Neelsen Christian, Sachpekidis Christos, John Lukas, Neher Peter, Mai Elias, Grözinger Martin, Paech Daniel, Dimitrakopoulou-Strauss Antonia, Kurz Felix T, Sauer Sandra, Raab Marc S, Schlemmer Heinz-Peter, Wennmann Markus, Weinhold Niels
German Cancer Research Center, Division of Radiology, Heidelberg, Germany.
German Cancer Research Center, Clinical Cooperation Unit Nuclear Medicine, Heidelberg, Germany.
Eur Radiol. 2025 Jun;35(6):3576-3586. doi: 10.1007/s00330-024-11191-8. Epub 2024 Nov 27.
This study aims to evaluate correlations between spleen signal changes in different MRI sequences and bone marrow plasma cell infiltration as potential indicator of disease burden in multiple myeloma (MM) patients.
We retrospectively analyzed 45 patients with newly diagnosed MM that underwent whole-body MRI with axial DWI at b-values 50 (b50) and 800 (b800), and coronal T1 and T2 fast spin-echo (T2-TSE) imaging. A subcohort of 39 patients had concomitant [F]FDG PET/CT. The spleen was segmented in all MRI sequences and signal intensities were normalized. MR signal intensities and ADC values were correlated with bone marrow plasma cell infiltration from biopsy, laboratory markers (Beta 2-microglobulin, M-Protein, Red blood count (RBC), Hemoglobin, Hematocrit, Total protein, Creatinine), clinical data (ISS stages, high-risk chromosomal aberrations), and standardized uptake value (SUV) in the spleen as well as spleen-to-liver and spleen-to-blood pool SUV ratios on [F]FDG PET-CT.
Bone marrow plasma cell infiltration was negatively correlated with (normalized) mean splenic signal intensity on DWI-b50, DWI-b800, and T2-TSE images (r = -0.64, p < 0.001, r = -0.58, p < 0.001, and r = -0.66, p < 0.001, respectively) while there was no correlation with the apparent diffusion coefficient or spleen size (p = 0.52). In the subgroup analysis of 39 patients with concomitant [F]FDG PET-CT, there was no correlation of normalized splenic [F]FDG uptake either with MR spleen signal (for T2 p = 0.64) or with bone marrow plasma cell infiltration (p = 0.37).
Our findings reveal a significant association between spleen signal intensity especially on normalized T2-weighted images and tumor burden.
Question What changes occur in spleen signal on MRI as tumor load marker changes in multiple myeloma (MM)? Findings Spleen signal intensity, particularly on T2-weighted MRI, negatively correlates with bone marrow plasma cell infiltration and laboratory markers of tumor burden. Clinical relevance Standardized quantification of splenic T2 signal is proposed as a new marker for MM disease burden.
本研究旨在评估不同MRI序列中脾脏信号变化与骨髓浆细胞浸润之间的相关性，以此作为多发性骨髓瘤（MM）患者疾病负担的潜在指标。
我们回顾性分析了45例新诊断的MM患者，这些患者接受了全身MRI检查，包括b值为50（b50）和800（b800）的轴向扩散加权成像（DWI）以及冠状面T1加权和T2加权快速自旋回波（T2-TSE）成像。39例患者的亚组同时进行了[F]氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）。在所有MRI序列中对脾脏进行分割，并对信号强度进行标准化。将MR信号强度和表观扩散系数（ADC）值与活检所得的骨髓浆细胞浸润、实验室指标（β2微球蛋白、M蛋白、红细胞计数、血红蛋白、血细胞比容、总蛋白、肌酐）、临床数据（国际分期系统（ISS）分期、高危染色体异常）以及脾脏的标准化摄取值（SUV），以及[F]FDG PET-CT上的脾肝SUV比值和脾血池SUV比值进行相关性分析。
骨髓浆细胞浸润与DWI-b50、DWI-b800和T2-TSE图像上（标准化后的）脾脏平均信号强度呈负相关（r分别为-0.64，p<0.001；r为-0.58，p<0.001；r为-0.66，p<0.001），而与表观扩散系数或脾脏大小无相关性（p=0.52）。在39例同时进行[F]FDG PET-CT检查的患者亚组分析中，标准化后的脾脏[F]FDG摄取与MR脾脏信号（T2序列p=0.64）或骨髓浆细胞浸润均无相关性（p=0.37）。
我们的研究结果显示，脾脏信号强度尤其是标准化后的T2加权图像上的信号强度与肿瘤负荷之间存在显著关联。
问题：在多发性骨髓瘤（MM）中，随着肿瘤负荷标志物的变化，MRI上脾脏信号会发生哪些变化？发现：脾脏信号强度，尤其是在T2加权MRI上，与骨髓浆细胞浸润及肿瘤负荷的实验室指标呈负相关。临床意义：建议将脾脏T2信号的标准化定量作为MM疾病负担的新标志物。
