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Baseline bone marrow ADC value of diffusion-weighted MRI: a potential independent predictor for progression and death in patients with newly diagnosed multiple myeloma

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Abstract

Objectives

To illuminate the prognostic value of ADC (apparent diffusion coefficient), an important quantitative parameter of diffusion-weighted MRI, for multiple myeloma (MM).

Methods

A prospective single-center study which enrolled 114 consecutive newly diagnosed MM patients with baseline whole-body diffusion-weighted MRI (WB DW-MRI) results was conducted. Baseline clinical and MRI parameters were analyzed with univariate and multivariate approaches to identify independent risk factors for progression-free survival (PFS) and overall survival (OS).

Results

Five different DW-MRI patterns were seen, and the mean ADC value of the representative background bone marrow was 0.4662 ± 0.1939 × 10−3 mm2/s. After a mean follow-up of 50.2 months (range, 15.7–75.8 months), twenty-four patients died and seven were lost to follow-up. The mean ADC value of the representative background bone marrow was showed to be an independent risk factor for both PFS (HR 4.664; 95% confidence interval (CI) 1.138–19.121; p = 0.032) and OS (HR 14.130; 95% CI 1.544–129.299; p = 0.019). Normal/salt-and-pepper pattern on DW-MRI was associated with PFS using univariate analysis (p = 0.035) but lost the significance with multivariate Cox regression.

Conclusions

Mean ADC value of the representative background bone marrow predicts both PFS and OS which suggests the role of baseline DW-MRI for risk stratification in newly diagnosed MM patients.

Key Points

• Whole-body diffusion-weighted MRI (WB DW-MRI) might be helpful to improve the current risk stratification systems for newly diagnosed multiple myeloma (MM).

• Morphological parameters as MRI pattern and focal lesion–associated parameters have been reported to be related to survival. However, important functional parameters such as apparent diffusion coefficient (ADC) values were not incorporated into the current risk stratification model.

• This study is one of the first endeavors to delineate the correlation of baseline ADC values and survival in MM patients. It is revealed that the mean ADC value of the representative background bone marrow (L3-S1 and iliac bone) was an independent risk factor for both PFS and OS.

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Abbreviations

ADC:

Apparent diffusion coefficient

FISH:

Fluorescence in situ hybridization

IMWG:

International Myeloma Working Group

MGUS:

Monoclonal gammopathy of undetermined significance

MM:

Multiple myeloma

OS:

Overall survival

PFS:

Progression-free survival

WB DW-MRI:

Whole-body diffusion-weighted MRI

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Funding

Institutional research funding was provided by the National Natural Science Foundation of China (81900202, for L.Z.), the Fundamental Research Funds for the Central Universities (3332018036, for L.Z.), National Public Welfare Basic Scientific Research Program of Chinese Academy of Medical Sciences (2018PT32003 and 2017PT32004, for H.-d.X), and Youth Science Foundation of Peking Union Medical College Hospital (pumch201911423, for Q.W.).

Author information

Author notes

  1. Lu Zhang and Qin Wang contributed equally as first co-authors.

  2. Jian Li and Huadan Xue contributed equally as co-corresponding authors.

Authors and Affiliations

  1. Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Lu Zhang, Xia Wu, Ailin Zhao, Jun Feng, Xinxin Cao, Huacong Cai, Minghui Duan, Tienan Zhu, Wei Zhang, Daobin Zhou & Jian Li

  2. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Qin Wang, Shuo Li, Zhaoyong Sun, Zhengyu Jin & Huadan Xue

  3. Department of Radiology, China-Japan Friendship Hospital, Yinghua East Road 2#, Heping Street, Chaoyang District, Beijing, 100029, China

    Haibo Zhang

Authors
  1. Lu Zhang
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  2. Qin Wang
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  3. Xia Wu
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Corresponding authors

Correspondence to Huadan Xue or Jian Li.

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Guarantor

The scientific guarantor of this publication is Jian Li, MD, Deputy Director of the Department of Hematology, Peking Union Medical College Hospital.

Conflict of interest

The authors have no conflicts of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Peking Union Medical College Hospital Ethics Committee approval was obtained.

Methodology

• prospective

• diagnostic or prognostic

• performed at one institution

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Zhang, L., Wang, Q., Wu, X. et al. Baseline bone marrow ADC value of diffusion-weighted MRI: a potential independent predictor for progression and death in patients with newly diagnosed multiple myeloma. Eur Radiol 31, 1843–1852 (2021). https://doi.org/10.1007/s00330-020-07295-6

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  • DOI: https://doi.org/10.1007/s00330-020-07295-6

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