Abstract
This study investigated the clinical significance of loss of spleen visualization (LSV) on whole-body diffusion-weighted imaging (WB-DWI) in patients with multiple myeloma (MM). The WB-DWI of 96 patients with newly diagnosed MM (NDMM) and 15 patients with smoldering MM (sMM) were retrospectively reviewed. LSV was observed in 56 patients with NDMM (58.3%) and 1 patient with sMM (6.7%). Patients with NDMM with LSV had a higher median infiltration of bone marrow plasma cells (80.0% vs. 50.0%, p < 0.001) and median total diffusion volume (median; 540.2 vs. 137.0 mL, p = 0.003) than patients without LSV. Patients with LSV had a lower spleen-to-spinal cord ratio (0.36 vs. 0.96, p < 0.001) and worse 2-year overall survival (OS) (84.6% vs. 100%, p = 0.032). Patients who did not recover spleen visualization during treatment had a worse prognosis, even when they obtained very good partial response (median progression-free survival: 13.2 months). Spleen histopathological findings revealed higher cellularity and diffuse myeloma cell infiltration in a patient with LSV and splenic amyloidosis without extramedullary hematopoiesis in a patient without LSV. Therefore, LSV indicates worse prognosis for patients with MM, even when the patient responds to treatment. Further studies are warranted to clarify the immunological role of spleen in MM.
Highlights
This study investigated the clinical significance of loss of spleen visualization (LSV) on whole-body diffusion-weighted imaging (WB-DWI) in patients with multiple myeloma (MM)
We previously reported that the total diffusion volume by pre-treatment WB-DWI was associated with a high bone marrow plasma cell (BMPC) count and poor prognosis in patients with MM10
This study aimed to investigate the association between WB-DWI, myeloma load and prognosis in patients with MM, focusing on: (1) the relationship among spleen signal loss, total diffusion volume (tDV), and tumor volume at diagnosis; (2) the change in spleen signal intensity and visualization during treatment; (3) the relationship between follow-up spleen signal, follow-up tDV, clinical data, and prognosis; and (4) the mechanism of the loss of spleen signal
Summary
This study investigated the clinical significance of loss of spleen visualization (LSV) on whole-body diffusion-weighted imaging (WB-DWI) in patients with multiple myeloma (MM). We previously reported that the total diffusion volume (tDV) by pre-treatment WB-DWI was associated with a high bone marrow plasma cell (BMPC) count and poor prognosis in patients with MM10. This study aimed to investigate the association between WB-DWI, myeloma load and prognosis in patients with MM, focusing on: (1) the relationship among spleen signal loss, tDV, and tumor volume at diagnosis; (2) the change in spleen signal intensity and visualization during treatment; (3) the relationship between follow-up spleen signal, follow-up tDV, clinical data, and prognosis; and (4) the mechanism of the loss of spleen signal
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