5064
Quantitative parameters of bone marrow segmentation on WB-DWI in the prognostic staging of R-ISS II multiple myeloma1Peking Union Medical College Hospital, Beijing, China, 2MR Research Collaboration, Siemens Healthineers Ltd, Beijing, China, 3MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
Synopsis
Keywords: DWI/DTI/DKI, Diffusion/other diffusion imaging techniques
Motivation: Revised International Staging System stage II multiple myeloma (R-ISS II MM) patients have considerable prognostic heterogeneity.
Goal(s): Use quantitative parameters of bone marrow segmentation on whole-body diffusion-weighted imaging (WB-DWI) for risk stratification among R-ISS II MM patients.
Approach: Univariate and multivariate analyses of clinical features and quantitative parameters of bone marrow segmentation extracted from MR Total Tumor Load software were used to identify predictors of progression-free survival and overall survival (OS).
Results: On multivariate analysis, mean apparent diffusion coefficient (odds ratio=1.003, p=0.029, 95% confidence interval [95%CI]: 1.000-1.003) and albumin (odds ratio=0.942, p=0.051, 95%CI: 0.888-1.000) were independent predictors of OS.
Impact: Quantitative parameters of bone marrow segmentation on WB-DWI can predict OS in R-ISS II MM patients, suggesting that these parameters can facilitate prognostic assessment of R-ISS II MM patients.
Introduction
Multiple myeloma (MM) is the most common malignant plasma cell disease and the second most common hematologic malignancy; it is associated with a high mortality rate[1]. Currently, the Revised International Staging System (R-ISS) is recognized as the risk stratification tool for MM[2]. R-ISS stage II (R-ISS II) is present in the largest number of patients and has the greatest prognostic heterogeneity. Computer-aided bone marrow segmentation and quantification technology is a novel post-processing technique for whole-body diffusion-weighted imaging (WB-DWI), which allows three-dimensional voxel-based quantification of total diffusion volume (tDV) and total tumor apparent diffusion coefficient (ttADC) of bone marrow lesions[3], resolving the limitations of manual region-of-interest delineation. It is effective for the detection of whole-body bone metastases in breast cancer and prostate cancer[3,4], as well as malignant lymph nodes in lymphoma[5]. Significant correlations have been reported between R-ISS stage and the two-dimensional local ADC values of vertebral bodies and iliac bones, suggesting prognostic value[6]. This retrospective study assessed quantitative parameters of bone marrow segmentation among R-ISS II MM patients to determine quantitative prognostic factors for R-ISS II patients, identify high-risk patients who were stratified incorrectly, and address the limitations of current staging tools. The results are expected to provide an objective quantitative basis for precise risk stratification among R-ISS II patients.Methods
Seventy-two R-ISS II MM patients were included in this study. All patients underwent magnetic resonance (MR) examination including WB-DWI on a 3T system (MAGNETOM Skyra, Siemens Healthcare, Erlangen, Germany) with an 18-channel phased-array body coil. WB-DWI was acquired using an experimental single-shot echo planar imaging sequence and an integrated slice-by-slice shimming technique, with the following parameters: repetition time/echo time, 5600/60 ms; field of view, 480×330 mm; slice thickness, 5 mm; interval, 0 mm; number of stations, 5-6 (depending on patient height from head to thigh); and b-values, 50 and 800 s/mm2.Quantitative parameters of bone marrow segmentation (including tDV, ttADC_Mean, ttADC_Std, ttADC_Median, ttADC_5%, ttADC_95%, ttADC_Skewness, and ttADC_E.Kurtosis) on WB-DWI were determined and analyzed using research software (MR Total Tumor Load, Siemens Healthcare, Erlangen, Germany). Intraclass correlation coefficients (ICCs) were used to assess inter- and intraobserver reproducibility in measuring quantitative parameters of bone marrow segmentation. Clinical features of R-ISS II MM patients such