Whole-body diffusion-weighted MR imaging for assessment of treatment response in myeloma.

PURPOSE To determine the feasibility of whole-body diffusion-weighted (DW) magnetic resonance (MR) imaging for assessment of treatment response in myeloma. MATERIALS AND METHODS This prospective single-institution study was HIPAA-compliant with local research ethics committee approval. Written informed consent was obtained from each subject. Eight healthy volunteers (cohort 1a) and seven myeloma patients (cohort 1b) were imaged twice to assess repeatability of quantitative apparent diffusion coefficient (ADC) estimates. Thirty-four additional myeloma patients (cohort 2) underwent whole-body DW imaging before treatment; 26 completed a posttreatment imaging. Whole-body DW data were compared before and after treatment by using qualitative (ie, observer scores) and quantitative (ie, whole-body segmentation of marrow ADC) methods. Serum paraproteins and/or light chains or bone marrow biopsy defined response. RESULTS Whole-body DW imaging scores were significantly different between observers (P < .001), but change in scores between observers after treatment was not (P = .49). Sensitivity and specificity for detecting response according to observer scores were 86% (18 of 21 patients) and 80% (4 of 5 patients) for both observers. ADC measurement was repeatable: mean coefficient of variation was 3.8% in healthy volunteers and 2.8% in myeloma patients. Pretreatment ADC in cohort 2 was significantly different from that in cohort 1a (P = .03), but not from that in cohort 1b (P = .2). Mean ADC increased in 95% (19 of 20) of responding patients and decreased in all (five of five) nonresponders (P = .002). A 3.3% increase in ADC helped identify response with 90% sensitivity and 100% specificity; an 8% increase (greater than repeatability of cohort 1b) resulted in 70% sensitivity and 100% specificity. There was a significant negative correlation between change in ADC and change in laboratory markers of response (r = -0.614; P = .001). CONCLUSION Preliminary work demonstrates whole-body DW imaging is a repeatable, quantifiable technique for assessment of treatment response in myeloma.

[1]  P. Armitage,et al.  Statistical methods in medical research. , 1972 .

[2]  R. Fletcher,et al.  Clinical Epidemiology: The Essentials , 1982 .

[3]  D. Altman,et al.  Measuring agreement in method comparison studies , 1999, Statistical methods in medical research.

[4]  Kenneth C. Anderson,et al.  Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group , 2003, British journal of haematology.

[5]  M. Beksac,et al.  International uniform response criteria for multiple myeloma , 2006, Leukemia.

[6]  R. Gonzalez,et al.  Improved Detection of Skull Metastasis with Diffusion-Weighted MR Imaging , 2007, American Journal of Neuroradiology.

[7]  E Terpos,et al.  International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple Myeloma , 2009, Leukemia.

[8]  M. Okada,et al.  [New response evaluation criteria in solid tumours-revised RECIST guideline (version 1.1)]. , 2009, Gan to kagaku ryoho. Cancer & chemotherapy.

[9]  K. Scheffler,et al.  Signal characteristics of focal bone marrow lesions in patients with multiple myeloma using whole body T1w-TSE, T2w-STIR and diffusion-weighted imaging with background suppression , 2011, European Radiology.

[10]  M. Gertz.  review: Current status of stem cell mobilization , 2010, British journal of haematology.

[11]  Christopher J. Hanrahan,et al.  Current concepts in the evaluation of multiple myeloma with MR imaging and FDG PET/CT. , 2010, Radiographics : a review publication of the Radiological Society of North America, Inc.

[12]  Pt Sutton,et al.  Reproducibility and changes in the apparent diffusion coefficients of solid tumours treated with combretastatin A4 phosphate and bevacizumab in a two-centre phase I clinical trial , 2010 .

[13]  C. Claussen,et al.  Response assessment in patients with multiple myeloma during antiangiogenic therapy using arterial spin labeling and diffusion-weighted imaging: a feasibility study. , 2010, Academic radiology.

[14]  Matthew D. Blackledge,et al.  Techniques and Optimization , 2010 .

[15]  G. Morgan,et al.  Guidelines for the diagnosis and management of multiple myeloma 2011 , 2011, British journal of haematology.

[16]  H. Goldschmidt,et al.  Diffusion‐weighted imaging for non‐invasive and quantitative monitoring of bone marrow infiltration in patients with monoclonal plasma cell disease: a comparative study with histology , 2011, British journal of haematology.

[17]  Epsrc Cancer.  Metastatic ovarian and primary peritoneal cancer:assessing chemotherapy response with diffusion-weighted MR imaging—value of histogram analysis of apparent diffusion coefficients , 2011 .

[18]  Hartmut Goldschmidt,et al.  Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel 3. , 2011, Blood.

[19]  M. Dimopoulos,et al.  Advances in imaging and the management of myeloma bone disease. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  D. Collins,et al.  Optimising diffusion weighted MRI for imaging metastatic and myeloma bone disease and assessing reproducibility , 2011, European Radiology.

[21]  M. Dimopoulos,et al.  Consensus recommendations for the uniform reporting of clinical trials: report of the International Myeloma Workshop Consensus Panel 1. , 2011, Blood.

[22]  C. Claussen,et al.  Modern imaging techniques during therapy in patients with multiple myeloma , 2011, Acta radiologica.

[23]  S. Delorme,et al.  Imaging in multiple myeloma. , 2011, Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer.

[24]  P. Choyke,et al.  Current and future imaging modalities for multiple myeloma and its precursor states , 2011, Leukemia & lymphoma.

[25]  D. Collins,et al.  Whole-body diffusion-weighted MR imaging in cancer: current status and research directions. , 2011, Radiology.

[26]  M. Fenchel,et al.  Whole-body diffusion-weighted MRI with apparent diffusion coefficient mapping for early response monitoring in multiple myeloma: preliminary results. , 2011, AJR. American journal of roentgenology.

[27]  D. Collins,et al.  Whole-body diffusion-weighted MRI: tips, tricks, and pitfalls. , 2012, AJR. American journal of roentgenology.

[28]  D. Hose,et al.  Changes in magnetic resonance imaging before and after autologous stem cell transplantation correlate with response and survival in multiple myeloma , 2012, Haematologica.

[29]  T. Derlin,et al.  Diagnostic performance of whole-body MRI for the detection of persistent or relapsing disease in multiple myeloma after stem cell transplantation , 2012, European Radiology.

[30]  Celia P. Corona-Villalobos,et al.  Oncologic applications of diffusion‐weighted MRI in the body , 2012, Journal of magnetic resonance imaging : JMRI.

[31]  G. Morgan,et al.  Assessing response of myeloma bone disease with diffusion-weighted MRI. , 2012, The British journal of radiology.

[32]  Namkug Kim,et al.  Reproducibility of measurement of apparent diffusion coefficients of malignant hepatic tumors: Effect of DWI techniques and calculation methods , 2012, Journal of magnetic resonance imaging : JMRI.

[33]  Celia P. Corona-Villalobos,et al.  Agreement and Reproducibility of Apparent Diffusion Coefficient Measurements of Dual-b-Value and Multi-b-Value Diffusion-Weighted Magnetic Resonance Imaging at 1.5 Tesla in Phantom and in Soft Tissues of the Abdomen , 2013, Journal of computer assisted tomography.