Maximilian Merz1,2, Thomas M Moehler3, Judith Ritsch3, Tobias Bäuerle4, Christian M Zechmann5, Barbara Wagner6, Anna Jauch7, Dirk Hose6, Christina Kunz8, Thomas Hielscher8, Hendrik Laue9, Hartmut Goldschmidt6,10, Stefan Delorme3, Jens Hillengass3,6. 1. German Cancer Research Center, Department of Radiology, Heidelberg, Germany. maximilian.merz@med.uni-heidelberg.de. 2. Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. maximilian.merz@med.uni-heidelberg.de. 3. German Cancer Research Center, Department of Radiology, Heidelberg, Germany. 4. Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany. 5. Rinecker Proton Therapy, München, Germany. 6. Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. 7. Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany. 8. German Cancer Research Center, Department of Biostatistics, Heidelberg, Germany. 9. Fraunhofer MEVIS, Bremen, Germany. 10. National Center for Tumor Diseases, Heidelberg, Germany.
Abstract
OBJECTIVES: Aim of this prospective study was to investigate prognostic significance of increased bone marrow microcirculation as detected by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for survival and local complications in patients with multiple myeloma (MM). METHODS: We performed DCE-MRI of the lumbar spine in 131 patients with newly diagnosed MM and analysed data according to the Brix model to acquire amplitude A and exchange rate constant kep. In 61 patients a second MRI performed after therapy was evaluated to assess changes in vertebral height and identify vertebral fractures. RESULTS: Correlation analysis revealed significant positive association between beta2-microglobulin as well as immunoparesis with DCE-MRI parameters A and kep. Additionally, A was negatively correlated with haemoglobin levels and kep was positively correlated with LDH levels. Higher baseline kep values were associated with decreased vertebral height in a second MRI (P = 0.007) and A values were associated with new vertebral fractures in the lower lumbar spine (P = 0.03 for L4). Pre-existing lytic bone lesions or remission after therapy had no impact on the occurrence of vertebral fractures. Multivariate analysis revealed that amplitude A is an independent adverse risk factor for overall survival. CONCLUSION: DCE-MRI is a non-invasive tool with significance for systemic prognosis and vertebral complications. KEY POINTS: • Qualitative parameters from DCE-MRI are correlated with established factors of disease activity • Increased marrow microcirculation might be a risk factor for loss of vertebral height and fractures • Amplitude A is an independent predictor for shortened overall survival.
OBJECTIVES: Aim of this prospective study was to investigate prognostic significance of increased bone marrow microcirculation as detected by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for survival and local complications in patients with multiple myeloma (MM). METHODS: We performed DCE-MRI of the lumbar spine in 131 patients with newly diagnosed MM and analysed data according to the Brix model to acquire amplitude A and exchange rate constant kep. In 61 patients a second MRI performed after therapy was evaluated to assess changes in vertebral height and identify vertebral fractures. RESULTS: Correlation analysis revealed significant positive association between beta2-microglobulin as well as immunoparesis with DCE-MRI parameters A and kep. Additionally, A was negatively correlated with haemoglobin levels and kep was positively correlated with LDH levels. Higher baseline kep values were associated with decreased vertebral height in a second MRI (P = 0.007) and A values were associated with new vertebral fractures in the lower lumbar spine (P = 0.03 for L4). Pre-existing lytic bone lesions or remission after therapy had no impact on the occurrence of vertebral fractures. Multivariate analysis revealed that amplitude A is an independent adverse risk factor for overall survival. CONCLUSION:DCE-MRI is a non-invasive tool with significance for systemic prognosis and vertebral complications. KEY POINTS: • Qualitative parameters from DCE-MRI are correlated with established factors of disease activity • Increased marrow microcirculation might be a risk factor for loss of vertebral height and fractures • Amplitude A is an independent predictor for shortened overall survival.
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