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Radiologie up2date 2014; 14(03): 239-255
DOI: 10.1055/s-0034-1377578
Muskuloskelettale Erkrankungen
© Georg Thieme Verlag KG Stuttgart · New York

Bildgebung des multiplen Myeloms und verwandter monoklonaler Plasmazellerkrankungen – ein Update

Imaging of multiple myeloma and related monoclonal plasma cell diseases – an update
M.-A. Weber
,
S. Delorme
,
J. Hillengass
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Publication History

Publication Date:
15 September 2014 (online)

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Zusammenfassung

Das multiple Myelom ist eine hämatologische Erkrankung, die durch die Infiltration und Proliferation monoklonaler Plasmazellen vor allem im Knochenmark gekennzeichnet ist. Die häufigsten Symptome sind eine Hyperkalzämie, Nierenfunktionseinschränkungen, eine Zytopenie bzw. Anämie und eine Knochenschädigung, die auch als sog. CRAB-Kriterien zusammengefasst werden. Das symptomatische multiple Myelom hat asymptomatische Vorstufen, welche regelhaft der symptomatischen Erkrankung vorausgehen. Diese sind die monoklonale Gammopathie unklarer Signifikanz (MGUS) und das sog. „smoldering multiple myeloma“. Das Staging des multiplen Myeloms basiert auf der Messung des M-Proteins und der Beeinträchtigung von Hämatopoiese, Nierenfunktion und mineralisiertem Knochen. In den letzten Jahrzehnten wurden neue therapeutische Agenzien entwickelt, mit denen die Ansprechrate und die Überlebensrate der Patienten mit multiplem Myelom verbessert werden konnten. Die Bildgebung spielt beim Staging und der Beurteilung des Therapieansprechens eine wichtige Rolle. Die Schnittbilddiagnostik mittels MRT und CT ersetzt derzeit den konventionellen röntgenologischen Skelettstatus (Pariser Schema), sowohl bei der initialen Diagnostik als auch bei der Verlaufsbeurteilung von Patienten mit monoklonalen Plasmazellerkrankungen. Der zusätzliche Wert der MRT beim initialen Staging des multiplen Myeloms liegt in der Differenzierung zwischen diffuser Knochenmarkinfiltration von Plasmazellen, fokalem Befall und einer Kombination von beidem. Eine komplette Remission des multiplen Myeloms, die mittels Bildgebung durch MRT und CT bestätigt wird, geht mit einer besseren Prognose einher verglichen mit der Complete Response, die nur anhand serologischer Parameter festgestellt wird.

Abstract

Multiple myeloma is a hematologic disorder characterized by the infiltration and proliferation of monoclonal plasma cells mainly in the bone marrow. The main symptoms are hypercalcemia, renal impairment, cytopenia/anemia and bone disease – summarized as CRAB-criteria. Symptomatic multiple myeloma is consistently preceded by asymptomatic premalignant stages called monoclonal gammopathy of undetermined significance and smoldering multiple myeloma. Staging of multiple myeloma is based on the measurement of the monoclonal protein in serum and urine as well as the assessment of impairment of hematopoiesis, renal function and mineralized bone. In the last decade the development of novel therapeutic agents has led to an increase in response rates and survival time of patients with multiple myeloma, which further stresses the value of response assessment by imaging. Cross sectional imaging like MRI and CT is currently replacing conventional radiological surveys in the initial work-up and follow-up of patients with monoclonal plasma cell diseases. The added value of MRI is to improve initial staging by unraveling a diffuse infiltration of bone marrow by plasma cells, a focal pattern or a combination of both. Furthermore, a complete remission of myeloma confirmed by MRI and CT goes along with a better prognosis compared to a complete response based only on serological parameters.

Keywords

Multiple myeloma - monoclonal plasma cell diseases - staging - treatment monitoring - dedicated imaging
 

