Comparison of Whole-Body DWI and 18F-FDG PET/CT for Detecting Intramedullary and Extramedullary Lesions in Multiple Myeloma
Jianpu Chen1, Chongjiao Li1, Yueli Tian1, Qing Xiao1 ... Show all
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Citation: American Journal of Roentgenology: 1-9. 10.2214/AJR.18.20989
AbstractFull TextReferencesPDFPDF PlusSupplementalAdd to FavoritesPermissionsDownload Citation
ABSTRACT :
OBJECTIVE. The purpose of this study was to compare the ability of whole-body (WB) DWI and 18F-FDG PET/CT in detecting intramedullary and extramedullary lesions in multiple myeloma.
MATERIALS AND METHODS. The study included 49 patients with multiple myeloma who had undergone WB DWI and PET/CT. Intramedullary lesions for each region were scored by a scoring system using WB DWI and PET/CT separately. Extramedullary lesions seen separately on WB DWI and PET/CT per patient were recorded. Patients with diffuse lesions of the whole spine seen using both modalities were defined as group A, and those with such lesions seen on WB DWI only were defined as group B. The mean scores assigned to intramedullary lesions using the two modalities, the numbers of extramedullary lesions detected by WB DWI and PET/CT, and the mean percentages of plasma cells in the two patient groups were compared.
RESULTS. Scores were higher for WB DWI than for PET/CT in all regions of the body (p < 0.05) except the skull, both in patients with a new diagnosis of multiple myeloma and in previously treated patients. Mean (± SD) percentages of plasma cells were significantly higher in group A than group B (50.458% ± 16.036% vs 18.682% ± 15.524%; p = 0.00). The mean number of extramedullary lesions detected by WB DWI was slightly higher than the mean number detected by PET/CT, although there was no statistical difference (4.48 ± 6.70 vs 4.39 ± 6.46 lesions; p = 0.86).
CONCLUSION. For detecting intramedullary lesions, WB DWI is more sensitive than PET/CT in all regions except the skull, both in patients with a new diagnosis and previously treated patients and especially in patients with a low percentage of plasma cells. For detecting extramedullary lesions, WB DWI has sensitivity equivalent to that of PET/CT. The use of both modalities may offer complementary information.
Keywords: DWI, extramedullary lesion, multiple myeloma, PET/CT
References
Previous section
1. Tirumani SH, Sakellis C, Jacene H, et al. Role of FDG-PET/CT in extramedullary multiple myeloma: correlation of FDG-PET/CT findings with clinical outcome. Clin Nucl Med 2016; 41:e7–e13 [Crossref] [Medline] [Google Scholar]
2. Bladé J, de Larrea CF, Rosiñol L. Extramedullary involvement in multiple myeloma. Haematologica 2012; 97:1618–1619 [Crossref] [Medline] [Google Scholar]
3. Giles SL, deSouza NM, Collins DJ, et al. Assessing myeloma bone disease with whole-body diffusion-weighted imaging: comparison with x-ray skeletal survey by region and relationship with laboratory estimates of disease burden. Clin Radiol 2015; 70:614–621 [Crossref] [Medline] [Google Scholar]
4. Horger M, Weisel K, Horger W, Mroue A, Fenchel M, Lichy M. Whole-body diffusion-weighted MRI with apparent diffusion coefficient mapping for early response monitoring in multiple myeloma: preliminary results. AJR 2011; 196:[web]W790–W795 [Abstract] [Google Scholar]
5. Mai EK, Hielscher T, Kloth JK, et al. A magnetic resonance imaging-based prognostic scoring system to predict outcome in transplant-eligible patients with multiple myeloma. Haematologica 2015; 100:818–825 [Crossref] [Medline] [Google Scholar]
6. Usmani SZ, Mitchell A, Waheed S, et al. Prognostic implications of serial 18-fluoro-deoxyglucose emission tomography in multiple myeloma treated with total therapy 3. Blood 2013; 121:1819–1823 [Crossref] [Medline] [Google Scholar]
7. Zamagni E, Patriarca F, Nanni C, et al. Prognostic relevance of 18-F FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation. Blood 2011; 118:5989–5995 [Crossref] [Medline] [Google Scholar]
