Πολλαπλό μυέλωμα: συσχέτιση ευρημάτων δυναμικής μαγνητικής τομογραφίας με προγνωστικούς παράγοντες της νόσου και παράγοντες αγγειογένεσης ; Multiple myeloma: correlation of findings of dynamic contrast enhanced MRI with high risk features of the disease and with circulating angiogenic cytokines levels

The aim of the study was to assess the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in patients with newly diagnosed multiple myeloma (MM) who were treated with novel antimyeloma agents. We studied 60 previously untreated MM patients at diagnosis, 14 with smoldering MM (SMM) and 5 with MGUS. All patients underwent MRI of the thoracolumbar spine and pelvis before the administration of any kind of therapy, and DCE-MRI was performed. The MRI perfusion parameters evaluated were wash-in (WIN), washout (WOUT), time-to-peak (TTPK), time-to-maximum slope (TMSP), and the WIN/TMSP ratio. The following serum levels of angiogenic cytokines were measured on the day of MRI: VEGF, angiogenin (Ang), angiopoietin-1 (Angp-1), and −2 (Angp-2). Symptomatic MM patients had increased WIN compared to SMM (p < 0.05) and MGUS patients (p = 0.001). TTPK was decreased, and WIN/TMSP was increased in both symptomatic and SMM patients compared to MGUS patients (p < 0.05). Symptomatic MM patients had decreased TMSP compared to MGUS patients. The Angp-1/Angp-2 ratio was reduced in symptomatic MM compared to SMM (p = 0.017) and MGUS patients (p < 0.001). TTPK correlated with Angp-1/Angp-2 ratio and importantly with R-ISS. Patients with R-ISS-3 had lower TTPK median value (23 s, range 18–29 s) compared to patients with R-ISS-2 (48 s, range 27–68 s) and patients with RISS-1 MM (54 s, range 42–76 s; p ANOVA = 0.01). A subset of patients with low TTPK (lower quartile) had shorter time to progression compared to all other patients. These data suggest that certain DCE-MRI parameters correlate with R-ISS and adverse prognostic features of angiogenesis, such as the ratio of Angp-1/Angp-2. ; H μελέτη αξιολόγησε την πιθανή προοπτική της Δυναμικής Μαγνητικής Τομογραφίας (ΔΜΤ) του οστικού μυελού στο πολλαπλό μυέλωμα να διαδραματίσει το ρόλο ανεξάρτητου προγνωστικού παράγοντα στην εκτίμηση της βαρύτητας της νόσου, στην πρόβλεψη της κλινικής πορείας αλλά και της ανταπόκρισης στη θεραπευτική αγωγή.Υλικό-Μέθοδοι: Μελετήθηκαν ...