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01-04-2022 | Multiple Myeloma | Magnetic Resonance

Application of diffusion-weighted whole-body MRI for response monitoring in multiple myeloma after chemotherapy: a systematic review and meta-analysis

Authors: Kaiwen Wang, Elsa Lee, Shedrack Kenis, Simon Hallam, Athar Haroon, Simon Wan, Neil Rabin, Antonio Rojas-Garcia, Anwar Padhani, Sola Adeleke

Published in: European Radiology | Issue 4/2022

Abstract

Objective

Myeloma Response Assessment and Diagnosis System recently published provides a framework for the standardised interpretation of DW-WBMRI in response assessment of multiple myeloma (MM) based on expert opinion. However, there is a lack of meta-analysis providing higher-level evidence to support the recommendations. In addition, some disagreement exists in the literature regarding the effect of timing and lesion subtypes on apparent diffusion coefficient (ADC) value changes post-treatment.

Method

Medline, Cochrane and Embase were searched from inception to 20th July 2021, using terms reflecting multiple myeloma and DW-WBMRI. Using PRISMA reporting guidelines, data were extracted by two investigators. Quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 method.

Results

Of the 74 papers screened, 10 studies were included comprising 259 patients (127 males and 102 females) and 1744 reported lesions. Responders showed a significant absolute ADC change of 0.21×10⁻³ mm/s² (95% CI, 0.01–0.41) with little evidence of heterogeneity (Cochran Q, p = 0.12, I² = 45%) or publication bias (p = 0.737). Non-responders did not show a significant absolute difference in ADC (0.06 ×10⁻³ mm/s², 95% CI, −0.07 to 0.19). A percentage ADC increase of 34.78% (95% CI, 10.75–58.81) was observed in responders. Meta-regression showed an inverse trend between ADC increases and time since chemotherapy initiation which did not reach statistical significance (R² = 20.46, p = 0.282).

Conclusions

This meta-analysis supports the use of the DW-WBMRI as an imaging biomarker for response assessment. More evidence is needed to further characterise ADC changes by lesion subtypes over time.

Key Points

• In multiple myeloma patients who received chemotherapy, responders have a significant absolute increase in ADC values that is not seen in non-responders.

• A 35% increase in ADC from baseline values is found to classify response post-induction chemotherapy which corroborates with expert opinion from the Myeloma Response Assessment and Diagnosis System.

• More evidence is needed to further characterise ADC changes by lesion subtypes over time after induction of therapy.

Available only for authorised users

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Title: Application of diffusion-weighted whole-body MRI for response monitoring in multiple myeloma after chemotherapy: a systematic review and meta-analysis
Authors: Kaiwen Wang
Elsa Lee
Shedrack Kenis
Simon Hallam
Athar Haroon
Simon Wan
Neil Rabin
Antonio Rojas-Garcia
Anwar Padhani
Sola Adeleke
Publication date: 01-04-2022
Publisher: Springer Berlin Heidelberg
Keywords: Multiple Myeloma
Cytostatic Therapy
Biomarkers
Dexamethasone
Published in: European Radiology / Issue 4/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-021-08311-z

2024 ASCO Annual Meeting

Springer Medicine

Application of diffusion-weighted whole-body MRI for response monitoring in multiple myeloma after chemotherapy: a systematic review and meta-analysis

Abstract

Objective

Method

Results

Conclusions

Key Points

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Objective

Method

Results

Conclusions

Key Points

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