8. Usmani SZ, Heuck C, Mitchell A, et al. Extramedullary disease portends poor prognosis in multiple myeloma and is over-represented in high-risk disease even in the era of novel agents. Haematologica 2012; 97:1761–1767 [Crossref] [Medline] [Google Scholar]
9. Laura R, Cibeira MT, Uriburu C, et al. Bortezomib: an effective agent in extramedullary disease in multiple myeloma. Eur J Haematol 2006; 76:405–408 [Crossref] [Medline] [Google Scholar]
10. Rosiñol L, Cibeira MT, Bladé J, et al. Extramedullary multiple myeloma escapes the effect of thalidomide. Haematologica 2004; 89:832–836 [Medline] [Google Scholar]
11. Avigdor A, Raanani P, Levi I, Hardan I, Ben-Bassat I. Extramedullary progression despite a good response in the bone marrow in patients treated with thalidomide for multiple myeloma. Leuk Lymphoma 2001; 42:683–687 [Crossref] [Medline] [Google Scholar]
12. Durie BGM, Harousseau JL, Miguel JS, et al.; International Myeloma Working Group. International uniform response criteria for multiple myeloma. Leukemia 2006; 20:1467–1473 [Crossref] [Medline] [Google Scholar]
13. Kumar S, Paiva B, Anderson KC, et al. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol 2016; 17:e328–e346 [Crossref] [Medline] [Google Scholar]
14. Cavo M, Terpos E, Nanni C, et al. Role of 18 F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol 2017; 18:e206–e217 [Crossref] [Medline] [Google Scholar]
15. Lu Y, Chen J, Lin W, et al. FDG PET or PET/CT for detecting intramedullary and extramedullary lesions in multiple myeloma: a systematic review and meta-analysis. Clin Nucl Med 2012; 37:833–837 [Crossref] [Medline] [Google Scholar]
16. Sachpekidis C, Mosebach J, Freitag MT, et al. Application of 18 F-FDG PET and diffusion weighted imaging (DWI) in multiple myeloma: comparison of functional imaging modalities. Am J Nucl Med Mol Imaging 2015; 5:479–492 [Medline] [Google Scholar]
17. Pawlyn C, Fowkes L, Otero S, et al. Whole-body diffusion-weighted MRI: a new gold standard for assessing disease burden in patients with multiple myeloma? Leukemia 2016; 30:1446–1448 [Crossref] [Medline] [Google Scholar]
18. Rubini G, Niccoli-Asabella A, Ferrari C, Racanelli V, Maggialetti N, Dammacco F. Myeloma bone and extra-medullary disease: role of PET/CT and other whole-body imaging techniques. Crit Rev Oncol Hematol 2016; 101:169–183 [Crossref] [Medline] [Google Scholar]
19. Tirumani SH, Shinagare AB, Jagannathan JP, Krajewski KM, Munshi NC, Ramaiya NH. MRI features of extramedullary myeloma. AJR 2014; 202:803–810 [Abstract] [Google Scholar]
20. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014; 15:e538–e548 [Crossref] [Medline] [Google Scholar]
21. Giles SL, Messiou C, Collins DJ, et al. Whole-body diffusion-weighted MR imaging for assessment of treatment response in myeloma. Radiology 2014; 271:785–794 [Crossref] [Medline] [Google Scholar]
22. Bladé J, Fernández de Larrea C, Rosiñol L, Cibeira MT, Jiménez R, Powles R. Soft-tissue plasmacytomas in multiple myeloma: incidence, mechanisms of extramedullary spread, and treatment approach. J Clin Oncol 2011; 29:3805–3812 [Crossref] [Medline] [Google Scholar]
23. Lacognata C, Crimì F, Guolo A, et al. Diffusion-weighted whole-body MRI for evaluation of early response in multiple myeloma. Clin Radiol 2017; 72:850–857 [Crossref] [Medline] [Google Scholar]
24. Moreau P, Attal M, Caillot D, et al. Prospective evaluation of magnetic resonance imaging and [18 F]fluorodeoxyglucose positron emission tomography-computed tomography at diagnosis and before maintenance therapy in symptomatic patients with multiple myeloma included in the IFM/DFCI 2009 trial: results of the IMAJEM study. J Clin Oncol 2017; 35:2911–2918 [Crossref] [Medline] [Google Scholar]
25. Regelink JC, Minnema MC, Terpos E, et al. Comparison of modern and conventional imaging techniques in establishing multiple myeloma-related bone disease: a systematic review. Br J Haematol 2013; 162:50–61 [Crossref] [Medline] [Google Scholar]
26. Walker R, Barlogie B, Haessler J, et al. Magnetic resonance imaging in multiple myeloma: diagnostic and clinical implications. J Clin Oncol 2007; 25:1121–1128 [Crossref] [Medline] [Google Scholar]
