobulin, and tDV were significantly decreased and hemoglobin, mean ADC, and FF were significantly increased in the CR/VGPR group and serum M protein was significantly increased in the PR/SD/PD group. The general linear model demonstrated that percentage changes in FF and M protein contributed significantly to achieving CR/VGPR (P = 0.02, P = 0.04, respectively). AUCs of ROC curves were 0.964 for FF and 0.847 for M protein.

CONCLUSIONS

Early change in FF of lumbar BM and serum M protein soon after induction of chemotherapy contributed significantly to prediction of CR/VGPR.

目的

比较多发性骨髓瘤（MM）患者在完成化疗时的缓解状态，以及在诱导化疗后不久通过全身扩散加权成像（WB-DWI）计算的总扩散体积（tDV）和改良 Dixon Quant（mDixon Quant）的腰椎骨髓（BM）脂肪分数（FF）的变化，并评估 MRI 的预测价值。

方法

50 例有症状骨髓瘤患者（平均年龄 66.9±10.5 岁）在化疗前和化疗后 2 个周期时进行了检查。从 WB-DWI 数据中，使用阳性 BM 受累的阈值获得 tDV。使用 mDixon Quant 序列从腰椎 BM 计算平均 FF。在化疗完成时，将患者分为完全缓解/非常好的部分缓解（VGPR）组（n=15；平均年龄 67.6±10.3 岁）和部分缓解、稳定或进展组（n=35；平均年龄 69.1±8.6 岁）。绘制 ROC 曲线以评估预测实现 CR/VGPR 的性能。

结果

在第二次检查时，CR/VGPR 组的血清 M 蛋白、β2-微球蛋白和 tDV 明显降低，血红蛋白、平均 ADC 和 FF 明显升高，PR/SD/PD 组的血清 M 蛋白明显升高。一般线性模型表明，FF 和 M 蛋白的百分比变化对实现 CR/VGPR 有显著贡献（P=0.02，P=0.04）。FF 和 M 蛋白的 ROC 曲线 AUC 分别为 0.964 和 0.847。