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Diffusion-weighted imaging (DWI) in diagnosis, staging, and treatment response assessment of multiple myeloma: a systematic review and meta-analysis

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Abstract

Objective

To evaluate the role of diffusion-weighted imaging (DWI) in the initial diagnosis, staging, and assessment of treatment response in patients with multiple myeloma (MM).

Materials and methods

A systematic literature review was conducted in PubMed, the Cochrane Library, EMBASE, Scopus, and Web of Science databases. The primary endpoints were defined as the diagnostic performance of DWI for disease detection, staging of MM, and assessing response to treatment in these patients.

Results

Of 5881 initially reviewed publications, 33 were included in the final qualitative and quantitative meta-analysis. The diagnostic performance of DWI in the detection of patients with MM revealed pooled sensitivity and specificity of 86% (95% CI: 84–89) and 63% (95% CI: 56–70), respectively, with a diagnostic odds ratio (OR) of 14.98 (95% CI: 4.24–52.91). The pooled risk difference of 0.19 (95% CI: − 0.04–0.42) was reported in favor of upstaging with DWI compared to conventional MRI (P value = 0.1). Treatment response evaluation and ADCmean value changes across different studies showed sensitivity and specificity of approximately 78% (95% CI: 72–83) and 73% (95% CI: 61–83), respectively, with a diagnostic OR of 7.21 in distinguishing responders from non-responders.

Conclusions

DWI is not only a promising tool for the diagnosis of MM, but it is also useful in the initial staging and re-staging of the disease and treatment response assessment. This can aid clinicians with earlier initiation or change in treatment strategy, which could have prognostic significance for patients.

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Abbreviations

ADC:

Apparent diffusion coefficient

IMWG:

International Myeloma Working Group

MGUS:

Monoclonal gammopathy of undetermined significance

MM:

Multiple myeloma

MRI:

Magnetic resonance imaging

MY-RADS:

Myeloma Response Assessment and Diagnosis System

NLR:

Negative likelihood ratio

PLR:

Positive likelihood ratio

ROC:

Receiver operating characteristic

SMM:

Smoldering multiple myeloma

SNR:

Signal-to-noise ratio

WBLD-CT:

Whole-body low-dose computed tomography

WB-MRI:

Whole-body MRI

18F-FDG PET/CT:

Fluorine-18 fluorodeoxyglucose positron emission tomography with computed tomography

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Authors and Affiliations

  1. Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN, USA

    Pooya Torkian

  2. Department of Radiology, Division Abdominal Imaging, University of Washington, Seattle, WA, 98105, USA

    Bahar Mansoori

  3. Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Jens Hillengass

  4. Department of Radiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Javid Azadbakht

  5. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Sina Rashedi

  6. Department of Oncology, University of Washington, Seattle, WA, 98105, USA

    Sarah S. Lee

  7. Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Behrang Amini

  8. Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy

    Pietro Andrea Bonaffini

  9. University Milano Bicocca, Milan, Italy

    Pietro Andrea Bonaffini

  10. Department of Radiology, Division Musculoskeletal Imaging and Intervention, University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA

    Majid Chalian

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Key points

• The development of functional MRI sequences such as diffusion-weighted imaging (DWI) has made a functional assessment of lesions feasible.

• Diffusion-weighted imaging (DWI) has a role in the diagnosis, staging, and treatment response of multiple myeloma.

• DWI can quantitatively assess tissue cellularity by detecting free water molecule movements depicted on apparent diffusion coefficient (ADC) maps.

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Torkian, P., Mansoori, B., Hillengass, J. et al. Diffusion-weighted imaging (DWI) in diagnosis, staging, and treatment response assessment of multiple myeloma: a systematic review and meta-analysis. Skeletal Radiol 52, 565–583 (2023). https://doi.org/10.1007/s00256-022-04119-0

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