Abstract
BackgroundDiffusion-weighted whole-body MRI (DW-MRI) is increasingly used to evaluate bone diseases of multiple myeloma (MM), but there is lack of quantitative indicator for DW-MRI to reflect the prognosis of MM. Apparent diffusion coefficient (ADC) values in DW-MRI has potential correlations between some indexes of MM, but the influence of ADC on MM survival needs to be further verified.MethodsA total of 381 newly diagnosed MM patients were enrolled in the study to analyze the effect of ADC values in DW-MRI on progression-free survival (PFS) and overall survival (OS). The Kaplan–Meier method was used to perform univariate survival analysis, and the Cox proportional hazards model was used for multivariate analysis. In addition to the ADC value, genetic and serological indexes were also included.ResultsThe survivals were observed in univariate ADC stratification with median PFS of 52.0, 45.0, 34.0, and 26.0 months (the unit of ADC value was 10−3 mm2/s; the ADC ranges were ADC < 0.4886, 0.4886 ≤ ADC < 0.6545, 0.6545 ≤ ADC < 0.7750, and ADC ≥ 0.7750; 95% CI, 43.759–62.241, 46.336–53.664, 39.753–46.247, and 27.812–32.188). The OS were 81.0, 61.0, 47.0, and 36.0 months (p < 0.001; 95% CI, 71.356–82.644, 67.630–70.370, 57.031–60.969, and 36.107–43.893). In Cox proportional hazards model, the ADC value was considered to be an independent risk factor affecting PFS and OS of MM (both p < 0.001).ConclusionsThis study supports that ADC in DW-MRI may independently stratify MM patients and better predict their prognosis. The combined use of DW-MRI and other parameters allows more accurate evaluation of MM survival.Trial Registrationhttp://www.chictr.org.cn/showproj.aspx?proj=49012, ChiCTR2000029587.
Highlights
Multiple myeloma (MM) is a malignant hematological disease caused by abnormal clonal proliferation of plasma cells [1]
The survivals were observed in univariate Apparent diffusion coefficient (ADC) stratification with median progression-free survival (PFS) of 52.0, 45.0, 34.0, and 26.0 months
The inclusion criteria were as follows: [1] All of the MM patients meet the diagnostic criteria of the International Myeloma Working Group (IMWG); [2] All patients were newly diagnosed MM at the time of inclusion; [3] whole-body diffusion-weighted imaging (WB-DWI) was performed before treatment; [4] The interval between initial chemotherapy and WB-DWI was within 1 week; [5] All the patients enrolled were symptomatic or active MM with detectable M protein in blood or urine; [6] All the patients received at least four courses of firstline treatment based on bortezomib, and the treatment response was evaluated; [7] All patients received regular inpatient services, outpatient services, and telephone follow-up
Summary
Multiple myeloma (MM) is a malignant hematological disease caused by abnormal clonal proliferation of plasma cells [1]. About 80%–90% of MM patients will exhibit different degrees of MM-related bone diseases [3]. The severity of bone disease increases mortality [4]. With the change of treatment methods the 5-year survival rate of MM has increased from 28% to 56% (1975 to 2012) [5], the imaging methods that can effectively predict the prognosis of the disease still need to be explored. A reliable, noninvasive imaging method for survival prediction is urgently needed. Diffusion-weighted whole-body MRI (DW-MRI) is increasingly used to evaluate bone diseases of multiple myeloma (MM), but there is lack of quantitative indicator for DW-MRI to reflect the prognosis of MM. Apparent diffusion coefficient (ADC) values in DW-MRI has potential correlations between some indexes of MM, but the influence of ADC on MM survival needs to be further verified
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