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Keywords:
Haematologic, MR, Staging, Haematologic diseases
Authors:
L. Bertuzzo, A. Bissoli, M. C. Ambrosetti, M. Tinelli, R. Pozzi-Mucelli; Verona/IT
DOI:
10.1594/ecr2017/C-2707
Aims and objectives
Monoclonal plasma cell diseases are an heterogeneous group of disorders which include monoclonal gammopathy of undetermined significance (MGUS),
smoldering myeloma (SMM),
multiple myeloma (MM) and plasmacytoma (P).
Plasmacytoma is a condition in which there is a biopsy-proven solitary bone or soft tissue lesion with evidence of clonal plasma cells in an otherwise asymptomatic patient.
Clonal bone marrow plasma cells are <10% and there is no serum or urine paraprotein detectable.
MGUS describes an asymptomatic premalignant stage characterised by stable monoclonal paraprotein in serum (<30g/L) and limited bone marrow plasma cell proliferation (<10%).
The prevalence is 3-4% in the population over the age of 50 years.
The progression rate to MM is 0,5-1% per year.
SMM is an intermediate clinical stage which identifies patients with a paraprotein >30g/L in serum or urinary monoclonal protein >500mg/24h and >10% plasma cells in bone marrow.
In this stage patients are asymptomatic and there are no clinical signs of myeloma related end organ or tissue impairment such as lytic bone lesions,
anaemia,
hypercalcaemia and renal failure.
The risk of progression to MM is higher than MGUS and amounts to 10% per year.
MM identifies the symptomatic stage in which serum monoclonal paraprotein >30g/L or urinary monoclonal protein >500mg/24h and bone marrow plasma cells >10% associate with evidence of end organ damage.
It accounts for 1% of all malignancies and 13% of hematologic cancers.
The annual incidence is 5,6 cases per 100.000 persons per year and the 5 year overall survival is about 34,7% [1-4].
Seventy percent to 80% of patients have osteolytic lesions at diagnosis and up to 90% develop lytic lesions during the course of the disease.
A correct staging is essential in the management of these patients in order to guarantee them the best treatment [5].
Conventional radiography has been considered for decades the gold standard for the identification of osteolytic lesions both at diagnosis and during the course of the disease but it is being replaced by more sensitive techniques such as low dose computer tomography (LDCT) and magnetic resonance (MR).
As a result,
the International Myeloma Working Group (IMWG) has recently approved the use of whole-Body MRI (WBMRI) in the initial work-up for smoldering multiple myeloma to look for occult disease [3,6].
The aim of this study is to assess the correlation between WBMRI findings and the clinical evaluation of disease extent and compare the conspicuity of lesions in T1,
STIR and DWI images.