Baseline bone marrow ADC value of diffusion-weighted MRI: a potential independent predictor for progression and death in
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ONCOLOGY
Baseline bone marrow ADC value of diffusion-weighted MRI: a potential independent predictor for progression and death in patients with newly diagnosed multiple myeloma Lu Zhang 1 & Qin Wang 2 & Xia Wu 1 & Ailin Zhao 1 & Jun Feng 1 & Haibo Zhang 3 & Xinxin Cao 1 & Shuo Li 2 & Huacong Cai 1 & Zhaoyong Sun 2 & Minghui Duan 1 & Tienan Zhu 1 & Wei Zhang 1 & Zhengyu Jin 2 & Daobin Zhou 1 & Huadan Xue 2 & Jian Li 1 Received: 9 June 2020 / Revised: 7 August 2020 / Accepted: 15 September 2020 # European Society of Radiology 2020
Abstract Objectives To illuminate the prognostic value of ADC (apparent diffusion coefficient), an important quantitative parameter of diffusion-weighted MRI, for multiple myeloma (MM). Methods A prospective single-center study which enrolled 114 consecutive newly diagnosed MM patients with baseline whole-body diffusion-weighted MRI (WB DW-MRI) results was conducted. Baseline clinical and MRI parameters were analyzed with univariate and multivariate approaches to identify independent risk factors for progression-free survival (PFS) and overall survival (OS). Results Five different DW-MRI patterns were seen, and the mean ADC value of the representative background bone marrow was 0.4662 ± 0.1939 × 10−3 mm2/s. After a mean follow-up of 50.2 months (range, 15.7–75.8 months), twenty-four patients died and seven were lost to follow-up. The mean ADC value of the representative background bone marrow was showed to be an independent risk factor for both PFS (HR 4.664; 95% confidence interval (CI) 1.138–19.121; p = 0.032) and OS (HR 14.130; 95% CI 1.544–129.299; p = 0.019). Normal/salt-and-pepper pattern on DW-MRI was associated with PFS using univariate analysis (p = 0.035) but lost the significance with multivariate Cox regression. Conclusions Mean ADC value of the representative background bone marrow predicts both PFS and OS which suggests the role of baseline DW-MRI for risk stratification in newly diagnosed MM patients. Key Points • Whole-body diffusion-weighted MRI (WB DW-MRI) might be helpful to improve the current risk stratification systems for newly diagnosed multiple myeloma (MM). • Morphological parameters as MRI pattern and focal lesion–associated parameters have been reported to be related to survival. However, important functional parameters such as apparent diffusion coefficient (ADC) values were not incorporated into the current risk stratification model. Lu Zhang and Qin Wang contributed equally as first co-authors. Jian Li and Huadan Xue contributed equally as co-corresponding authors. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07295-6) contains supplementary material, which is available to authorized users. * Huadan Xue [email protected] * Jian Li [email protected] 1
Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
2
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical
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