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Imaging for Multiple Myeloma according to the Recent International Myeloma Working Group Guidelines: Analysis of Image Acquisition Techniques and Response Evaluation in Whole-Body MRI according to MY-RADS

International Myeloma Working Group의 최신 가이드 라인에 따른 다발성 골수종의 영상검사법 및 MY-RADS에 따른 전신 MRI에서의 영상 획득과 반응 평가 소개

  • A Yeon Son (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hye Won Chung (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine)
  • 손아연 (울산대학교 의과대학 서울아산병원 영상의학과) ;
  • 정혜원 (울산대학교 의과대학 서울아산병원 영상의학과)
  • Received : 2021.11.18
  • Accepted : 2022.02.12
  • Published : 2023.01.01

Abstract

Multiple myeloma (MM) is a malignant hematologic disease caused by the proliferation of clonal plasma cells in the bone marrow, and its incidence is increasing in Korea. With the development of treatments for MM, the need for early diagnosis and treatment has emerged. In recent years, the International Myeloma Working Group (IMWG) has been constantly revising the laboratory and radiological diagnostic criteria for MM. In addition, as whole-body MRI (WBMR) has been increasing used in the diagnosis and treatment response evaluation of patients with MM, the Myeloma Response Assessment and Diagnosis System (MY-RADS) was created to standardize WBMR image acquisition techniques, image interpretation, and response evaluation methods. Radiologists need to have a detailed knowledge of the features of MM for accurate diagnosis. Thus, in this review article, we describe the imaging method for MM according to the latest IMWG guidelines as well as the image acquisition and response evaluation technique for WBMR according to MY-RADS.

다발성 골수종은 골수에서 클론 형질 세포의 증식으로 인한 악성 혈액 질환으로 최근 우리나라에서도 발병률이 증가하고 있다. 다발성 골수종의 치료법이 발전하면서 질환의 조기 진단과 조기 치료의 필요성이 대두되었고 International Myeloma Working Group (이하 IMWG) 중심으로 질병의 진단의학적, 영상의학적 진단 기준이 여러 차례 개정되고 있다. 또한 다발성 골수종 환자의 진단과 치료 반응 평가에 전신 자기공명영상(whole body MR; 이하 WBMR)의 사용량이 증가하면서 WBMR의 영상 획득 기법이나 영상 결과 해석, 반응평가법을 표준화하기 위해 Myeloma Response Assessment and Diagnosis System (이하 MYRADS)가 만들어졌다. 이 종설에서는 다발성 골수종의 정확한 진단을 위해 영상의학과 의사로서 알아야 할 최신 지견으로 IMWG의 최신 가이드라인에 따른 다발성 골수종의 영상검사법 및 MY-RADS에 따른 WBMR에서의 영상 획득 기법 및 반응 평가 기법에 대해 설명하였다.

