Abstract
PurposeTo compare various pulse sequences in terms of percent contrast and contrast-to-noise ratio (CNR) for detection of focal multiple myeloma lesions and to assess the dependence of lesion conspicuity on the bone marrow plasma cell percent (BMPC%).Materials and MethodsSagittal T1-weighted FSE, fat-suppressed T2-weighted FSE (FS- T2 FSE), fast STIR and iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) imaging of the lumbar spine were performed (n = 45). Bone marrow (BM)-focal myeloma lesion percent contrast and CNR were calculated. Spearman rank correlation coefficients were obtained between percent contrast, CNR and BMPC%. Percent contrasts and CNRs were compared among the three imaging sequences.ResultsBM-focal lesion percent contrasts, CNRs and BMPC% showed significant negative correlations in the three fat-suppression techniques. Percent contrast and CNRs were significantly higher for FS- T2 FSE than for STIR (P<0.01, P<0.05, respectively), but no significant differences were found among the three fat-suppression methods in the low tumor load BM group.ConclusionThe higher BMPC% was within BM, the less conspicuous the focal lesion was on fat-suppressed MRI. The most effective protocol for detecting focal lesions was FS- T2 FSE. In the high tumor load BM group, no significant differences in lesion conspicuity were identified among the three fat-suppression techniques.
Highlights
Multiple myeloma is a plasma-cell malignancy characterized by the presence of lytic bone disease causing severe bone pain, pathological fractures, spinal cord compression and hypercalcemia [1]
Percent contrast and contrast-to-noise ratio (CNR) were significantly higher for FS- T2 fast spin-echo (FSE) than for short inversion time inversion recovery (STIR) (P,0.01, P,0.05, respectively), but no significant differences were found among the three fat-suppression methods in the low tumor load bone marrow (BM) group
The higher BMPC% was within BM, the less conspicuous the focal lesion was on fat-suppressed magnetic resonance imaging (MRI)
Summary
Multiple myeloma is a plasma-cell malignancy characterized by the presence of lytic bone disease causing severe bone pain, pathological fractures, spinal cord compression and hypercalcemia [1]. Up to 90% of myeloma patients develop osteolytic lesions during the course of the disease [2]. In patients with active myeloma, the number of lesions on MRI correlates very well with treatment outcomes and overall survival [5] This excellent correlation with survival outcome is the primary reason for the inclusion of MRI into the Durie-Salmon PLUS system. The Durie-Salmon PLUS staging system does not include the presence or absence of diffuse infiltration of tumor cells into the bone marrow (BM). This means that focal myeloma lesions must be detected regardless of any abnormality in background BM. The optimal MRI sequence for detecting focal bone lesions remains to be determined
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