Whole-body diffusion-weighted MR imaging for assessment of treatment response in myeloma.
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Date
2014-06-01Author
Giles, SL
Messiou, C
Collins, DJ
Morgan, VA
Simpkin, CJ
West, S
Davies, FE
Morgan, GJ
deSouza, NM
Type
Journal Article
Metadata
Show full item recordAbstract
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.
Subject
Humans
Multiple Myeloma
Boronic Acids
Thalidomide
Cyclophosphamide
Pyrazines
Dexamethasone
Granulocyte Colony-Stimulating Factor
Antineoplastic Combined Chemotherapy Protocols
Diffusion Magnetic Resonance Imaging
Treatment Outcome
Prospective Studies
Pilot Projects
Reproducibility of Results
Adult
Aged
Middle Aged
Female
Male
Whole Body Imaging
Bortezomib
Lenalidomide
Research team
Myeloma Target Treatment
Molecular Haematology (including Cytogenetics Group and Cell Markers)
Magnetic Resonance
Language
eng
License start date
2014-06
Citation
Radiology, 2014, 271 (3), pp. 785 - 794
Publisher
RADIOLOGICAL SOC NORTH AMERICA