27. Padhani AR, Koh D-M, Collins DJ. Whole-body diffusion-weighted MR imaging in cancer: current status and research directions. Radiology 2011; 261:700–718 [Crossref] [Medline] [Google Scholar]
28. Cui F-Z, Cui J-L, Wang S-L, et al. Signal characteristics of normal adult bone marrow in whole-body diffusion-weighted imaging. Acta Radiol 2016; 57:1230–1237 [Crossref] [Medline] [Google Scholar]
29. Lavdas I, Rockall AG, Castelli F, et al. Apparent diffusion coefficient of normal abdominal organs and bone marrow from whole-body DWI at 1.5 T: the effect of sex and age. AJR 2015; 205:242–250 [Abstract] [Google Scholar]
30. Koh DM, Blackledge M, Padhani AR, et al. Whole-body diffusion-weighted MRI: tips, tricks, and pitfalls. AJR 2012; 199:252–262 [Abstract] [Google Scholar]
31. Lin C, Luciani A, Itti E, et al. Whole-body diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient mapping for staging patients with diffuse large B-cell lymphoma. Eur Radiol 2010; 20:2027–2038 [Crossref] [Medline] [Google Scholar]
32. Wale A, Pawlyn C, Kaiser M, Messiou C. Frequency, distribution and clinical management of incidental findings and extramedullary plasmacytomas in whole body diffusion weighted magnetic resonance imaging in patients with multiple myeloma. Haematologica 2016; 101:e142–e144 [Crossref] [Medline] [Google Scholar]
33. Hanaoka K, Hosono M, Usami K, et al. Fluorodeoxyglucose uptake in the bone marrow after granulocyte colony-stimulating factor administration in patients with non-Hodgkin's lymphoma. Nucl Med Commun 2011; 32:678–683 [Crossref] [Medline] [Google Scholar]
34. Hartman RP, Sundaram M, Okuno SH, Sim FH. Effect of granulocyte-stimulating factors on marrow of adult patients with musculoskeletal malignancies: incidence and MRI findings. AJR 2004; 183:645–653 [Abstract] [Google Scholar]
Address correspondence to Y. He (vincentheyong@163.com).
Read More: https://www.ajronline.org/doi/abs/10.2214/AJR.18.20989
Jianpu Chen1, Chongjiao Li1, Yueli Tian1, Qing Xiao1 ... Show all
Share Share
+ Affiliations:
Citation: American Journal of Roentgenology: 1-9. 10.2214/AJR.18.20989
AbstractFull TextReferencesPDFPDF PlusSupplementalAdd to FavoritesPermissionsDownload Citation
ABSTRACT :
OBJECTIVE. The purpose of this study was to compare the ability of whole-body (WB) DWI and 18F-FDG PET/CT in detecting intramedullary and extramedullary lesions in multiple myeloma.
MATERIALS AND METHODS. The study included 49 patients with multiple myeloma who had undergone WB DWI and PET/CT. Intramedullary lesions for each region were scored by a scoring system using WB DWI and PET/CT separately. Extramedullary lesions seen separately on WB DWI and PET/CT per patient were recorded. Patients with diffuse lesions of the whole spine seen using both modalities were defined as group A, and those with such lesions seen on WB DWI only were defined as group B. The mean scores assigned to intramedullary lesions using the two modalities, the numbers of extramedullary lesions detected by WB DWI and PET/CT, and the mean percentages of plasma cells in the two patient groups were compared.
RESULTS. Scores were higher for WB DWI than for PET/CT in all regions of the body (p < 0.05) except the skull, both in patients with a new diagnosis of multiple myeloma and in previously treated patients. Mean (± SD) percentages of plasma cells were significantly higher in group A than group B (50.458% ± 16.036% vs 18.682% ± 15.524%; p = 0.00). The mean number of extramedullary lesions detected by WB DWI was slightly higher than the mean number detected by PET/CT, although there was no statistical difference (4.48 ± 6.70 vs 4.39 ± 6.46 lesions; p = 0.86).
CONCLUSION. For detecting intramedullary lesions, WB DWI is more sensitive than PET/CT in all regions except the skull, both in patients with a new diagnosis and previously treated patients and especially in patients with a low percentage of plasma cells. For detecting extramedullary lesions, WB DWI has sensitivity equivalent to that of PET/CT. The use of both modalities may offer complementary information.
