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The diagnostic value of SE MRI and DWI of the spine in patients with monoclonal gammopathy of undetermined significance, smouldering myeloma and multiple myeloma

  • Musculoskeletal
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Abstract

Objectives

To evaluate DWI of the bone marrow in the differentiation of monoclonal gammopathy of undetermined significance (MGUS), smouldering myeloma (SMM) and multiple myeloma (MM).

Methods

The retrospective study includes 64 patients with MGUS, 27 with SMM, 64 with new MM and 12 controls. Signal intensity (SI) of spinal SE-MRI and DWI (b0-1000) as well as apparent diffusion coefficients (ADC) were measured in the T10 and L3. Qualitative assessment of b-images was performed by one experienced radiologist.

Results

ADC600 and ADC1000 are the best ADC values in differentiating patient groups (p < 0.030). SIT2, SIb1000 and ADC1000 are higher and SIT1 lower in L3 compared to T10 (p < 0.050). All quantitative parameters of L3 can differentiate significantly between MGUS and MM (p < 0.050) and between patients with percentage plasma cells (PC%) between 0-10 % compared to >50 % (p = 0.001). Only SIT2 for L3 can differentiate MGUS from SMM (p = 0.044) and PC%0-10 from PC%10-25 (p = 0.033). Qualitative interpretation of b1000 images allows differentiating MM patients from those with MGUS or SMM (p < 0.001).

Conclusions

Spinal SE-MRI can differentiate among MGUS, SMM, MM and control subjects. DWI based on the SI on b1000 images and ADC values is increased in MM compared to MGUS and SMM. Qualitative assessment of b-images can differentiate MM from MGUS or SMM.

Key points

• ADC values are higher in patients with MM compared to MGUS

• DWI parameters change late in disease evolution

• DWI is sensitive but not specific in diagnosing patients with MM

• Qualitative DWI assessment is good in detecting myeloma patients

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Abbreviations

IMWG:

International Myeloma Working Group

MRI:

Magnetic resonance imaging

CT:

Computed tomography

PET:

Positron emission tomography

DWI:

Diffusion-weighted imaging

ADC:

Apparent diffusion coefficient

SI:

Signal intensity

MGUS:

Monoclonal gammopathy of undetermined significance

SMM:

Smouldering myeloma

MM:

Multiple myeloma

ISS:

International Staging System

HME:

Hereditary multiple exostoses

NF:

Neurofibromatosis

EPI:

Echo planar imaging

ROI:

Region of interest

T:

Thoracic

L:

Lumbar

ROC:

Receiver-operating characteristic

AUC:

Area under the curve

PC%:

Percentage plasma cells

T1:

T1 weighted

fsT2:

Fat-suppressed T2 weighted

ST:

Slice thickness

TSE:

Turbo spin echo

TR:

Repetition time

TE:

Echo time

TI:

Inversion time

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Acknowledgments

The scientific guarantor of this publication is Koenraad Verstraete. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Some study subjects or cohorts have been previously reported in Euro J Radiol, A correlation was made between data of conventional whole-body MRI and dynamic contrast-enhanced MRI. Methodology: retrospective, diagnostic or prognostic study/observational, performed at one institution.

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Authors and Affiliations

  1. Ghent University, De Pintelaan 185, 9000, Ghent, Belgium

    Joris Anthonissen

  2. Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Julie C. Dutoit, Matthias A. Vanderkerken, Frederick Dochy & Koenraad L. Verstraete

Authors
  1. Julie C. Dutoit
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  2. Matthias A. Vanderkerken
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  3. Joris Anthonissen
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  4. Frederick Dochy
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  5. Koenraad L. Verstraete
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Correspondence to Julie C. Dutoit.

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Dutoit, J.C., Vanderkerken, M.A., Anthonissen, J. et al. The diagnostic value of SE MRI and DWI of the spine in patients with monoclonal gammopathy of undetermined significance, smouldering myeloma and multiple myeloma. Eur Radiol 24, 2754–2765 (2014). https://doi.org/10.1007/s00330-014-3324-5

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  • DOI: https://doi.org/10.1007/s00330-014-3324-5

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