Sun Mengtian, Cheng Jingliang, Ren Cuiping, Zhang Yong, Li Yinhua, Li Ying, Zhang Suping
Department of Magnetic Resonance, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Hematology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Quant Imaging Med Surg. 2021 Aug;11(8):3767-3780. doi: 10.21037/qims-20-1361.
To assess the quantification of tumor burden in multiple myeloma (MM) patients using whole-body magnetic resonance imaging (MRI) and to identify the correlation between MRI parameters and prognostic biomarkers.
We retrospectively analyzed 95 newly diagnosed MM patients treated at our hospital from June 2018 to March 2020. All patients underwent whole-body MRI examination, including diffusion-weighted whole-body imaging with background body signal suppression (DWIBS), modified Dixon chemical-shift imaging (mDIXON), and short TI inversion recovery (STIR) sequences. The MRI presentation was used to determine MM infiltration patterns and calculate apparent diffusion coefficient (ADC) and a fat fraction (FF). The one-way ANOVA and Kruskal-Wallis test were used to compare the differences of these values between DS, ISS, and R-ISS stages in different MM infiltration patterns. Spearman correlation test was used for correlation analysis of ADC and FF against prognostic biomarkers, and two independent sample -test was used to evaluate the differences of ADC and FF in different free light-chain ratio groups.
The MRI presentation was classified into normal pattern (36 patients; 37.9%), diffuse (27 patients; 28.4%), and focal (32 patients; 33.7%) infiltration patterns. Statistically significant ADC and FF differences between different DS, ISS, and R-ISS stages were observed in normal/diffuse infiltration patterns but not in focal infiltration patterns. The ADC and FF of the normal/diffuse infiltration pattern showed correlations with hemoglobin, β2-microglobulin, bone marrow plasma cells, flow cytometry of bone marrow cells, and serum monoclonal protein. In contrast, ADC in focal infiltration patterns was negatively correlated with β2-microglobulin and C-reactive protein. The FF of patients with a normal/diffuse infiltration pattern was higher in the low free light-chain ratio group than that in the high free light-chain ratio group (P=0.023).
Our observations indicate that quantitative whole-body functional MRI examination may serve as an effective complement to imaging diagnosis based on morphology and provide further information on the tumor burden of patients with MM.
利用全身磁共振成像（MRI）评估多发性骨髓瘤（MM）患者的肿瘤负荷定量，并确定MRI参数与预后生物标志物之间的相关性。
我们回顾性分析了2018年6月至2020年3月在我院接受治疗的95例新诊断MM患者。所有患者均接受了全身MRI检查，包括背景体部信号抑制的扩散加权全身成像（DWIBS）、改良Dixon化学位移成像（mDIXON）和短TI反转恢复（STIR）序列。MRI表现用于确定MM浸润模式，并计算表观扩散系数（ADC）和脂肪分数（FF）。采用单因素方差分析和Kruskal-Wallis检验比较不同MM浸润模式下DS、ISS和R-ISS分期之间这些值的差异。采用Spearman相关检验对ADC和FF与预后生物标志物进行相关性分析，采用两独立样本t检验评估不同游离轻链比例组中ADC和FF的差异。
MRI表现分为正常模式（36例患者；37.9%）、弥漫性（27例患者；28.4%）和局灶性（32例患者；33.7%）浸润模式。在正常/弥漫性浸润模式下，不同DS、ISS和R-ISS分期之间观察到ADC和FF存在统计学显著差异，但在局灶性浸润模式下未观察到。正常/弥漫性浸润模式的ADC和FF与血红蛋白、β2-微球蛋白、骨髓浆细胞、骨髓细胞流式细胞术和血清单克隆蛋白相关。相比之下，局灶性浸润模式下的ADC与β2-微球蛋白和C反应蛋白呈负相关。正常/弥漫性浸润模式患者的FF在低游离轻链比例组中高于高游离轻链比例组（P=0.023）。
我们的观察表明，定量全身功能MRI检查可作为基于形态学的影像诊断的有效补充，并为MM患者的肿瘤负荷提供进一步信息。
