Prognostic significance of focal lesions and diffuse infiltration on MRI for multiple myeloma: a meta-analysis

So-Yeon Lee; Hyun-Jung Kim; Yu Ri Shin; Hee-Jin Park; Yun-Gyoo Lee; Suk Joong Oh

doi:10.1007/s00330-016-4543-8

European Radiology

June 2017, Volume 27, Issue 6, pp 2333–2347 | Cite as

Prognostic significance of focal lesions and diffuse infiltration on MRI for multiple myeloma: a meta-analysis

Authors
Authors and affiliations

So-Yeon Lee
Hyun-Jung KimEmail author
Yu Ri Shin
Hee-Jin Park
Yun-Gyoo Lee
Suk Joong Oh

Magnetic Resonance

First Online: 05 September 2016

Received: 10 June 2015

Revised: 30 June 2016

Accepted: 08 August 2016

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Abstract

Objectives

MRI of bone marrow of the axial skeleton is recommended for evaluation of multiple myeloma. The impact of bone marrow involvement pattern on MRI for determining progression-free survival (PFS) and overall survival (OS) is not yet clear.

Methods

We performed a meta-analysis of research on the prognostic significance of MRI patterns for OS and PFS using a random effects model. Databases searched without language restriction were MEDLINE, EMBASE, and the Cochrane Library (January 1976 to April 2014). Manual searches were also conducted.

Results

Of 10,953 citations identified in the original search, 10 cohort studies for a total of 2015 patients met the inclusion criteria. Nine of the 10 included studies are from three research groups. Pooled hazard ratios were 1.80 (95 % confidence interval [CI] 1.32–2.46; P < 0.001) for OS and 2.30 (95 % CI 1.65–3.20; P < 0.001) for PFS for focal lesions on MRI; and 1.70 (95 % CI 1.30–2.21; P < 0.001) for OS and 1.74 (95 % CI 1.07–2.85; P = 0.03) for PFS for diffuse infiltration on MRI. No significant heterogeneity was observed among studies.

Conclusions

This meta-analysis demonstrated an association between focal lesions and diffuse infiltration and poor prognosis in this population.

Key Points

• MRI findings of multiple myeloma include normal, focal, variegated and diffuse infiltration

• Focal lesions and diffuse infiltration on MRI were poor prognostic factors

• Bone marrow involvement pattern on MRI can help physicians assess prognosis

Keywords

Multiple myeloma MRI Prognosis Bone marrow Meta-analysis

Abbreviations

CRAB: Hypercalcemia, renal failure, anemia and bone lesions
CT: Computed tomography
HR: Hazard ratio
IMWG: International Myeloma Working Group
ISS: International staging system
MGUS: Monoclonal gammopathy of undetermined significance
MRI: Magnetic resonance imaging
OS: Overall survival
PFS: Progression-free survival
QUIPS: Quality in prognosis studies

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Notes

Acknowledgments

The scientific guarantor of this publication is Hyun-Jung Kim. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Methodology: retrospective, performed at one institution.

Appendix 1 Search strategy for each database

1.1.
MEDLINE
1. 1.
  
  ("Multiple Myeloma"[Mesh:NoExp]) OR "Bone Marrow Neoplasms"[Mesh]
2. 2.
  
  "Bone Marrow Neoplasms/secondary"[Mesh]
3. 3.
  
  1 NOT 2
4. 4.
  
  ("Monoclonal Gammopathy of Undetermined Significance"[Mesh]) OR "Plasmacytoma"[Mesh]
5. 5.
  
  "Bone Marrow Neoplasms"[tiab] OR "Bone Marrow Neoplasm"[tiab] OR "Myeloma"[tiab] OR "Myelomas"[tiab] OR "Monoclonal Gammopathy"[tiab] OR "Monoclonal Gammapathies"[tiab] OR "plasmacytoma"[tiab] OR "Plasmocytomas"[tiab]
6. 6.
  
