A Preliminary Study On The Assessment Of Multiple Myeloma By Whole Body Magnetic Resonance Imaging And Computed Tomography

Section Ⅰ:Integrated Shimming Improves the image quality of Whole Body Diffusion Weighted Imaging of Multiple Myeloma at 3.0TObjective:To determine the improvement of of image quality by using integrated shimming (iShim) for whole body diffusion weighted imaging (WBDWI) in multiple myeloma patients at 3.0T MRI.Material and Methods:After the approval of local institutional review board, two healthy volunteers and 29 patients with suspected multiple myeloma (MM) participated this study. Both the volunteers and patients performed WBMRI(include T1W TSE. T2W TSE and WBDWI sequence) with 3.0T MRIscaner. Before the imaging parameters of WBDWI acquired, both ishim and 3Dshim methods should be applied. So all participants received WBDWI twice with the same scan parameters except the shimming method. The improvements of WBDWI images by ishim technique evalutated via analyzing SNR, image quality scored subjectively and objectively, the sensitivity of detecting focal lesions and the identity of ADC value of lesion and muscle compared to 3Dshim WBDWI.Results:For the SNR comparison in volunteers, iShim technique yielded 500.0% in the tall volunteer and 1300.0% improvements in the other one in neck region, respectively(P<0.05); while all the SNR improvements of head, thorax, pelvis and proximal femur region are 5%, and the abdomen is nearly 20%(P). Compared with 3DshimWBDWI, the improvement of image quality for spatial alignment was 2.45(0-4 scoring system) with significant statistics difference (P<0.05); while the averaged improved spatial alignment score was 1.27,0.89 and 1.17 for throat, abdomen and pelvis regions respectively. Spinal displacement off the center in 3DshimWBDWI is much more obvious than ishimWBDWI.The sensitivity of detectability of focal lesion with ishim is 100%, while with 3Dshim is 66.67%. With the two different shimming techniques, the identity of ADC value of lesion and muscle of head, thorax, abdomen and pelvis region were excellent(r>0.75) with no significant statistics difference (P>0.05), but in neck region the statistics difference is significantly (P<0.05).Conclusion:IShim technique can improve the image quality of WBDWI effectively, especially for the neck region and provide technical support for further clinical application of WBDWI.Section Ⅱ:The Correlations Between the Parameters of Magnetic Resonance Imaging and the Clinical Results of Multiple MyelomaObjective:To determine correlations between the parameters of magnetic resonance imaging and the results of bone marrow aspiration and serology exam in multiple myeloma patients.Material and Methods:After the approval of local institutional review board and informed consents were signed, this study enrolled 71 patients diagnosed as multiple myeloma and 53 of them without any treatments and 18 patients diagnosed as completely relieved by bone marrow biopsy or clinical serology. All of the patients performed Whole-Body MRI (Whole-Body DWI included) exam on 3.0T MRI scanner. Both the bone marrow aspiration and serology exam of every patient must be finished in 5 days and the results should be recorded. The difference of ADC values of focal lesions of pre-treatment and CR patients analyzed and the cut off value of ADC was determined. The differences between the bone marrow ADC values of diffuse infiltrative patients pre-treatment and CR patients excluding FLs were analyzed and the cut off values of ADC was determined, too. The correlations between MR image parameters of pre-treatment and clinical data were analyzed.Results:The ADC values of focal lesions of pre-treatment and CR patients are 891.75± 150.86 X 10-6mm2/s and 1685.28 ± 541.04, respectively,with significant statistics difference. The cut off value is 1022.35× 10-6 mm2/s with the sensitivity and specificity are 85.7% and 85.0%, respectively, and the area under the curve is 89.6%(p=0.000). The bone marrow ADC value of pre-treatment diffuse infiltrative patients and CR patients exclude FLs were 614.60 ± 132.57 × 10-6mm2/s and 257.36±70.08 × 10-6mm2/s, respectively, with significant statistics difference. And the cut off value between them is 395.49×10-6mm2/s with the sensitivity and specificity are 78.0% and 100.0%, respectively, and the area under the curve is 100.0%(p=0.000). No correlations between MR image parameters of FLs pre-treatment and clinical data were found; but the ADC value of the pre-treatment bone marrow is negatively correlated with hemoglobin(r=-0.533,P=0.000) and positively correlated with β2MG(r=0.446, P=0.000).Conclusion:ADC value can be used to differentiate the activity of focal lesions and the diffuse infiltration MM. The ADC value of bone marrow was correlated with hemoglobin and β2MG, and it can be used to evaluated the severity of the disease.Section Ⅱ:The diagnostic ability of dual energy CT with virtual non-calcium technique on diffuse infltrative multiple myelomaObjective:To discuss the delectability of dual-energy CT with bone marrow virtual non-calcium technique to evaluate diffuse infiltrative multiple myeloma.Material and Methods:After the approval of local institutional review board and informed consents were signed, the study enrolled multiple myeloma patients without any treatments and those who were diagnosed as completely relieve by bone marrow biopsy or clinical serology between Jan 1,2013 and Apri 30,2015. All participants received whole-body dual-energy CT scan and whole-body MRI (whole-body DWI included), viewed as a golden standard, in the same day. Both the virtual non-calcium (VNC) and mixed CT numbers were evaluated in spinal bone marrow of the two groups, respectively. T test was performed with the SPSS 19.0 software package to compare VNca CT number, Mixed CT number, Ca CT number, the ratio of VNC CT number/Mixed CT number and the ratio of Ca CT number/Mixed CT number of diffuse infiltrative MM patients with those of CR patients. P< 0.05 indicated significant statistics difference. The cut off value of VNCa CT of the two was determined by ROC curve.Results:Finally,38 patients were enrolled in total; 24 of them (M:F=14:10, Age range: 50-77 years and average 60.50 years)were diffuse infiltrated without any treatments and the others(M:F=9:5, Age range:51-72 years and average 60.07 years) are diagnosed as CR. The VNC CT numbers of diffuse infiltrated and CR MM are-112.70±57.58HUand-182.92±50.78HU with significant statistics difference(P=0.000). The Mixed0.5 CT numbers of diffuse infiltrated and CR MM are135.43±66.54HU and 115.92±71.94HU with no significant statistics difference(P=0.088). The cut off value of VNCa CT number between diffuse infiltration group and the CR group is-132.05HU with the sensitivity and specificity is 68.10% and 84.30%, respectively.Conclusion:Dual-energy CT with bone marrow virtual non-calcium technique can be used to evaluate diffuse infiltrative multiple myeloma.