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. 2013 Jan 10;3(1):e002025.
doi: 10.1136/bmjopen-2012-002025.

Assessment of whole body MRI and sestamibi technetium-99m bone marrow scan in prediction of multiple myeloma disease progression and outcome: a prospective comparative study

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Assessment of whole body MRI and sestamibi technetium-99m bone marrow scan in prediction of multiple myeloma disease progression and outcome: a prospective comparative study

Alhossain A Khalafallah et al. BMJ Open. .

Abstract

Objectives: This study aims primarily to determine whether whole body MRI (WB-MRI) and Sestamibi Technetium-99m-bone marrow (MIBI) scans in the same patients produce the same estimate of disease load and location, and secondly, to study possible association between the bone disease detected by these scans and the effect on disease outcome and survival. Bone disease occurs in about 90% of multiple myeloma (MM) patients. There are no data comparing the new diagnostic modalities with WB-MRI and MIBI in MM.

Design: A prospective comparative study between WB-MRI and MIBI scans in assessing bone disease and outcome of MM.

Participants and methods: Sixty-two consecutive patients with confirmed MM underwent simultaneous WB-MRI (both axial T1 and turbo spin echo short tau inversion recovery (STIR)) and MIBI scans at a single institution from January 2010 to January 2011, and their survival status was determined in January 2012. The median age was 62 years (range 37-88) with a male-to-female ratio of 33 : 29.

Results: In vertebrae and long bones, MRI scan detected more disease compared with MIBI scan (p<0.001) but there was less difference in the skull (p=0.09). In the ribcage, the MIBI scan detected more lytic lesions of the ribs compared with MRI scan (p<0.001). Thirteen of the 62 patients died during the 24-month follow-up. Increased disease detected in all bones by both scans was associated with increased mortality risk (MIBI p=0.001; MRI-STIR p=0.044; but not MRI-T1 p=0.44). In all combined bone groups, the mean MIBI scan results provided a better prediction of mortality than MRI scan over the follow-up period (MRI-T1 vs MIBI p=0.019; MRI-STIR vs MIBI p=0.047).

Conclusions: Although WB-MRI detected more MM bone disease, MIBI scan predicted overall disease outcome and mortality better than MRI scan. Further studies to define optimum use of these imaging techniques are warranted.

Trial registration number: The study was registered prospectively in the Australian and New Zealand Clinical Trials Registry at http://www.ANZCTR.org.au under No: ACTRN12609000761268.

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Figures

Figure 1
Figure 1
Prediction of death due to disease progression by types of lesions in different imaging methods. In the 62 myeloma patients, the upper graph represents sestamibi bone marrow scan, middle graph; whole body MRI-T1 scan and the lower graph represents the STIR version of MRI scan.
Figure 2
Figure 2
Association between result score of imaging modality: relative risk as HR (95% CIs; p value) was estimated using Cox proportional hazards regression, adjusted for age, gender and time from diagnosis to imaging scans; p values corrected for multiple comparisons by the Holm method. Each result score value was treated as a continuous variable to estimate the linear trends in mortality: the absolute trend for each modality was estimated (shown as symbol and error bars), and then the relative trends of the two MRI modalities were compared to the MIBI scan trend (shown as p values only).
Figure 3
Figure 3
The image on the upper left is a Sestamibi Technetium-99m-bone marrow scan that demonstrates high-grade focal lesions in the sacrum plus L3, L4 and L5 vertebrae. Low-grade focal lesions are also seen in the T1 vertebrae, right scapula, right-sided sixth rib, bilateral femora and humeri. The upper right is a T1-weighted MRI of the spine that demonstrates high grade focal lesions from L2 to L5 and in the sacrum in the same patient. Low-grade focal lesions are also demonstrated in the T4–T7 vertebrae while T7 shows an old compression fracture. The lower image is a short tau inversion recovery sequence (STIR) MRI of the spine that demonstrates heterogeneous signal from L2-L5, compatible with but not as obvious as the findings on the T1 image in the lumbar region of the same patient in our study cohort.

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