Zhang Lu, Wang Qin, Wu Xia, Zhao Ailin, Feng Jun, Zhang Haibo, Cao Xinxin, Li Shuo, Cai Huacong, Sun Zhaoyong, Duan Minghui, Zhu Tienan, Zhang Wei, Jin Zhengyu, Zhou Daobin, Xue Huadan, Li Jian
Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Eur Radiol. 2021 Apr;31(4):1843-1852. doi: 10.1007/s00330-020-07295-6. Epub 2020 Sep 23.
To illuminate the prognostic value of ADC (apparent diffusion coefficient), an important quantitative parameter of diffusion-weighted MRI, for multiple myeloma (MM).
A prospective single-center study which enrolled 114 consecutive newly diagnosed MM patients with baseline whole-body diffusion-weighted MRI (WB DW-MRI) results was conducted. Baseline clinical and MRI parameters were analyzed with univariate and multivariate approaches to identify independent risk factors for progression-free survival (PFS) and overall survival (OS).
Five different DW-MRI patterns were seen, and the mean ADC value of the representative background bone marrow was 0.4662 ± 0.1939 × 10 mm/s. After a mean follow-up of 50.2 months (range, 15.7-75.8 months), twenty-four patients died and seven were lost to follow-up. The mean ADC value of the representative background bone marrow was showed to be an independent risk factor for both PFS (HR 4.664; 95% confidence interval (CI) 1.138-19.121; p = 0.032) and OS (HR 14.130; 95% CI 1.544-129.299; p = 0.019). Normal/salt-and-pepper pattern on DW-MRI was associated with PFS using univariate analysis (p = 0.035) but lost the significance with multivariate Cox regression.
Mean ADC value of the representative background bone marrow predicts both PFS and OS which suggests the role of baseline DW-MRI for risk stratification in newly diagnosed MM patients.
• Whole-body diffusion-weighted MRI (WB DW-MRI) might be helpful to improve the current risk stratification systems for newly diagnosed multiple myeloma (MM). • Morphological parameters as MRI pattern and focal lesion-associated parameters have been reported to be related to survival. However, important functional parameters such as apparent diffusion coefficient (ADC) values were not incorporated into the current risk stratification model. • This study is one of the first endeavors to delineate the correlation of baseline ADC values and survival in MM patients. It is revealed that the mean ADC value of the representative background bone marrow (L3-S1 and iliac bone) was an independent risk factor for both PFS and OS.
阐明扩散加权磁共振成像的重要定量参数——表观扩散系数（ADC）对多发性骨髓瘤（MM）的预后价值。
进行了一项前瞻性单中心研究，纳入114例连续的新诊断MM患者，这些患者均有基线全身扩散加权磁共振成像（WB DW-MRI）结果。采用单因素和多因素方法分析基线临床和MRI参数，以确定无进展生存期（PFS）和总生存期（OS）的独立危险因素。
观察到五种不同的DW-MRI模式，代表性背景骨髓的平均ADC值为0.4662±0.1939×10⁻³mm²/s。平均随访50.2个月（范围15.7 - 75.8个月）后，24例患者死亡，7例失访。代表性背景骨髓的平均ADC值被证明是PFS（风险比[HR]4.664；95%置信区间[CI]1.138 - 19.121；p = 0.032）和OS（HR 14.130；95%CI 1.544 - 129.299；p = 0.019）的独立危险因素。DW-MRI上的正常/椒盐模式在单因素分析中与PFS相关（p = 0.035），但在多因素Cox回归中失去显著性。
代表性背景骨髓的平均ADC值可预测PFS和OS，这表明基线DW-MRI在新诊断MM患者风险分层中的作用。
• 全身扩散加权磁共振成像（WB DW-MRI）可能有助于改进当前新诊断多发性骨髓瘤（MM）的风险分层系统。
• 据报道，MRI模式等形态学参数和局灶性病变相关参数与生存相关。然而，诸如表观扩散系数（ADC）值等重要功能参数未纳入当前风险分层模型。
• 本研究是最早描述MM患者基线ADC值与生存相关性的研究之一。结果显示，代表性背景骨髓（L3 - S1和髂骨）的平均ADC值是PFS和OS的独立危险因素。
