Combination of Whole Body MRI and MY-RADS: A Promising Standardised Approach for Treatment Response Evaluation in Multiple Myeloma Patients

Introduction: Multiple Myeloma (MM) is a malignancy that impacts the bones, kidneys, and immune system. Wholebody Magnetic Resonance Imaging (MRI) is recognised as the most sensitive modality for bone marrow assessment, providing advantages such as enhanced speed, comprehensive coverage, and precise quantification compared to traditional MRI methods. This technique circumvent the necessity for intravenous contrast agents and minimises radiation exposure. The Myeloma Response Assessment and Diagnosis System (MY-RADS) represents a standardised framework designed to evaluate and document the therapeutic response of patients with multiple myeloma through imaging techniques, particularly utilising whole-body MRI. Aim: To evaluate the effectiveness of the MY-RADS scoring system using whole-body MRI for treatment response assessment of patients with Multiple Myeloma. Materials and Methods: A prospective observational study was conducted at Gauhati Medical College and Hospital from April 2021 to September 2022. A total of 50 patients diagnosed with multiple myeloma and undergoing treatment were subjected to whole-body MRI evaluations. All participants adhered to a standardised MRI protocol employing uniform sequence parameters utilising the 3T Siemens Magnetom Skyra technology both pre-and post-treatment, with a burden score allocated to reflect the extent and severity of the disease. Disease progression was subsequently evaluated following MYRADS guidelines consisting of tumour burden score, Apparent Diffusion Coefficient (ADC), and fat fraction to improve reporting consistency and minimise exposure to ionizing radiation. Statistical analyses were conducted utilising IBM SPSS Statistics version 26.0. Pearson’s correlation test was applied to evaluate the correlation between various parameters assessed. A p-value of less than 0.05 was considered statistically significant. Results: A total of 18 (36%) patients were in the MY-RADS 5 score category indicating extensive disease followed by 13 (26%) patients in MY-RADS 4. The mean ADC seen on follow up was 0.71 +/- 0.08 x 10-3 mm2 /sec in MY- RADS score 5 while it was 1.47 +/- 0.22×10-3 mm2 /sec in MY-RADS score 1. There was a statistically significant correlation between MY-RADS score and clinical biomarkers. Conclusion: MY-RADS along with Whole-body MRI offers a non-invasive, radiation-free modality for assessment of response to treatment for Multiple Myeloma, enabling healthcare professionals to timely adjust treatment and improve patient outcomes.