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Prognostic significance of increased bone marrow microcirculation in newly diagnosed multiple myeloma: results of a prospective DCE-MRI study

  • Magnetic Resonance
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European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Aim of this prospective study was to investigate prognostic significance of increased bone marrow microcirculation as detected by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for survival and local complications in patients with multiple myeloma (MM).

Methods

We performed DCE-MRI of the lumbar spine in 131 patients with newly diagnosed MM and analysed data according to the Brix model to acquire amplitude A and exchange rate constant k ep. In 61 patients a second MRI performed after therapy was evaluated to assess changes in vertebral height and identify vertebral fractures.

Results

Correlation analysis revealed significant positive association between beta2-microglobulin as well as immunoparesis with DCE-MRI parameters A and k ep. Additionally, A was negatively correlated with haemoglobin levels and k ep was positively correlated with LDH levels. Higher baseline k ep values were associated with decreased vertebral height in a second MRI (P = 0.007) and A values were associated with new vertebral fractures in the lower lumbar spine (P = 0.03 for L4). Pre-existing lytic bone lesions or remission after therapy had no impact on the occurrence of vertebral fractures. Multivariate analysis revealed that amplitude A is an independent adverse risk factor for overall survival.

Conclusion

DCE-MRI is a non-invasive tool with significance for systemic prognosis and vertebral complications.

Key Points

• Qualitative parameters from DCE-MRI are correlated with established factors of disease activity

• Increased marrow microcirculation might be a risk factor for loss of vertebral height and fractures

• Amplitude A is an independent predictor for shortened overall survival

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Abbreviations

beta2-MG:

beta2-microglobulin

DCE-MRI:

Dynamic contrast-enhanced magnetic resonance imaging

LDH:

Lactate dehydrogenase

MM:

Multiple myeloma

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Acknowledgments

The authors thank the Deutsche Forschungsgemeinschaft (DFG, Transregio SFB 79) and the Deutsche Jose Carreras Leukämie-Stiftung e.V. for their financial support.

The scientific guarantor of this publication is Jens Hillengass. 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. Two of the authors (CK and TH) have significant statistical expertise.

Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study.

Some study subjects or cohorts have been previously reported (Merz et al., Clinical Cancer Research, 2015 Jan 1;21(1):106–112. doi:10.1158/1078-0432.CCR-14-1029)

Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Author notes

    Authors and Affiliations

    1. German Cancer Research Center, Department of Radiology, Heidelberg, Germany

      Maximilian Merz, Thomas M. Moehler, Judith Ritsch, Stefan Delorme & Jens Hillengass

    2. Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

      Maximilian Merz, Barbara Wagner, Dirk Hose, Hartmut Goldschmidt & Jens Hillengass

    3. Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany

      Tobias Bäuerle

    4. Rinecker Proton Therapy, München, Germany

      Christian M. Zechmann

    5. Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany

      Anna Jauch

    6. German Cancer Research Center, Department of Biostatistics, Heidelberg, Germany

      Christina Kunz & Thomas Hielscher

    7. Fraunhofer MEVIS, Bremen, Germany

      Hendrik Laue

    8. National Center for Tumor Diseases, Heidelberg, Germany

      Hartmut Goldschmidt

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    1. Maximilian Merz
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    Correspondence to Maximilian Merz.

    Additional information

    Maximilian Merz and Thomas M. Moehler contributed equally to this work.

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    Merz, M., Moehler, T.M., Ritsch, J. et al. Prognostic significance of increased bone marrow microcirculation in newly diagnosed multiple myeloma: results of a prospective DCE-MRI study. Eur Radiol 26, 1404–1411 (2016). https://doi.org/10.1007/s00330-015-3928-4

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    • DOI: https://doi.org/10.1007/s00330-015-3928-4

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