Originally published as JCO Early Release 10.1200/JCO.2006.08.5803 on February 12 2007

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Magnetic Resonance Imaging in Multiple Myeloma: Diagnostic and Clinical Implications

Ronald Walker, Bart Barlogie, Jeffrey Haessler, Guido Tricot, Elias Anaissie, John D. Shaughnessy, Jr, Joshua Epstein, Rudy van Hemert, Eren Erdem, Antje Hoering, John Crowley, Ernest Ferris, Klaus Hollmig, Frits van Rhee, Maurizio Zangari, Mauricio Pineda-Roman, Abid Mohiuddin, Shmuel Yaccoby, Jeffrey Sawyer, Edgardo J. Angtuaco

From the Departments of Radiology and Pathology, Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; and Cancer Research and Biostatistics, Seattle, WA

Address reprint requests to Bart Barlogie, MD, PhD, University of Arkansas for Medical Sciences, Arkansas Cancer Research Center, 4301 West Markham St, Mail Slot 816, Little Rock, AR 72205; e-mail: barlogiebart{at}uams.edu

Purpose Magnetic resonance imaging (MRI) permits the detection of diffuse and focal bone marrow infiltration in the absence of osteopenia or focal osteolysis on standard metastatic bone surveys (MBSs).

Patients and Methods Both baseline MBS and MRI were available in 611 of 668 myeloma patients who were treated uniformly with a tandem autologous transplantation–based protocol and were evaluated to determine their respective merits for disease staging, response assessment, and outcome prediction.

Results MRI detected focal lesions (FLs) in 74% and MBS in 56% of imaged anatomic sites; 52% of 267 patients with normal MBS results and 20% of 160 with normal MRI results had FL on MRI and MBS, respectively. MRI- but not MBS-defined FL independently affected survival. Cytogenetic abnormalities (CAs) and more than seven FLs on MRI (MRI-FLs) distinguished three risk groups: 5-year survival was 76% in the absence of both more than seven MRI-FLs and CA (n = 276), 61% in the presence of one MRI-FL (n = 262), and 37% in the presence of both unfavorable parameters (n = 67). MRI-FL correlated with low albumin and elevated levels of C-reactive protein, lactate dehydrogenase, and creatinine, but did not correlate with age, beta-2-microglobulin, and CA. Resolution of MRI-FL, occurring in 60% of cases and not seen with MBS-defined FL, conferred superior survival.

Conclusion MRI is a more powerful tool for detection of FLs than is MBS. MRI-FL number had independent prognostic implications; additionally, MRI-FL resolution identified a subgroup with superior survival. We therefore recommend that, in addition to MBS, MRI be used routinely for staging, prognosis, and response assessment in myeloma.

published online ahead of print at www.jco.org on February 12, 2007.

Supported in part by National Cancer Institute Grant No. CA55819.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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