Aims and objectives
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) studies the kinetics of the distribution of paramagnetic contrast in the microvessels and in the interstitial space of the imaged tissue.
It has been previously reported that DCE-MRI parameters correlate with increased angiogenesis and event-free survival (EFS) of patients with multiple myeloma (MM) in the conventional chemotherapy era.
The aim of this study was to evaluate the value of DCE-MRI in the era of novel anti-myeloma agents and explore possible correlation with angiogenic cytokines that have prognostic value in...
Methods and materials
We studied 46,
previously untreated,
newly diagnosed multiple myeloma (MM) patients (24M/22F,
median age 67 years,
range 33-88 years) (37 with symptomatic MM and 9 with smoldering MM) and 5 patients with MGUS.
All patients underwent MRI of the lumbar spine and DCE-MRI was performed (Fig.
1).Regions of Interest (ROI) were manually drawn in vertebral bodies avoiding areas with degenerative changes,
hemangiomas and basivertebral vessels.
ROI values were then extracted and fitted bymeans of a nonlinear regression analysis method based on Marquardt algorithm,
according to...
Results
Evaluation of conventional T1-weighted imagesof the spine revealed that 11 (23.9%) myeloma patients had focal,
12 (26.1%) diffuse,
16 (34.8%) normal,
and 7 (15.2%)variegated pattern of marrow involvement.
Symptomatic MM patients had increased WIN values [median 18.7 sec-1,
range (2-111 sec-1)] compared to smoldering multiple myeloma (SMM) patients [5.7 (1.3-30),
p<0.05) and MGUS patients [1.7 (1.1-5),
p=0.001].
TTPK values were decreased and WTSP values were increased in both symptomatic [47 sec (18-76 sec) and 0.47 sec (0.04-9.73 sec),
respectively] and smoldering [60.4 (36-98) and 0.35...
Conclusion
We conclude that DCE-MRI can provide clinically relevant information in patients with newly diagnosed MM.
DCE-MRI parameters,
such as the TTPK,
correlate with increased angiogenic capacity,
as reflected by the low ratio of Angp-1/Angp-2,
while others,
such as the WIN value,
correlate with high risk features of MM.
Higher number of patients and longer follow-up is needed to reveal if DCE-MRI can be of prognostic significance in the era of novel anti-myeloma agents.
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