Keywords:
Cancer, Imaging sequences, Decision analysis, MR-Diffusion/Perfusion, MR, Oncology, Haematologic, Bones, Haematologic diseases
Authors:
O. A. Westerland1, N. Sivarasan2, S. A. Natas1, H. Verma3, R. Neji4, M. kazmi1, I. El-Najjar1, M. Streetly1, V. Goh1; 1London/UK, 2Orpington, Kent/UK, 3London /UK, 4Erlangen/DE
DOI:
10.1594/ecr2018/C-1224
Results
100 patients with suspected/proven plasma cell disorders underwent wbMRI (January 2014 - July 2017).
There were 53 female,
47 male patients,
median age of 65 years (range 38-90 years).
Myeloma = 63,
smouldering myeloma = 11,
monoclonal gammopathy of unknown significance (MGUS) = 12,
plasmacytoma = 6 and other diagnoses = 8.
348 incidental findings were detected on the T2-W sequences in 97/100 (97%) patients,
(median = 3 findings per patient,
range = 1-9 findings).
The five commonest incidental findings were 1,
hepatic/renal/splenic cysts (23%) 2,
sinusitis (9.8%),
3,
colonic diverticulosis (5.2%),
uterine fibroids (5.2%) and chronic small vessel disease (4.6%).
Clinical significance of findings was as shown in Table 2 below:
Category |
Number of patients & percentage |
I |
197 (56.6%) |
IIA |
113 (32.5%) |
IIB |
38 (10.9%) |
III |
0 (0%) |
38/348 (10.9%) findings could not be characterized on T2-W sequences alone.
Indeterminate findings included liver (7),
spleen (2),
adrenal (5) and prostate (5) lesions,
lymph nodes (5) and others (14).
T1-W,
CE T1-W and DWI sequences resulted in increased diagnostic confidence for characterisation of lesions which were indeterminate on baseline T2-W sequences (see below Table 3):
Sequence name |
Proportion of indeterminate lesions where sequence results in improved confidence for lesion characterization |
T1-W |
12/38 (31.6%) |
CE T1-W |
16/32 (50%) |
DWI |
21/38 (55.3%) |
T1-W Dixon sequences were helpful in the characterisation of lesions containing fat e.g.
adrenal adenoma or haemorrhage.
CE T1-W sequences were particularly helpful in characterisation of hepatic and renal lesions.
DWI sequences were also useful in characterizing hepatic lesions,
as well as prostatic lesions and lymph nodes.
No new additional malignancies were detected.
There were three cases of known concurrent malignancy and two new cases of extramedullary plasmacytoma (both nodal).
The incidental findings detection rate in this study exceeds that of previous studies/rates observed in routine clinical practice and this may be due to differences in imaging protocol and also due to the fact that in this study the reviewing staff radiologist was tasked with recording all incidental findings,
including findings which were not of clinical significance.