Quantitative Whole-Body MRI for Treatment Response Monitoring in Multiple Myeloma

Transcription

1 Quantitative Whole-Body MRI for Treatment Response Monitoring in Multiple Myeloma Arash Latifoltojar

2 Background- Initial disease assessment - Whole body Imaging skeletal survey WB-CT PET-CT WB-MRI - Improved diagnostic performance compared to Skeletal survey 1, CT 2 and PET-CT 3 - Recommended as first line imaging by IMWG 4 and NICE 5 1 Giles et al. Clin Rad 2015;; 70: Baur-Melnyk et al. AJR 2008;; 190: Moreau et al Blood 2014;; 124:3359 (abstract 395) 4 Dimopoulos et al. J Clin Oncol 2015;; 33: NICE guideline, recommendations on imaging investigation in MM.

3 Background-Response Monitoring - Qualitative assessments Number of Focal lytic (FL) lesions 6 Pattern of bone marrow (BM) involvement 6 - Quantitative assessments Single axis size measurements of FLs 7, 8 Dynamic contrast enhanced quantitative changes: FLE max, BME max 8 Diffusion weighted imaging s apparent diffusion coefficient changes 9 6 Hillengass et al. Haematologica 2012;; 97: Messiou et al. Br J Haematol 2015;; 171: Lin et al. radiology 2010;; 254: Giles et al. Radiology 2014;; 271:

4 4 The Research Project

5 Material and Methods-Cohort selection - Prospective single centre observational study - Suspected symptomatic multiple myeloma - WB-MRI (3.0T, Ingenia, Phillips) - Post two cycles of Bortezomib based chemotherapy WB- MRI 5

6 6 Material and Methods- MRI protocol

7 Material and Methods-Image analysis - Two Radiologists reviewed images in consensus - Pattern of involvement and presence of FLs - A 5-point scale: 0=non-diagnostic quality images, 1=unlikely, 2=indeterminate, 3=likely and 4=highly likely disease - Maximum of 20 FLs 5mm (score 3/4) were selected for each patients for quantitative analysis 7

8 8 Material and Methods- Measurements

9 Material and Methods- Measurements - Three axis size measurements, Estimated tumour volume (etv): (X*Y*Z) / 2 - Enhancement ratio (ER): [ (SI post-contrast-w - SI pre-contrast-w )/SI pre-contrast-w ] * Apparent diffusion coefficient (ADC): Mono-exponential curve fitting - Signal fat fraction (sff): SI pre-contrast-f / (SI pre-contrast-f + SI pre-contrast-w ) 9

10 10 Results

11 11 Results-Patient cohort

12 1.0 *** Results- Entire Cohort 2.4 *** Signal FF (a.u.) ADC (x 10-3 mm 2 /s) weeks 1.5 *** etv (cm 3 ) ER (%) * p<5, ** p<1 and *** p<

13 CR/VGPR Signal FF(a.u.) *** Results- Per-group analysis Signal FF (a.u.) * PR ADC (x 10-3 mm 2 /s) ** ADC (x 10-3 mm 2 /s) * * p<5, ** p<1 and *** p<01 13

14 CR/VGPR 1.5 * Results- Per group analysis 1.5 ** PR etv (cm 3 ) etv (cm 3 ) ER(%) ER(%)

15 4 *** Results- Group analysis 4 ΔSignal FF (fold change) ΔADC (fold change) CR/VGPR ΡR 0 CR/VGPR ΡR 4 4 ΔeTV (fold change) ΔER (fold chnage) CR/VGPR ΡR 0 CR/VGPR ΡR 15

16 Results- Per-patient analysis VGPR PR SD 1.0 *** 1.0 * Signal FF (a.u.) Signal FF (a.u.) Signal FF (a.u.)

17 1.0 PR * 0.8 Signal FF (a.u.)

18 18 8 weeks

19 1.0 PR * 0.8 Signal FF (a.u.)

20 20 8 weeks

21 21 Results

22 Limitations -Small cohort of patient -FL only analysis -No long-term follow-up WB-MR imaging -Generalisation 22

23 Discussion and Conclusions - WB-MRI provides comprehensive assessment of BM changes following therapy - Dixon based MRI provides a reliable, fast imaging technique with quantifiable sff - Advances in MR field provide an opportunity to implement WB-MRI protocols that assess qualitative and quantitative (Imaging biomarkers) information reflecting structural and functional changes - A larger prospective study with long-term F/U imaging could clarify the possibility of integration of available functional MR techniques in response assessment of MM patients 23

24 Acknowledgments - Dr Shonit Punwani - Professor Margaret Hall-Craggs - Professor Stuart Taylor - Professor Steve Halligan - Dr Alan Bainbridge - Ms Magdalena Sokolska - Dr Nikolaos Dikaios - Ms Heather Fitzke - Professor Kwee Yong - Dr Neil Rabin - Dr Rakesh Popat - Dr Shirely D Sa - Dr Ali Rismani 24