  3 OR 4 OR 5
7. 7.
  
  (((("Magnetic Resonance Imaging"[Mesh:NoExp]) OR "Bone Marrow"[Mesh]) OR "Bone and Bones"[Mesh:NoExp]) OR "Spine"[Mesh]) OR "Bone Density"[Mesh]
8. 8.
  
  marrow[tiab] OR Spine[tiab] OR Spinal[tiab] OR Vertebra*[tiab] OR "Magnetic Resonance"[tiab] OR "MRI"[tiab] OR "MR"[tiab] OR "MRIs"[tiab] OR "Bones"[tiab] OR "Bone"[tiab]
9. 9.
  
  7 OR 8
10. 10.
  
  6 AND 9
11. 11.
  
  Prognosis[tiab] OR Predictive Value[tiab] OR Progression[tiab] OR Progressions[tiab] OR Risk[tiab] OR Risks[tiab] OR Survival[tiab] OR Survivals[tiab]
12. 12.
  
  (((("Prognosis"[Mesh:NoExp]) OR "Survival Analysis"[Mesh]) OR "Risk"[Mesh]) OR "Predictive Value of Tests"[Mesh]) OR "Disease Progression"[Mesh]
13. 13.
  
  11 or 12
14. 14.
  
  mortality[MeSH Terms] OR follow up studies[MeSH:noexp] OR prognos*[tiab] OR predict*[tiab] OR course*[tiab]
15. 15.
  
  13 OR 14
16. 16.
  
  15 AND 10
17. 17.
  
  16/humans
1.2
EMBASE
1. 1.
  
  'multiple myeloma'/exp OR 'bone marrow cancer'/exp
2. 2.
  
  'monoclonal immunoglobulinemia'/exp OR 'plasmacytoma'/exp
3. 3.
  
  'Bone Marrow Neoplasms':ab,ti OR 'Bone Marrow Neoplasm':ab,ti OR 'Myeloma':ab,ti OR 'Myelomas':ab,ti OR 'Monoclonal Gammopathy':ab,ti OR 'Monoclonal Gammapathies':ab,ti OR 'plasmacytoma':ab,ti OR 'Plasmocytomas':ab,ti
4. 4.
  
  1 OR 2 OR 3
5. 5.
  
  'nuclear magnetic resonance imaging'/de OR 'bone marrow'/exp OR 'bone'/de OR 'spine'/exp OR 'bone density'/exp
6. 6.
  
  marrow:ab,ti OR Spine:ab,ti OR Spinal:ab,ti OR Vertebra*:ab,ti OR 'Magnetic Resonance':ab,ti OR 'MRI':ab,ti OR 'MR':ab,ti OR 'MRIs':ab,ti OR 'Bones':ab,ti OR 'Bone':ab,ti
7. 7.
  
  5 OR 6
8. 8.
  
  7 AND 8
9. 9.
  
  Prognosis:ab,ti OR Predictive Value:ab,ti OR Progression:ab,ti OR Progressions:ab,ti OR Risk:ab,ti OR Risks:ab,ti OR Survival:ab,ti OR Survivals:ab,ti
10. 10.
  
  'cancer prognosis'/exp OR 'survival'/exp OR 'risk'/de OR 'risk assessment'/exp OR 'risk factor'/exp OR 'predictive value'/exp OR 'disease course'/exp OR 'cancer mortality'/exp
11. 11.
  
  prognos*:ab,ti OR predict*:ab,ti OR course*:ab,ti
12. 12.
  
  9 OR 10 OR 11
13. 13.
  
  12 AND 8
14. 14.
  
  13/humans
1.3
Cochrane library
1. 1.
  
  MeSH descriptor: [Multiple Myeloma] this term only
2. 2.
  
  MeSH descriptor: [Bone Marrow Neoplasms] explode all trees
3. 3.
  
  #1 or #2
4. 4.
  
  MeSH descriptor: [Bone Marrow Neoplasms] explode all trees and with qualifier(s): [Secondary]
5. 5.
  
  #3 not #4
6. 6.
  
  MeSH descriptor: [Monoclonal Gammopathy of Undetermined Significance] explode all trees
7. 7.
  
  MeSH descriptor: [Plasmacytoma] explode all trees
8. 8.
  
