Whole-Body Diffusion-weighted MR Imaging for Assessment of Treatment Response in Myeloma
Whole-Body Diffusion-weighted MR Imaging for Assessment of Treatment Response in Myeloma
复制标题
DOI：
10.1148/radiol.13131529
复制
发表时间：
2014-06-01
期刊：
影响因子：
19.7
通讯作者：
deSouza, Nandita M.
中科院分区：
文献类型：
--
作者：
Giles, Sharon L.;Messiou, Christina;deSouza, Nandita M.
目的：确定全身弥散加权 (DW) 磁共振 (MR) 成像用于评估骨髓瘤治疗反应的可行性。材料和方法：这项前瞻性单机构研究符合 HIPAA，并获得当地研究伦理委员会的批准。每个受试者都获得了书面知情同意书。对八名健康志愿者（队列 1a）和七名骨髓瘤患者（队列 1b）进行两次成像，以评估定量表观扩散系数 (ADC) 估计值的重复性。另外 34 名骨髓瘤患者（第 2 组）在治疗前接受了全身 DW 成像； 26 完成了治疗后成像。使用定性（即观察者评分）和定量（即骨髓ADC的全身分割）方法比较治疗前后的全身DW数据。血清副蛋白和/或轻链或骨髓活检定义反应。结果：观察者之间的全身 DW 成像评分显着不同 (P < .001)，但治疗后观察者之间的评分变化则没有 (P = .49)。根据观察者评分检测反应的敏感性和特异性对于两名观察者分别为 86%（21 名患者中的 18 名）和 80%（5 名患者中的 4 名）。 ADC 测量具有可重复性：健康志愿者的平均变异系数为 3.8%，骨髓瘤患者的平均变异系数为 2.8%。队列 2 中的治疗前 ADC 与队列 1a 显着不同 (P = .03)，但与队列 1b 没有显着差异 (P = .2)。 95%（20 人中的 19 人）有反应的患者的平均 ADC 增加，而所有（5 人中的 5 人）无反应的患者的平均 ADC 有所下降 (P = .002)。 ADC 增加 3.3% 有助于识别反应，灵敏度为 90%，特异性为 100%； 8% 的增加（大于队列 1b 的重复性）导致 70% 的敏感性和 100% 的特异性。 ADC 的变化与实验室反应标志物的变化之间存在显着的负相关（r = -0.614；P = .001）。 结论：初步工作表明全身 DW 成像是一种可重复、可量化的技术，用于评估骨髓瘤的治疗反应。 (C) 北美放射学会，2014
Purpose: To determine the feasibility of whole-body diffusion-weighted (DW) magnetic resonance (MR) imaging for assessment of treatment response in myeloma.Materials and Methods: This prospective single-institution study was HIPAA-compliant with local research ethics committee approval. Written informed consent was obtained from each subject. Eight healthy volunteers (cohort 1a) and seven myeloma patients (cohort 1b) were imaged twice to assess repeatability of quantitative apparent diffusion coefficient (ADC) estimates. Thirty-four additional myeloma patients (cohort 2) underwent whole-body DW imaging before treatment; 26 completed a posttreatment imaging. Whole-body DW data were compared before and after treatment by using qualitative (ie, observer scores) and quantitative (ie, whole-body segmentation of marrow ADC) methods. Serum paraproteins and/or light chains or bone marrow biopsy defined response.Results: Whole-body DW imaging scores were significantly different between observers (P < .001), but change in scores between observers after treatment was not (P = .49). Sensitivity and specificity for detecting response according to observer scores were 86% (18 of 21 patients) and 80% (4 of 5 patients) for both observers. ADC measurement was repeatable: mean coefficient of variation was 3.8% in healthy volunteers and 2.8% in myeloma patients. Pretreatment ADC in cohort 2 was significantly different from that in cohort 1a (P = .03), but not from that in cohort 1b (P = .2). Mean ADC increased in 95% (19 of 20) of responding patients and decreased in all (five of five) non-responders (P = .002). A 3.3% increase in ADC helped identify response with 90% sensitivity and 100% specificity; an 8% increase (greater than repeatability of cohort 1b) resulted in 70% sensitivity and 100% specificity. There was a significant negative correlation between change in ADC and change in laboratory markers of response (r = -0.614; P = .001).Conclusion: Preliminary work demonstrates whole-body DW imaging is a repeatable, quantifiable technique for assessment of treatment response in myeloma. (C) RSNA, 2014