Keywords

References

  1. Hong S, Won YJ, Lee JJ, Jung KW, Kong HJ, Im JS, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2018. Cancer Res Treat 2021;53:301-315 https://doi.org/10.4143/crt.2021.291
  2. Rollig C, Knop S, Bornhauser M. Multiple myeloma. Lancet 2015;385:2197-2208 https://doi.org/10.1016/S0140-6736(14)60493-1
  3. Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014;15:e538-e548 https://doi.org/10.1016/S1470-2045(14)70442-5
  4. Hillengass J, Usmani S, Rajkumar SV, Durie BGM, Mateos MV, Lonial S, et al. International Myeloma Working Group consensus recommendations on imaging in monoclonal plasma cell disorders. Lancet Oncol 2019;20:e302-e312 https://doi.org/10.1016/S1470-2045(19)30309-2
  5. Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia 2009;23:3-9 https://doi.org/10.1038/leu.2008.291
  6. Kyle RA, Remstein ED, Therneau TM, Dispenzieri A, Kurtin PJ, Hodnefield JM, et al. Clinical course and prognosis of smoldering (asymptomatic) multiple myeloma. N Engl J Med 2007;356:2582-2590 https://doi.org/10.1056/NEJMoa070389
  7. Lee K, Kim KW, Ko Y, Park HY, Chae EJ, Lee JH, et al. Comprehensive updates in the role of imaging for multiple myeloma management based on recent international guidelines. Korean J Radiol 2021;22:1497-1513 https://doi.org/10.3348/kjr.2020.0886
  8. Mateos MV, Hernandez MT, Giraldo P, de la Rubia J, de Arriba F, Lopez Corral L, et al. Lenalidomide plus dexamethasone for high-risk smoldering multiple myeloma. N Engl J Med 2013;369:438-447 https://doi.org/10.1056/NEJMoa1300439
  9. Dispenzieri A, Stewart AK, Chanan-Khan A, Rajkumar SV, Kyle RA, Fonseca R, et al. Smoldering multiple myeloma requiring treatment: time for a new definition? Blood 2013;122:4172-4181 https://doi.org/10.1182/blood-2013-08-520890
  10. Regelink JC, Minnema MC, Terpos E, Kamphuis MH, Raijmakers PG, Pieters-van den Bos IC, et al. Comparison of modern and conventional imaging techniques in establishing multiple myeloma-related bone disease: a systematic review. Br J Haematol 2013;162:50-61 https://doi.org/10.1111/bjh.12346
  11. International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol 2003;121:749-757 https://doi.org/10.1046/j.1365-2141.2003.04355.x
  12. Hillengass J, Fechtner K, Weber MA, Bauerle T, Ayyaz S, Heiss C, et al. Prognostic significance of focal lesions in whole-body magnetic resonance imaging in patients with asymptomatic multiple myeloma. J Clin Oncol 2010;28:1606-1610 https://doi.org/10.1200/JCO.2009.25.5356
  13. Dimopoulos M, Terpos E, Comenzo RL, Tosi P, Beksac M, Sezer O, et al. International Myeloma Working Group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple myeloma. Leukemia 2009;23:1545-1556 https://doi.org/10.1038/leu.2009.89
  14. Edelstyn GA, Gillespie PJ, Grebbell FS. The radiological demonstration of osseous metastases. Experimental observations. Clin Radiol 1967;18:158-162 https://doi.org/10.1016/S0009-9260(67)80010-2
  15. Hillengass J, Moulopoulos LA, Delorme S, Koutoulidis V, Mosebach J, Hielscher T, et al. Whole-body computed tomography versus conventional skeletal survey in patients with multiple myeloma: a study of the International Myeloma Working Group. Blood Cancer J 2017;7:e599
  16. Wolf MB, Murray F, Kilk K, Hillengass J, Delorme S, Heiss C, et al. Sensitivity of whole-body CT and MRI versus projection radiography in the detection of osteolyses in patients with monoclonal plasma cell disease. Eur J Radiol 2014;83:1222-1230 https://doi.org/10.1016/j.ejrad.2014.02.008
  17. Yoon MA, Chee CG, Chung HW, Lee DH, Kim KW. Diagnostic performance of computed tomography and diffusion-weighted imaging as first-line imaging modality according to the International Myeloma Working Group (IMWG) imaging algorithm for monoclonal plasma cell disorders. Acta Radiol 2022;63:672-683 https://doi.org/10.1177/02841851211008383
  18. Costello JE, Cecava ND, Tucker JE, Bau JL. CT radiation dose: current controversies and dose reduction strategies. AJR Am J Roentgenol 2013;201:1283-1290 https://doi.org/10.2214/AJR.12.9720
  19. Ormond Filho AG, Carneiro BC, Pastore D, Silva IP, Yamashita SR, Consolo FD, et al. Whole-body imaging of multiple myeloma: diagnostic criteria. Radiographics 2019;39:1077-1097 https://doi.org/10.1148/rg.2019180096