  • Literatur

  • 1 Raab MS, Podar K, Breitkreutz I et al. Multiple myeloma. Lancet 2009; 374: 324-339
    CrossrefPubMedSearch in Google Scholar
  • 2 Graham-Rowe D. Overview: Multiple lines of attack. Nature 2011; 480: 34-35
    CrossrefPubMedSearch in Google Scholar
  • 3 Kyle RA, Durie BG, Rajkumar SV et al. International Myeloma Working Group. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Leukemia 2010; 24: 1121-1127
    CrossrefPubMedSearch in Google Scholar
  • 4 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
    CrossrefPubMedSearch in Google Scholar
  • 5 Delorme S, Baur-Melnyk A. Imaging in multiple myeloma. Eur J Radiol 2009; 70: 401-408
    CrossrefPubMedSearch in Google Scholar
  • 6 Hillengass J, Delorme S. Multiples Myelom: Aktuelle Empfehlungen für die Bildgebung. Radiologe 2012; 52: 360-365
    CrossrefPubMedSearch in Google Scholar
  • 7 Wolf MB, Murray F, Kilk K 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
    CrossrefPubMedSearch in Google Scholar
  • 8 Dimopoulos M, Kyle R, Fermand JP et al. on behalf of the International Myeloma Workshop Consensus Panel 3. Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel 3. Blood 2011; 117: 4701-4705
    CrossrefPubMedSearch in Google Scholar
  • 9 Bäuerle T, Hillengass J, Fechtner K et al. Multiple myeloma and monoclonal gammopathy of undetermined significance: importance of whole-body versus spinal MR imaging. Radiology 2009; 252: 477-485
    CrossrefPubMedSearch in Google Scholar
  • 10 Fechtner K, Hillengass J, Delorme S et al. Staging monoclonal plasma cell disease: comparison of the Durie-Salmon and the Durie-Salmon PLUS staging systems. Radiology 2010; 257: 195-204
    CrossrefPubMedSearch in Google Scholar
  • 11 Kloth JK, Hillengass J, Listl K et al. Appearance of monoclonal plasma cell diseases in whole-body magnetic resonance imaging and correlation with parameters of disease activity. Int J Cancer 2014;
    PubMedSearch in Google Scholar
  • 12 Durie BG, Harousseau JL, Miguel JS et al. On behalf of the International Myeloma Working Group. International uniform response criteria for multiple myeloma. Leukemia 2006; 20: 1467-1473
    CrossrefPubMedSearch in Google Scholar
  • 13 Hillengass J, Ayyaz S, Kilk K et al. Changes in magnetic resonance imaging before and after autologous stem cell transplantation correlate with response and survival in multiple myeloma. Haematologica 2012; 97: 1757-1760
    CrossrefPubMedSearch in Google Scholar
  • 14 Horger M, Kanz L, Denecke B et al. The benefit of using whole-body, low-dose, nonenhanced, multidetector computed tomography for follow-up and therapy response monitoring in patients with multiple myeloma. Cancer 2007; 109: 1617-1626
    CrossrefPubMedSearch in Google Scholar
  • 15 Walker R, Barlogie B, Haessler J et al. Magnetic resonance imaging in multiple myeloma: diagnostic and clinical implications. J Clin Oncol 2007; 25: 1121-1128
    CrossrefPubMedSearch in Google Scholar
  • 16 Hillengass J, Fechtner K, Weber MA 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
    CrossrefPubMedSearch in Google Scholar
  • 17 Hillengass J, Weber MA, Kilk K et al. Prognostic significance of whole-body MRI in patients with monoclonal gammopathy of undetermined significance. Leukemia 2014; 28: 174-178
    CrossrefPubMedSearch in Google Scholar
  • 18 Merz M, Hielscher T, Wagner B et al. Predictive value of longitudinal whole-body magnetic resonance imaging in patients with smoldering multiple myeloma. Leukemia 2014;
    PubMedSearch in Google Scholar
  • 19 Lin C, Luciani A, Belhadj K et al. Multiple myeloma treatment response assessment with whole-body dynamic contrast-enhanced MR imaging. Radiology 2010; 254: 521-531
    CrossrefPubMedSearch in Google Scholar
  • 20 Hillengass J, Bäuerle T, Bartl R 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
    CrossrefPubMedSearch in Google Scholar
  • 21 Shah R, Stieltjes B, Andrulis M et al. Intravoxel incoherent motion imaging for assessment of bone marrow infiltration of monoclonal plasma cell diseases. Ann Hematol 2013; 92: 1553-1557
    CrossrefPubMedSearch in Google Scholar
  • 22 Horger M, Weisel K, Horger W et al. Whole-body diffusion-weighted MRI with apparent diffusion coefficient mapping for early response monitoring in multiple myeloma: preliminary results. AJR Am J Roentgenol Am J Roentgenol 2011; 196: 790-795
    PubMedSearch in Google Scholar
  • 23 Giles SL, Messiou C, Collins DJ et al. Whole-Body Diffusion-weighted MR Imaging for Assessment of Treatment Response in Myeloma. Radiology 2014; 271: 785-794
    CrossrefPubMedSearch in Google Scholar
  • 24 Walker RC, Brown TL, Jones-Jackson LB et al. Imaging of multiple myeloma and related plasma cell dyscrasias. J Nucl Med 2012; 53: 1091-1101
    CrossrefPubMedSearch in Google Scholar
  • 25 Spinnato P, Bazzocchi A, Brioli A et al. Contrast enhanced MRI and ¹⁸F-FDG PET-CT in the assessment of multiple myeloma: a comparison of results in different phases of the disease. Eur J Radiol 2012; 81: 4013-4018
    CrossrefPubMedSearch in Google Scholar
  • 26 Shortt CP, Gleeson TG, Breen KA et al. Whole-Body MRI versus PET in assessment of multiple myeloma disease activity. AJR Am J Roentgenol Am J Roentgenol 2009; 192: 980-986
    PubMedSearch in Google Scholar
  • 27 Bartel TB, Haessler J, Brown TL et al. F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myeloma. Blood 2009; 114: 2068-2076
    CrossrefPubMedSearch in Google Scholar
  • 28 Zamagni E, Patriarca F, Nanni C et al. Prognostic relevance of 18-F FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation. Blood 2011; 118: 5989-5995
    CrossrefPubMedSearch in Google Scholar
  • 29 Nanni C, Zamagni E, Celli M et al. The value of 18F-FDG PET/CT after autologous stem cell transplantation (ASCT) in patients affected by multiple myeloma (MM): experience with 77 patients. Clin Nucl Med 2013; 38: e74-79
    CrossrefPubMedSearch in Google Scholar