Diffuse infiltration in multiple myeloma treatment response assessment with "total-spine" contrast enhanced MR imaging Poster No.: C-0276 Congress: ECR 2011 Type: Scientific Paper Authors: P. P. Arcuri, G. Fodero, S. Roccia, S. Molica, V. Arcuri; Catanzaro/ IT Keywords: Oncology, Bones, Spine, MR, Metastases, Tissue characterisation, Neoplasia DOI: 10.1594/ecr2011/C-0276 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 11
Purpose The purpose of our study was to compare post-treatment bone marrow changes at totalspine contrast material-enhanced magnetic resonance imaging with clinical response and bone-biopsy in patients with diffuse bone infiltration in multiple myeloma and to determine if this technique can be used to assess treatment response in patients with multiple myeloma. Methods and Materials Thirty patients (21 women, 9 men; mean age, 56 years) underwent total spine contrast enhancement RM imaging before treatment and after induction chemotherapy. MRI sequences were performed in a 1,5 T unit. The sequences were: TSE T1, T2 STIR and T1 SPIR (pre- and post-contrast material injection). In the T1 SPIR sequences (both in pre-contrast and post-contrast images) largest possible regions of interest (ROIs) were drown in the body of three vertebras (8-14 pixels). Post-treatment changes in ROIs Signal Intensity were compared with clinical response to therapy and with bone-biopsy by using the Mann-Whitney U test. Results Twenty-one of thirty patients were good response to induction chemotherapy, demonstrated by bone-biopsy; in this patients, ROIs Signal Intensity in post contrast sequences were enhanced only of 83% (e.g.: fig. 1-2, case A). In these patients the biopsy confirmed the imaging data demonstrating a drastic reduction of neoplastic cells (fig. 3 and 4). In poor non-responders patients, ROIs Signal Intensity were enhanced of 275% (e.g.: fig. 5-7, case B). In these patients the biopsy demonstrated a lot of neoplastic cells. The quantitative evaluation of ROIs Signal Intensity from pre- to post-contrast media sequences demonstrated a 100% of sensitivity and 77% of specificity (p=.0001) in identification of response patients. Images for this section: Page 2 of 11
Fig. 1: Case A. T1 SPIR pre-contrast image: ROIs value (in the body of vertebra) is 111,63. Page 3 of 11
Fig. 2: Case A. T1 SPIR post-contrast image: ROIs value is 183,84. The increase of ROIs value is of 65% (responder patient). Page 4 of 11
Fig. 3: Case A. Hematoxylin-eosin coloration: no neoplstic cell is evident. Page 5 of 11
Fig. 4: Case A. The immunohistochemical evaluation show only two neoplastic cells not showed in hematoxylin-eosin coloration (responder patient). Page 6 of 11
Fig. 5: Case B. T1 SPIR pre-contrast image: ROIs value is 76,49 (body of vertebra) and 126,99 (vertebral spinous process). Page 7 of 11
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Fig. 6: Case B. T1 SPIR post-contrast image: ROIs value is 236,48 (body of vertebra) and 369,17 (vertebral spinous process). In this patient (non-responder) the increase of ROIs value is of 200%. Fig. 7: Case B. The immunohistochemical evaluation show a lot of neoplastic cells (nonresponder patient). Page 9 of 11
Conclusion With quantitative analysis of ROIs Signal Intensity, total spine contrast-enhanced MR imaging can be used to assess treatment response in patients with diffuse infiltration in multiple myeloma. References 1) Choyke PL, Dwyer AJ, Knopp MV. Functional tumor imaging with dynamic contrastenhanced magnetic resonance imaging. J Magn Reson Imaging 2003;17:509-520. 2) Griffith JF, Yeung DK, Antonio GE, et al. Vertebral marrow fat content and diffusion and perfusion indexes in women with varying bone density: MR evaluation. Radiology 2006;241:831-838. 3) Kim JK, Hong SS, Choi YJ, et al. Wash-in rate on the basis of dynamic contrastenhanced MRI: usefulness for prostate cancer detection and localization. J Magn Reson Imaging 2005;22:639-646. 4) Lauenstein TC, Goehde SC, Herborn CU, et al. Whole-body MR imaging: evaluation of patients for metastases. Radiology 2004;233:139-148. 5) Lavini C, de Jonge MC, van de Sande MG, et al. Pixel-by-pixel analysis of DCE MRI curve patterns and an illustration of its application to the imaging of the musculoskeletal system. Magn Reson Imaging 2007;25:604-612. 6) Padhani AR. Dynamic contrast-enhanced MRI in clinical oncology: current status and future directions. J Magn Reson Imaging 2002;16:407-422. 7) Zahra MA, Hollingsworth KG, Sala E, et al. Dynamic contrast-enhanced MRI as a predictor of tumour response to radiotherapy. Lancet Oncol 2007;8:63-74. Personal Information Pier Paolo Arcuri MD. Department of Radiology, A.O. "Pugliese-Ciaccio", Catanzaro, Italy. Page 10 of 11
E-mail: arppaolo@alice.it Page 11 of 11