Keywords: DWI, extramedullary lesion, multiple myeloma, PET/CT
References
Previous section
1. Tirumani SH, Sakellis C, Jacene H, et al. Role of FDG-PET/CT in extramedullary multiple myeloma: correlation of FDG-PET/CT findings with clinical outcome. Clin Nucl Med 2016; 41:e7–e13 [Crossref] [Medline] [Google Scholar]
2. Bladé J, de Larrea CF, Rosiñol L. Extramedullary involvement in multiple myeloma. Haematologica 2012; 97:1618–1619 [Crossref] [Medline] [Google Scholar]
3. Giles SL, deSouza NM, Collins DJ, et al. Assessing myeloma bone disease with whole-body diffusion-weighted imaging: comparison with x-ray skeletal survey by region and relationship with laboratory estimates of disease burden. Clin Radiol 2015; 70:614–621 [Crossref] [Medline] [Google Scholar]
4. Horger M, Weisel K, Horger W, Mroue A, Fenchel M, Lichy M. Whole-body diffusion-weighted MRI with apparent diffusion coefficient mapping for early response monitoring in multiple myeloma: preliminary results. AJR 2011; 196:[web]W790–W795 [Abstract] [Google Scholar]
5. Mai EK, Hielscher T, Kloth JK, et al. A magnetic resonance imaging-based prognostic scoring system to predict outcome in transplant-eligible patients with multiple myeloma. Haematologica 2015; 100:818–825 [Crossref] [Medline] [Google Scholar]
6. Usmani SZ, Mitchell A, Waheed S, et al. Prognostic implications of serial 18-fluoro-deoxyglucose emission tomography in multiple myeloma treated with total therapy 3. Blood 2013; 121:1819–1823 [Crossref] [Medline] [Google Scholar]
7. Zamagni E, Patriarca F, Nanni C, et al. Prognostic relevance of 18-F FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation. Blood 2011; 118:5989–5995 [Crossref] [Medline] [Google Scholar]
8. Usmani SZ, Heuck C, Mitchell A, et al. Extramedullary disease portends poor prognosis in multiple myeloma and is over-represented in high-risk disease even in the era of novel agents. Haematologica 2012; 97:1761–1767 [Crossref] [Medline] [Google Scholar]
9. Laura R, Cibeira MT, Uriburu C, et al. Bortezomib: an effective agent in extramedullary disease in multiple myeloma. Eur J Haematol 2006; 76:405–408 [Crossref] [Medline] [Google Scholar]
10. Rosiñol L, Cibeira MT, Bladé J, et al. Extramedullary multiple myeloma escapes the effect of thalidomide. Haematologica 2004; 89:832–836 [Medline] [Google Scholar]
11. Avigdor A, Raanani P, Levi I, Hardan I, Ben-Bassat I. Extramedullary progression despite a good response in the bone marrow in patients treated with thalidomide for multiple myeloma. Leuk Lymphoma 2001; 42:683–687 [Crossref] [Medline] [Google Scholar]
12. Durie BGM, Harousseau JL, Miguel JS, et al.; International Myeloma Working Group. International uniform response criteria for multiple myeloma. Leukemia 2006; 20:1467–1473 [Crossref] [Medline] [Google Scholar]
13. Kumar S, Paiva B, Anderson KC, et al. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol 2016; 17:e328–e346 [Crossref] [Medline] [Google Scholar]
14. Cavo M, Terpos E, Nanni C, et al. Role of 18 F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol 2017; 18:e206–e217 [Crossref] [Medline] [Google Scholar]
15. Lu Y, Chen J, Lin W, et al. FDG PET or PET/CT for detecting intramedullary and extramedullary lesions in multiple myeloma: a systematic review and meta-analysis. Clin Nucl Med 2012; 37:833–837 [Crossref] [Medline] [Google Scholar]
16. Sachpekidis C, Mosebach J, Freitag MT, et al. Application of 18 F-FDG PET and diffusion weighted imaging (DWI) in multiple myeloma: comparison of functional imaging modalities. Am J Nucl Med Mol Imaging 2015; 5:479–492 [Medline] [Google Scholar]
17. Pawlyn C, Fowkes L, Otero S, et al. Whole-body diffusion-weighted MRI: a new gold standard for assessing disease burden in patients with multiple myeloma? Leukemia 2016; 30:1446–1448 [Crossref] [Medline] [Google Scholar]
