Theranostics 2019; 9(16):4756-4763. doi:10.7150/thno.33289 This issue

Research Paper

Lack of Spleen Signal on Diffusion Weighted MRI is associated with High Tumor Burden and Poor Prognosis in Multiple Myeloma: A Link to Extramedullary Hematopoiesis?

Leo Rasche1,2✉, Manoj Kumar3, Grant Gershner1, Rohan Samant3, Rudy Van Hemert3, Anke Heidemeier4, Constantin Lapa5, Thorsten Bley4, Andreas Buck5, James McDonald3, Jens Hillengass6, Joshua Epstein1, Sharmilan Thanendrarajan1, Carolina Schinke1, Frits van Rhee1, Maurizio Zangari1, Bart Barlogie1, Faith E Davies1, Gareth J Morgan1, Niels Weinhold1,7

1. Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
2. Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
3. Radiology Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
4. Radiology Department, University Hospital of Würzburg, Würzburg, Germany
5. Department of Nuclear Medicine, University Hospital of Würzburg, Würzburg, Germany
6. Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
7. Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Citation:
Rasche L, Kumar M, Gershner G, Samant R, Van Hemert R, Heidemeier A, Lapa C, Bley T, Buck A, McDonald J, Hillengass J, Epstein J, Thanendrarajan S, Schinke C, van Rhee F, Zangari M, Barlogie B, Davies FE, Morgan GJ, Weinhold N. Lack of Spleen Signal on Diffusion Weighted MRI is associated with High Tumor Burden and Poor Prognosis in Multiple Myeloma: A Link to Extramedullary Hematopoiesis?. Theranostics 2019; 9(16):4756-4763. doi:10.7150/thno.33289. Available from https://www.thno.org/v09p4756.htm

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Abstract

Graphic abstract

Due to the low frequency of abnormalities affecting the spleen, this organ is often overlooked during radiological examinations. Here, we report on the unexpected finding, that the spleen signal on diffusion-weighted MRI (DW-MRI) is associated with clinical parameters in patients with plasma cell dyscrasias.

Methods: We investigated the spleen signal on DW-MRI together with clinical and molecular parameters in 295 transplant-eligible newly diagnosed Multiple Myeloma (NDMM) patients and in 72 cases with monoclonal gammopathy of undetermined significance (MGUS).

Results: Usually, the spleen is the abdominal organ with the highest intensities on DW-MRI. Yet, significant signal loss on DW-MRI images was seen in 71 of 295 (24%) NDMM patients. This phenomenon was associated with the level of bone marrow plasmacytosis (P=1x10-10) and International Staging System 3 (P=0.0001) but not with gain(1q), and del(17p) or plasma cell gene signatures. The signal was preserved in 72 individuals with monoclonal gammopathy of undetermined significance and generally re-appeared in MM patients responding to treatment, suggesting that lack of signal reflects increased tumor burden. While absence of spleen signal in MM patients with high risk disease defined a subgroup with very poor outcome, re-appearance of the spleen signal after autologous stem cell transplantation was seen in patients with improved outcome. Our preliminary observation suggests that extramedullary hematopoiesis in the spleen is a factor that modifies the DW-MRI signal of this organ.

Conclusions: The DW-MRI spleen signal is a promising marker for tumor load and provides prognostic information in MM.

Keywords: multiple myeloma, diffusion weighted mri, spleen, tumor burden, high risk, extramedullary hematopoiesis