The diagnostic value of SE MRI and DWI of the spine in patients with monoclonal gammopathy of undetermined significance, smouldering myeloma and multiple myeloma



To evaluate DWI of the bone marrow in the differentiation of monoclonal gammopathy of undetermined significance (MGUS), smouldering myeloma (SMM) and multiple myeloma (MM).


The retrospective study includes 64 patients with MGUS, 27 with SMM, 64 with new MM and 12 controls. Signal intensity (SI) of spinal SE-MRI and DWI (b0-1000) as well as apparent diffusion coefficients (ADC) were measured in the T10 and L3. Qualitative assessment of b-images was performed by one experienced radiologist.


ADC600 and ADC1000 are the best ADC values in differentiating patient groups (p < 0.030). SIT2, SIb1000 and ADC1000 are higher and SIT1 lower in L3 compared to T10 (p < 0.050). All quantitative parameters of L3 can differentiate significantly between MGUS and MM (p < 0.050) and between patients with percentage plasma cells (PC%) between 0-10 % compared to >50 % (p = 0.001). Only SIT2 for L3 can differentiate MGUS from SMM (p = 0.044) and PC%0-10 from PC%10-25 (p = 0.033). Qualitative interpretation of b1000 images allows differentiating MM patients from those with MGUS or SMM (p < 0.001).


Spinal SE-MRI can differentiate among MGUS, SMM, MM and control subjects. DWI based on the SI on b1000 images and ADC values is increased in MM compared to MGUS and SMM. Qualitative assessment of b-images can differentiate MM from MGUS or SMM.

Key points

ADC values are higher in patients with MM compared to MGUS

DWI parameters change late in disease evolution

DWI is sensitive but not specific in diagnosing patients with MM

Qualitative DWI assessment is good in detecting myeloma patients

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Fig. 1
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Fig. 3



International Myeloma Working Group


Magnetic resonance imaging


Computed tomography


Positron emission tomography


Diffusion-weighted imaging


Apparent diffusion coefficient


Signal intensity


Monoclonal gammopathy of undetermined significance


Smouldering myeloma


Multiple myeloma


International Staging System


Hereditary multiple exostoses




Echo planar imaging


Region of interest






Receiver-operating characteristic


Area under the curve


Percentage plasma cells


T1 weighted


Fat-suppressed T2 weighted


Slice thickness


Turbo spin echo


Repetition time


Echo time


Inversion time


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The scientific guarantor of this publication is Koenraad Verstraete. 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. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Some study subjects or cohorts have been previously reported in Euro J Radiol, A correlation was made between data of conventional whole-body MRI and dynamic contrast-enhanced MRI. Methodology: retrospective, diagnostic or prognostic study/observational, performed at one institution.

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Correspondence to Julie C. Dutoit.

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Dutoit, J.C., Vanderkerken, M.A., Anthonissen, J. et al. The diagnostic value of SE MRI and DWI of the spine in patients with monoclonal gammopathy of undetermined significance, smouldering myeloma and multiple myeloma. Eur Radiol 24, 2754–2765 (2014).

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  • Diffusion-weighted imaging
  • Magnetic resonance imaging
  • Multiple myeloma
  • Monoclonal gammopathy of undetermined significance
  • Diagnosis