  #6 or #7
9. 9.
  
  "Bone Marrow Neoplasms" or "Bone Marrow Neoplasm" or "Myeloma" or "Myelomas" or "Monoclonal Gammopathy" or "Monoclonal Gammapathies" or "plasmacytoma" or "Plasmocytomas":ti,ab,kw (Word variations have been searched)
10. 10.
  
  #5 or #8 or #9
11. 11.
  
  MeSH descriptor: [Magnetic Resonance Imaging] this term only
12. 12.
  
  MeSH descriptor: [Bone Marrow] explode all trees
13. 13.
  
  MeSH descriptor: [Bone and Bones] this term only
14. 14.
  
  MeSH descriptor: [Spine] explode all trees
15. 15.
  
  MeSH descriptor: [Bone Density] explode all trees
16. 16.
  
  #11 or #12 or #13 or #14 or #15
17. 17.
  
  "marrow" or "Spine" or "Spinal" or "Vertebra*" or "Magnetic Resonance" or "MRI" or "MR" or "MRIs" or "Bones" or "Bone":ti,ab,kw (Word variations have been searched)
18. 18.
  
  #16 or #17
19. 19.
  
  #10 and #18
20. 20.
  
  "Prognosis" or "Predictive Value" or "Progression" or "Progressions" or "Risk" or "Risks" or "Survival" or "Survivals":ti,ab,kw (Word variations have been searched)
21. 21.
  
  MeSH descriptor: [Prognosis] this term only
22. 22.
  
  MeSH descriptor: [Survival Analysis] explode all trees
23. 23.
  
  MeSH descriptor: [Risk] explode all trees
24. 24.
  
  MeSH descriptor: [Predictive Value of Tests] explode all trees
25. 25.
  
  MeSH descriptor: [Disease Progression] explode all trees
26. 26.
  
  #21 or #22 or #23 or #24 or #25
27. 27.
  
  MeSH descriptor: [Mortality] explode all trees
28. 28.
  
  MeSH descriptor: [Follow-Up Studies] this term only
29. 29.
  
  "prognos*" or "predict*" or "course*":ti,ab,kw (Word variations have been searched)
30. 30.
  
  #27 or #28 or #29
31. 31.
  
  #26 or #30
32. 32.
  
  #19 and #31
33. 33.
  
  #32/trials

Appendix 2 Funnel Plots

2.1. Funnel plot of pooled studies with OS related to focal lesion on MRI in patients with multiple myeloma.

2.2. Funnel plot of pooled studies with PFS related to focal lesion on MRI in patients with multiple myeloma.

2.3. Funnel plot of pooled studies with OS related to diffuse infiltration on MRI in patients with multiple myeloma.

2.4. Funnel plot of pooled studies with PFS related to diffuse infiltration on MRI in patients with multiple myeloma.

2.5. Funnel plot of pooled studies with PFS related to focal lesion on MRI in patients with asymptomatic multiple myeloma.

2.6. Funnel plot of pooled studies with OS related to focal lesion on MRI in patients with symptomatic multiple myeloma.

2.7. Funnel plot of pooled studies with PFS related to diffuse infiltration on MRI in patients with asymptomatic multiple myeloma.

2.8. Funnel plot of pooled studies with OS related to diffuse infiltration on MRI in patients with symptomatic multiple myeloma.

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Authors and Affiliations

So-Yeon Lee
- 1
Hyun-Jung Kim
- 2
Email author
Yu Ri Shin
- 3
Hee-Jin Park
- 1
Yun-Gyoo Lee
- 4
Suk Joong Oh
- 4

1.Department of Radiology, Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulRepublic of Korea
2.Department of Preventive MedicineKorea University College of MedicineSeoulRepublic of Korea
3.Department of Radiology, Incheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
4.Division of Hematology and Oncology, Department of Internal Medicine, Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulRepublic of Korea

Prognostic significance of focal lesions and diffuse infiltration on MRI for multiple myeloma: a meta-analysis

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keywords

Abbreviations

Notes

Acknowledgments

References

Copyright information

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