Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Clinical Application and Limitations of Myeloma Response Assessment and Diagnosis System (MY-RADS)

골수종 반응평가와 진단체계의 임상적용 및 제한점

  • Dong Kyun Kim (Department of Radiology, Seoul St. Mary's Hospital, and, College of Medicine, The Catholic University of Korea) ;
  • Sung-Soo Park (Department of Hematology, Seoul St. Mary's Hospital, and, College of Medicine, The Catholic University of Korea) ;
  • Joon-Yong Jung (Department of Radiology, Seoul St. Mary's Hospital, and, College of Medicine, The Catholic University of Korea)
  • 김동균 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 박성수 (가톨릭대학교 의과대학 서울성모병원 혈액내과) ;
  • 정준용 (가톨릭대학교 의과대학 서울성모병원 영상의학과)
  • Received : 2022.11.13
  • Accepted : 2023.01.16
  • Published : 2023.01.01
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Abstract

Multiple myeloma, which is a proliferative disease of plasma cells that originate from a single clone, is the second most common hematologic malignancy following non-Hodgkin lymphoma. In the past, its diagnosis was made based on clinical findings (so-called "CRAB") and a skeletal survey using radiographs. However, since the implementation of the International Myeloma Working Group's revised guideline regarding the radiologic diagnosis of multiple myeloma, whole-body (WB) MRI has emerged to play a central role in the early diagnosis of multiple myeloma. Diffusion-weighted imaging and fat quantification using Dixon methods enable treatment response assessment by MRI. In keeping with the trend, a multi-institutional and multidisciplinary consensus for standardized image acquisition and reporting known as the Myeloma Response Assessment and Diagnostic System (MY-RADS) has recently been proposed. This review aims to describe the clinical application of WB-MRI based on MY-RADS in multiple myeloma, discuss its limitations, and suggest future directions for improvement.

다발성 골수종(multiple myeloma)은 단일 클론에서 기원한 형질세포의 증식성 질환으로 비호지킨림프종에 이어 두 번째로 흔한 악성 혈액종양질환이다. 과거에는 'CRAB'이라는 임상 소견과 일반 촬영을 통한 골격계 조사(skeletal survey)에 의존하여 진단하였으나, 최근 International Myeloma Working Group의 개정된 가이드라인에 영상의학적 진단기준이 새로 제시되었다. 이에 병변의 조기 발견이 가능한 전신자기공명영상(whole-body MRI; 이하 WB MRI)의 임상적 유용성이 강조되고 있다. 또한 WB-MRI의 확산강조영상(diffusion-weighted image)과 딕슨 기법을 이용한 지방함량 정량화(fat quantification) 영상을 이용한 정확한 치료반응 평가가 가능하다. 이러한 추세에 따라 표준화된 영상 획득 및 보고를 위한 다기관, 다학제적 컨센서스인 Myeloma Response Assessment and Diagnosis System (이하 MY-RADS)가 발표되었다. 본 종설은 다발성 골수종의 전신자기공명영상 및 MY-RADS의 임상 적용에 대하여 최신 지견을 중심으로 종합적 기술하고자 한다. 이에 더하여 한계점과 추후 개선 방향에 대해서도 고찰하고자 한다.

Keywords

Acknowledgement

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (2019R1C1C1007122).

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