Magnetic resonance imaging as a supplement for the clinical staging system of Durie and Salmon?

• Published in: Cancer 2002-09, Vol.95 (6), p.1334-1345
• Main Authors: Baur, Andrea, Stäbler, Axel, Nagel, Dorothea, Lamerz, Rolf, Bartl, Reiner, Hiller, Erhard, Wendtner, Clemens, Bachner, Fridleif, Reiser, Maximilian
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; bone marrow; Bone Marrow - pathology; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Lumbar Vertebrae - pathology; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Miscellaneous. Technology; MRI; multiple myeloma; Multiple Myeloma - mortality; Multiple Myeloma - pathology; Neoplasm Staging - methods; prognosis; Radiodiagnosis. Nmr imagery. Nmr spectrometry; spine; staging system; survival; Thoracic Vertebrae - pathology
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.10818

BACKGROUND This study evaluated the prognostic value of a three‐grade staging system of spinal involvement using magnetic resonance imaging (MRI) in patients with multiple myeloma and determined its usefulness as an independent parameter in the staging system of Durie and Salmon. METHODS Seventy‐seven previously untreated patients with multiple myeloma underwent MRI of the thoracic and lumbar spine with unenhanced T1‐weighted spin echo and short‐tau inversion time inversion recovery sequences. The patients were evaluated according to their infiltration patterns and the extent of bone marrow involvement was staged using a three‐grade scale: Stage I, no focal or diffuse infiltration; Stage II, 1–10 foci or mild diffuse infiltration; Stage III, more than 10 foci or strong diffuse infiltration. RESULTS The infiltration patterns had no significant effect on survival. Of 77 patients, 25 would have been understaged using the standard staging system of Durie and Salmon without the findings of MRI and 8 patients would have been understaged if the staging was based only on MRI. The combination of the staging system of Durie and Salmon and MRI was highly significant with respect to survival (P < 0.0001, log rank analysis). MRI staging I–III was independent of the staging system of Durie and Salmon (Cox regression model). CONCLUSIONS A three‐grade staging of spinal MRI provides a significant prognostic tool for patients with multiple myeloma. The authors propose including it in the staging system of Durie and Salmon. Cancer 2002;95:1334–45. © 2002 American Cancer Society. DOI 10.1002/cncr.10818 A three‐grade staging system of spinal involvement using magnetic resonance imaging in patients with multiple myeloma provided highly significant results for survival rates and enhanced the standard staging system of Durie and Salmon.