Journal Article

Whole-body MRI quantitative biomarkers are associated significantly with treatment response in patients with newly diagnosed symptomatic multiple myeloma following bortezomib induction

Punwani, Shonit, Rismani, Ali, D’Sa, Shirley, Taylor, Stuart A., Bainbridge, Alan, Latifoltojar, Arash, Rabin, Neil, Hall-Craggs, Margaret, Halligan, Steve, Ourselin, Sebastien, Dikaios, Nikolaos, Popat, Rakesh, Sokolska, Magdalena, Antonelli, Michela, Yong, Kwee

2017

Overview

Objectives To evaluate whole-body MRI (WB-MRI) parameters significantly associated with treatment response in multiple myeloma (MM). Methods Twenty-one MM patients underwent WB-MRI at diagnosis and after two cycles of chemotherapy. Scans acquired at 3.0 T included T2, diffusion-weighted-imaging (DWI) and mDixon pre- and post-contrast. Twenty focal lesions (FLs) matched on DWI and post-contrast mDixon were selected for each time point. Estimated tumour volume (eTV), apparent diffusion coefficient (ADC), enhancement ratio (ER) and signal fat fraction (sFF) were derived. Clinical treatment response to chemotherapy was assessed using conventional criteria. Significance of temporal parameter change was assessed by the paired t test and receiver operating characteristics/area under the curve (AUC) analysis was performed. Parameter repeatability was assessed by interclass correlation (ICC) and Bland–Altman analysis of 10 healthy volunteers scanned at two time points. Results Fifteen of 21 patients responded to treatment. Of 254 FLs analysed, sFF ( p  < 0.0001) and ADC ( p  = 0.001) significantly increased in responders but not non-responders. eTV significantly decreased in 19/21 cases. Focal lesion sFF was the best discriminator of treatment response (AUC 1.0). Bone sFF repeatability was excellent (ICC 0.98) and better than bone ADC (ICC 0.47). Conclusion WB-MRI derived focal lesion sFF shows promise as an imaging biomarker of treatment response in newly diagnosed MM. Key Points • Bone signal fat fraction using mDixon is a robust quantifiable parameter • Fat fraction and ADC significantly increase in myeloma lesions responding to treatment • Bone lesion fat fraction is the best discriminator of myeloma treatment response

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Adult / Aged / Aged, 80 and over / Antineoplastic Agents - therapeutic use / Biomarkers / Bone imaging / Bone lesions / Bortezomib / Bortezomib - therapeutic use / Chemotherapy / Correlation analysis / Diagnostic Radiology / Diffusion coefficient / Diffusion Magnetic Resonance Imaging - methods / Female / Humans / Imaging / Inhibitor drugs / Internal Medicine / Interventional Radiology / Lesions / Magnetic Resonance / Magnetic resonance imaging / Male / Medicine / Medicine & Public Health / Middle Aged / Multiple myeloma / Multiple Myeloma - diagnosis / Multiple Myeloma - diet therapy / Neuroradiology / Patients / Prospective Studies / Radiology / Reproducibility / Targeted cancer therapy / Treatment Outcome / Tumors / Ultrasound / Whole Body Imaging - methods