J Yeungnam Med Sci.  2022 Oct;39(4):300-308. 10.12701/jyms.2021.01648.

Clinical impact of spine magnetic resonance imaging as a valuable prognostic tool for patients with multiple myeloma: a retrospective study

• Lee JM
• Cho HJ
• Moon JH
• Sohn SK
• Park B
• Baek DW

• KMID: 2534657
• DOI: http://doi.org/10.12701/jyms.2021.01648

Abstract

Background
This study investigated the prognostic impact of spine magnetic resonance imaging (MRI) in patients newly diagnosed with multiple myeloma (MM).
Methods
We retrospectively evaluated 214 patients who were newly diagnosed with MM between March 2015 and December 2019. The patients were classified into five different infiltration patterns based on spine MRI as follows: (1) normal appearance, (2) focal, (3) diffuse, (4) combined focal and diffuse infiltration, and (5) “salt-and-pepper.”
Results
Forty patients (18.7%) showed a normal appearance, whereas focal, diffuse, combined focal and diffuse infiltration, and “salt-and-pepper” patterns were identified in 68 (31.8%), 40 (18.7%), 52 (24.3%), and 14 patients (6.5%), respectively. The patients with normal and “salt-and-pepper” patterns were younger than patients with other patterns (median age, 61.6 vs. 66.8 years; p=0.001). Moreover, 63% and 59.3% of patients with normal and “salt-and-pepper” patterns were scored International Staging System (ISS) stage I and revised ISS (R-ISS) stage I, respectively, whereas only 12.5% of patients with other patterns were scored ISS stage I and R-ISS stage I. Patients with normal and “salt-and-pepper” patterns had a better prognosis than those with other patterns, whereas relapse and death rates were significantly higher in patients with focal, diffuse, and combined MRI patterns.
Conclusion
Characteristic MRI findings have a significant prognostic value for long-term survival in patients newly diagnosed with MM. In particular, focal, diffuse, and combined focal and diffuse infiltration patterns are unfavorable prognostic factors.

Keyword

Autologous stem-cell transplantation; Magnetic resonance imaging; Multiple myeloma; Prognosis

Figure

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  Fig. 1. Magnetic resonance imaging classification of bone marrow involvement pattern in patients with multiple myeloma. (A) Normal bone marrow pattern. Homogeneous high signal intensity of bone marrow on sagittal T1-weighted image is compared with that of intervertebral disc. (B) Focal nodular infiltrative pattern. Focal nodular low signal intensity lesions (arrows) on sagittal T1-weighted image in T11 and L4 suggest focal nodular infiltrative pattern. (C) Diffuse infiltrative pattern. Diffuse homogeneous low signal intensity replacing normal marrow signal on sagittal T1-weighted image suggests diffuse infiltrative pattern. (D) Combined infiltrative pattern. Sagittal T1-weighted image shows diffuse homogeneous low signal intensity replacing normal marrow signal (arrow) in S2 and focal nodular low signal intensity lesions (arrowheads) in L1 and L2. Small foci also noted throughout the marrow suggest combined infiltrative pattern. (E) “Salt-and-pepper” pattern. Small foci of low signal intensity throughout the marrow on sagittal T1-weighted image suggest “salt-and-pepper” pattern.

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  Fig. 2. Kaplan-Meier curves according to the spine magnetic resonance imaging patterns. Patients show various prognoses in terms of (A) progression-free survival (PFS) and (B) overall survival (OS).

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  Fig. 3. Kaplan-Meier curves according to the spine magnetic resonance imaging patterns. Patients with normal and “salt-and-pepper” patterns show significantly superior (A) progression-free survival (PFS) and (B) overall survival (OS).

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  Fig. 4. Kaplan-Meier curves according to the spine magnetic resonance imaging patterns and autologous stem-cell transplantation (ASCT). In the focal, diffuse, and combined infiltration patterns, patients who underwent ASCT have superior (A) progression-free survival (PFS) and (B) overall survival (OS).

Reference

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