Myeloma is a debilitating cancer,
with 5540 new patients and 2928 death each year in the UK.
It is characterised by the clonal proliferation of plasma cells within the bone marrow resulting in significant bone pain,
pathological fractures,
a low blood count and high calcium levels,
affecting patients’ quality of life [1].
Advanced imaging techniques including whole-body magnetic resonance imaging (WB-MRI),
whole-body computed tomography (WB-CT) or 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) are now recommended for patients with suspected or newly diagnosed myeloma (International Myeloma Working Group 2014 guidelines [2]) in order to define disease extent and monitor its progression. Significantly,
the detection of more than one focal lesion is now considered to fulfill the criteria for symptomatic disease necessitating treatment [2].
Several studies have shown that MRI has a higher sensitivity for the detection of myeloma compared to both WB-CT and 18F FDG-PET/CT; PET/CT is particularly less sensitive for the assessment of diffuse marrow infiltration [3].
On WB-MRI,
numerous subtypes of marrow infiltration have been described,
including normal marrow,
focal infiltration,
diffuse infiltration and variegated or "salt-and-pepper" [4].
These patterns have been shown to correlate with Durie and Salmon staging and hence survival [5].
Unfortunately,
post therapy appearances on MRI remain inconsistent and subjective [6].
Functional imaging biomarkers,
for example standardised uptake value (SUV), apparent diffusion coefficient (ADC), and fat fraction may provide quantitative assessment of both baseline myeloma and treatment response with more accurate assessment of plasma cell infiltration and bone marrow composition.
However,
this has not been definitively investigated.
Hence,
we aimed to assess the association between ADC,
fat fraction,
SUV and bone marrow plasma cell percentage sampled from the iliac bone in patients withy newly diagnosed myeloma.
Quantitative parameters e.g.
standardised uptake value (SUV),
apparent diffusion coefficient (ADC) and fat fraction may enable more accurate assessment of plasma cell infiltration and bone marrow composition in newly diagnosed myeloma.
We aimed to assess the association between ADC,
fat fraction,
SUV and bone marrow plasma cell percentage sampled from the iliac bone.