  20. Messiou C, Hillengass J, Delorme S, Lecouvet FE, Moulopoulos LA, Collins DJ, et al. Guidelines for acquisition, interpretation, and reporting of whole-body MRI in myeloma: myeloma response assessment and diagnosis system (MY-RADS). Radiology 2019;291:5-13 https://doi.org/10.1148/radiol.2019181949
  21. Messiou C, Kaiser M. Whole body diffusion weighted MRI--a new view of myeloma. Br J Haematol 2015;171:29-37 https://doi.org/10.1111/bjh.13509
  22. Lecouvet FE, Vande Berg BC, Maldague BE, Michaux L, Laterre E, Michaux JL, et al. Vertebral compression fractures in multiple myeloma. Part I. Distribution and appearance at MR imaging. Radiology 1997;204:195-199 https://doi.org/10.1148/radiology.204.1.9205246
  23. Park HY, Kim KW, Yoon MA, Lee MH, Chae EJ, Lee JH, et al. Role of whole-body MRI for treatment response assessment in multiple myeloma: comparison between clinical response and imaging response. Cancer Imaging 2020;20:14
  24. Cavo M, Terpos E, Nanni C, Moreau P, Lentzsch S, Zweegman S, et al. Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol 2017;18:e206-e217 https://doi.org/10.1016/S1470-2045(17)30189-4
  25. Weng WW, Dong MJ, Zhang J, Yang J, Xu Q, Zhu YJ, et al. A systematic review of MRI, scintigraphy, FDG-PET and PET/CT for diagnosis of multiple myeloma related bone disease--which is best? Asian Pac J Cancer Prev 2014;15:9879-9884 https://doi.org/10.7314/APJCP.2014.15.22.9879
  26. Morone M, Bali MA, Tunariu N, Messiou C, Blackledge M, Grazioli L, et al. Whole-body MRI: current applications in oncology. AJR Am J Roentgenol 2017;209:W336-W349 https://doi.org/10.2214/AJR.17.17984
  27. Albano D, La Grutta L, Grassedonio E, Patti C, Lagalla R, Midiri M, et al. Pitfalls in whole body MRI with diffusion weighted imaging performed on patients with lymphoma: what radiologists should know. Magn Reson Imaging 2016;34:922-931 https://doi.org/10.1016/j.mri.2016.04.023
  28. Horger M, Weisel K, Horger W, Mroue A, Fenchel M, Lichy M. Whole-body diffusion-weighted MRI with apparent diffusion coefficient mapping for early response monitoring in multiple myeloma: preliminary results. AJR Am J Roentgenol 2011;196:W790-W795 https://doi.org/10.2214/AJR.10.5979
  29. Padhani AR, Lecouvet FE, Tunariu N, Koh DM, De Keyzer F, Collins DJ, et al. METastasis reporting and data system for prostate cancer: practical guidelines for acquisition, interpretation, and reporting of whole-body magnetic resonance imaging-based evaluations of multiorgan involvement in advanced prostate cancer. Eur Urol 2017;71:81-92 https://doi.org/10.1016/j.eururo.2016.05.033
  30. Perez-Lopez R, Nava Rodrigues D, Figueiredo I, Mateo J, Collins DJ, Koh DM, et al. Multiparametric magnetic resonance imaging of prostate cancer bone disease: correlation with bone biopsy histological and molecular features. Invest Radiol 2018;53:96-102 https://doi.org/10.1097/RLI.0000000000000415
  31. Koh DM, Blackledge M, Padhani AR, Takahara T, Kwee TC, Leach MO, et al. Whole-body diffusion-weighted MRI: tips, tricks, and pitfalls. AJR Am J Roentgenol 2012;199:252-262 https://doi.org/10.2214/AJR.11.7866
  32. Hillengass J, Bauerle T, Bartl R, Andrulis M, McClanahan F, Laun FB, et al. Diffusion-weighted imaging for non-invasive and quantitative monitoring of bone marrow infiltration in patients with monoclonal plasma cell disease: a comparative study with histology. Br J Haematol 2011;153:721-728 https://doi.org/10.1111/j.1365-2141.2011.08658.x
  33. Messiou C, Collins DJ, Morgan VA, Desouza NM. Optimising diffusion weighted MRI for imaging metastatic and myeloma bone disease and assessing reproducibility. Eur Radiol 2011;21:1713-1718 https://doi.org/10.1007/s00330-011-2116-4
  34. Dong H, Huang W, Ji X, Huang L, Zou D, Hao M, et al. Prediction of early treatment response in multiple myeloma using MY-RADS total burden score, ADC, and fat fraction from whole-body MRI: impact of anemia on predictive performance. AJR Am J Roentgenol 2022;218:310-319 https://doi.org/10.2214/AJR.21.26534
  35. Belotti A, Ribolla R, Cancelli V, Villanacci A, Angelini V, Chiarini M, et al. Predictive role of diffusion-weighted whole-body MRI (DW-MRI) imaging response according to MY-RADS criteria after autologous stem cell transplantation in patients with multiple myeloma and combined evaluation with MRD assessment by flow cytometry. Cancer Med 2021;10:5859-5865 https://doi.org/10.1002/cam4.4136