18. Rubini G, Niccoli-Asabella A, Ferrari C, Racanelli V, Maggialetti N, Dammacco F. Myeloma bone and extra-medullary disease: role of PET/CT and other whole-body imaging techniques. Crit Rev Oncol Hematol 2016; 101:169–183 [Crossref] [Medline] [Google Scholar]
19. Tirumani SH, Shinagare AB, Jagannathan JP, Krajewski KM, Munshi NC, Ramaiya NH. MRI features of extramedullary myeloma. AJR 2014; 202:803–810 [Abstract] [Google Scholar]
20. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014; 15:e538–e548 [Crossref] [Medline] [Google Scholar]
21. Giles SL, Messiou C, Collins DJ, et al. Whole-body diffusion-weighted MR imaging for assessment of treatment response in myeloma. Radiology 2014; 271:785–794 [Crossref] [Medline] [Google Scholar]
22. Bladé J, Fernández de Larrea C, Rosiñol L, Cibeira MT, Jiménez R, Powles R. Soft-tissue plasmacytomas in multiple myeloma: incidence, mechanisms of extramedullary spread, and treatment approach. J Clin Oncol 2011; 29:3805–3812 [Crossref] [Medline] [Google Scholar]
23. Lacognata C, Crimì F, Guolo A, et al. Diffusion-weighted whole-body MRI for evaluation of early response in multiple myeloma. Clin Radiol 2017; 72:850–857 [Crossref] [Medline] [Google Scholar]
24. Moreau P, Attal M, Caillot D, et al. Prospective evaluation of magnetic resonance imaging and [18 F]fluorodeoxyglucose positron emission tomography-computed tomography at diagnosis and before maintenance therapy in symptomatic patients with multiple myeloma included in the IFM/DFCI 2009 trial: results of the IMAJEM study. J Clin Oncol 2017; 35:2911–2918 [Crossref] [Medline] [Google Scholar]
25. Regelink JC, Minnema MC, Terpos E, et al. Comparison of modern and conventional imaging techniques in establishing multiple myeloma-related bone disease: a systematic review. Br J Haematol 2013; 162:50–61 [Crossref] [Medline] [Google Scholar]
26. Walker R, Barlogie B, Haessler J, et al. Magnetic resonance imaging in multiple myeloma: diagnostic and clinical implications. J Clin Oncol 2007; 25:1121–1128 [Crossref] [Medline] [Google Scholar]
27. Padhani AR, Koh D-M, Collins DJ. Whole-body diffusion-weighted MR imaging in cancer: current status and research directions. Radiology 2011; 261:700–718 [Crossref] [Medline] [Google Scholar]
28. Cui F-Z, Cui J-L, Wang S-L, et al. Signal characteristics of normal adult bone marrow in whole-body diffusion-weighted imaging. Acta Radiol 2016; 57:1230–1237 [Crossref] [Medline] [Google Scholar]
29. Lavdas I, Rockall AG, Castelli F, et al. Apparent diffusion coefficient of normal abdominal organs and bone marrow from whole-body DWI at 1.5 T: the effect of sex and age. AJR 2015; 205:242–250 [Abstract] [Google Scholar]
30. Koh DM, Blackledge M, Padhani AR, et al. Whole-body diffusion-weighted MRI: tips, tricks, and pitfalls. AJR 2012; 199:252–262 [Abstract] [Google Scholar]
31. Lin C, Luciani A, Itti E, et al. Whole-body diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient mapping for staging patients with diffuse large B-cell lymphoma. Eur Radiol 2010; 20:2027–2038 [Crossref] [Medline] [Google Scholar]
32. Wale A, Pawlyn C, Kaiser M, Messiou C. Frequency, distribution and clinical management of incidental findings and extramedullary plasmacytomas in whole body diffusion weighted magnetic resonance imaging in patients with multiple myeloma. Haematologica 2016; 101:e142–e144 [Crossref] [Medline] [Google Scholar]
33. Hanaoka K, Hosono M, Usami K, et al. Fluorodeoxyglucose uptake in the bone marrow after granulocyte colony-stimulating factor administration in patients with non-Hodgkin's lymphoma. Nucl Med Commun 2011; 32:678–683 [Crossref] [Medline] [Google Scholar]
34. Hartman RP, Sundaram M, Okuno SH, Sim FH. Effect of granulocyte-stimulating factors on marrow of adult patients with musculoskeletal malignancies: incidence and MRI findings. AJR 2004; 183:645–653 [Abstract] [Google Scholar]
Address correspondence to Y. He (vincentheyong@163.com).
Read More: https://www.ajronline.org/doi/abs/10.2214/AJR.18.20989
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