as albumin (Alb), lactate dehydrogenase (LDH), and hemoglobin (HGB) levels, as well as the percentage of bone marrow plasma cells (BMPC%), were recorded for analyses of Spearman correlation with quantitative parameters of bone marrow segmentation. Factors potentially associated with progression-free survival and overall survival (OS) were assessed using the chi-squared test and t-test (for univariate analysis), as well as multivariate Cox regression analysis. Factors with p<0.05 were considered independent predictors. Survival curves were depicted by the Kaplan-Meier method and compared using the log-rank test.Results
Thirty-two patients were randomly selected to test the inter- and intraobserver reproducibility of quantitative parameters of bone marrow segmentation. ttADC_Std and ttADC_95% had moderate (0.5<ICC<0.75) inter- and intraobserver reproducibility, and other parameters had good or excellent (ICC>0.75) reproducibility. Analyses of correlations between clinical features of MM and quantitative parameters of bone marrow segmentation showed that BMPC% had weak correlations with ttADC_Mean (r=-0.265, p=0.029), ttADC_Median (r=-0.249, p=0.041), ttADC_95% (r=-0.268, p=0.027), and ttADC_H.Entropy (r=-0.241, p=0.047). HGB had a weak correlation with tDV (r=-0.276, p=0.019). Multivariate survival analysis showed that the model contained ttADC_Mean, Alb, and calcium (Ca). ttADC_Mean with a cutoff threshold of 0.756×10−3mm2/s (odds ratio [OR]=1.003, 95% confidence interval [95%CI]: 1.000-1.003, p=0.029) and Alb (OR=0.942, 95%CI: 0.888-1.000, p=0.051) were independent predictors of OS.Discussion
In this study, MR Total Tumor Load software was used for post-processing of WB-DWI images to identify quantitative parameters for bone marrow segmentation that could be utilized in prediction of R-ISS II MM prognosis. The results suggested that quantitative parameters for bone marrow segmentation can be used to revise prognosis in R-ISS II MM patients and may overcome the lack of systemic representation in R-ISS staging. Additional clinical studies of quantitative parameters for bone marrow segmentation in MM patients are needed.Conclusion
ttADC_Mean in quantitative parameters of bone marrow segmentation on WB-DWI can independently predict the OS of MM R-ISS II patients, indicating the prognostic staging role of WB-DWI quantitative parameters of bone marrow segmentation in MM patients.Acknowledgements
No acknowledgement found.References
[1] Rajkumar S V, Dimopoulos M A, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma[J]. The Lancet Oncology, 2014, 15(12): e538-e548. DOI:10.1016/S1470-2045(14)70442-5.
[2] Palumbo A, Avet-Loiseau H, Oliva S, et al. Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group[J]. Journal of Clinical Oncology, 2015, 33(26): 2863-2869. DOI:10.1200/JCO.2015.61.2267.
[3] Blackledge M D, Collins D J, Tunariu N, et al. Assessment of Treatment Response by Total Tumor Volume and Global Apparent Diffusion Coefficient Using Diffusion-Weighted MRI in Patients with Metastatic Bone Disease: A Feasibility Study[J]. PLoS ONE, 2014, 9(4): e91779. DOI:10.1371/journal.pone.0091779.
[4] Sommer G, Klarhöfer M, Lenz C, et al. Signal characteristics of focal bone marrow lesions in patients with multiple myeloma using whole body T1w-TSE, T2w-STIR and diffusion-weighted imaging with background suppression[J]. European Radiology, 2011, 21(4): 857-862. DOI:10.1007/s00330-010-1950-0.
[5] Donners R, Yiin R S Z, Koh D M, et al. Whole-body diffusion-weighted MRI in lymphoma—comparison of global apparent diffusion coefficient histogram parameters for differentiation of diseased nodes of lymphoma patients from normal lymph nodes of healthy individuals[J]. Quantitative Imaging in Medicine and Surgery, 2021, 11(8): 3549-3561. DOI:10.21037/qims-21-50.
[6] Zhang L, Wang Q, Wu X, et al. Baseline bone marrow ADC value of diffusion-weighted MRI: a potential independent predictor for progression and death in patients with newly diagnosed multiple myeloma[J]. European Radiology, 2021, 31(4): 1843-1852. DOI:10.1007/s00330-020-07295-6.
Figures
