Early response assessment in patients with multiple myeloma during anti-angiogenic therapy using arterial spin labelling: first clinical results.

OBJECTIVE: To determine if arterial-spin-labelling (ASL) MRI can reliably detect early response to anti-angiogenic therapy in patients with multiple myeloma by comparison with clinical/haematological response. METHODS: Nineteen consecutive patients (10 men; mean age 63.5 ± 9.1 years) were included in the present study. Inclusion criteria were diagnosis of stage III multiple myeloma and clinical indication for therapeutical administration of bortezomib or lenalidomide. We performed MRI on 3.0T MR in the baseline setting, 3 weeks after onset of therapy and after 8 weeks. Clinical responses were determined on the basis of international uniform response criteria in correlation with haematological parameters and medium-term patient outcome. MRI studies were performed after approval by the local institutional review board. RESULTS: Fifteen patients responded to anti-myeloma therapy; 4/19 patients were non-responders to therapy. Mean tumour perfusion assessed by ASL-MRI in a reference lesion was 220.7 ± 132.5 ml min(-1) 100 g(-1) at baseline, and decreased to 125.7 ± 86.3 (134.5 ± 150.9) ml min(-1) 100 g(-1) 3 (8) weeks after onset of therapy (P < 0.02). The mean decrease in paraproteinaemia at week 3 (8) was 52.3 ± 47.7% (58.2 ± 58.7%), whereas ß2-microglobulinaemia decreased by 20.3 ± 53.1% (23.3 ± 57.0%). Correlation of ASL perfusion with outcome was significant (P = 0.0037). CONCLUSION: ASL tumour perfusion measurements are a valuable surrogate parameter for early assessment of response to novel anti-angiogenic therapy.

Imaging findings in immunosuppressed patients with Epstein Barr virus-related B cell malignant lymphoma.

OBJECTIVE: The purpose of this study was to describe multimodality imaging findings in immunosuppressed patients with Epstein-Barr virus (EBV)-related malignant lymphoproliferative diseases. CONCLUSION: EBV-related malignant lymphoproliferative diseases share common features with other aggressive lymphomas, including a high degree of extranodal involvement, tumor vascularization, and tumor necrosis. Cognizance of the particular underlying diseases and conditions associated with the development of EBV-related lymphoproliferative diseases and associated imaging results should provide more accurate diagnosis.

Response assessment in patients with multiple myeloma during antiangiogenic therapy using arterial spin labeling and diffusion-weighted imaging: a feasibility study.

RATIONALE AND OBJECTIVES: To determine whether response to anti-angiogenic therapy in patients with multiple myeloma can be assessed by noncontrast perfusion magnetic resonance imaging (MRI) (ie, arterial-spin-labeling [ASL]), and diffusion-weighted [DWI] MRI. MATERIALS AND METHODS: The study protocol was approved by the local institutional ethic board. Ten consecutive patients (eight men, two women; mean age 60.5 ± 8.5 years) with Stage III multiple myeloma were prospectively included. MRI was performed at baseline, as well as 3 and 8 weeks after onset of antiangiogenic therapy. Functional MRI data were compared with clinical outcome and conventional lesion size and signal-intensity measurements. Differences between baseline and follow-up values for ASL-MRI and DWI-MRI were assessed using a paired Student t-test. RESULTS: Nine patients responded well to therapy, whereas one patient was classified a nonresponder. Temporary changes in signal intensity between baseline and follow-up examinations were inconsistent on T1-weighted (w) and T2w images. Likewise, determination of lesion size at follow-up proved unreliable. ASL showed a marked decrease in perfusion from baseline (251 ± 159 mL/(min*100g)) to follow-up at 3 weeks (115 ± 85 mL/(min*100g), P = .01) and 8 weeks (101 ± 90 mL/(min*100g, P = .01), respectively. Relative to the baseline examination, mean diffusion increased from 0.68 ± 0.19 × 10(-3) s/mm(2) at baseline to 0.94 ± 0.24 × 10(-3) s/mm(2) after 3 weeks (P = .04), and 0.96 ± 0.40 × 10(-3) s/mm(2) after 8 weeks (P = .049). Both methods were able to correctly classify 9/10 patients as responder or nonresponder. CONCLUSION: ASL perfusion as well as DWI-MRI provide accurate, clinically relevant information regarding tumor viability and can predict response already early after therapy onset, as opposed to classical lesion size and MRI signal-intensity measurements.