Multi-Parametric Whole Body MRI before and after Bone Marrow Transplantation in Patients with Multiple Myeloma

Abstract Background Myeloma is the most common primary malignancy affecting the skeletal system. Most of the patients are presented and diagnosed late at the disease process, so early detection is very beneficial for patient management and choice of treatment. Multiparametric MRI with the added value of diffusion weighted images together with PETCT had been beneficial for early patient diagnosis, choice of treatment and follow up management after treatment. The study was conducted on 24 patients with bone marrow biopsy and aspiration proven multiple myeloma who also underwent PET-CT within 10 days of each other. Main body of the Abstract Whole body MRI had high diagnostic accuracy during initial staging and in disease assessment before treatment. After treatment, whole body MRI also showed high diagnostic accuracy in assessing progressive disease activity, while it proved low accuracy in stable disease and regressive disease activity. Whole body MRI showed sensitivity of 87.5%, specificity of 50%, positive predictive value of 78%, and negative prediction value of 67% (p = 0.01). PET had sensitivity of 75%, specificity of 75%, positive predictive value of 85%, and negative predictive value of 60% (p = 0.05). Whole body MRI findings was in agreement with PET-CT in most of the cases. Short Conclusion During the initial disease assessment, whole body MRI with DWI performed better than PET-CT in detecting small lesions < 5mm, diffuse (salt and pepper appearance) marrow involvement and total number of marrow lesions, having higher sensitivity and specificity. PET-CT performed better than whole-body MRI in assessment of disease activity before and after treatment. Whole body MRI is recommended for re-assessment if the patient had remission/exacerbation or progressive course of the disease. PET-CT is recommended if the patient had stationary or regressive course of the disease by clinical and laboratory data. When whole body MRI and PET-CT findings of the same patient combined with each other, it is found to have a high satisfactory results for patient management, which may be of value to hematologists in assessing the response of bone marrow transplantation