Purpose In multiple myeloma, skeletal radiographs are still regarded as the reference imaging examination because they help to establish the stage of the disease according to the Durie-Salmon Staging System. Whole-body MRI using T1 and STIR sequences increases the detection of myeloma lesions. MRI-measured diffusion has demonstrated high sensitivity in terms of detection in oncology. The main objective of this study is to compare conventional radiographic staging with an MRI whole-body diffusion technique (called DWIBS) in detecting bone lesion monoclonal plasma cell pathologies (multiple myeloma, plasma cell leukaemia, plasmacytoma and MGUS). Materials and methods Twenty-seven patients were included (multiple myeloma: 24; plasma cell leukaemia, MGUS and plasmacytoma: 1 each). All of them had a whole-body MRI diffusion examination (using a DWIBS sequence). Diffusion MRI and conventional radiographs were compared according to the Durie-Salmon Staging System. In case of doubtful lesions, 12 months of monitoring was used as the reference method for the definitive diagnosis. Results The overall concordance rate between the two techniques was 63%. The DWIBS sequence detected a higher number of lesions leading to a higher Durie-Salmon stage in 37% of the patients: one stage I to II, seven stage I to III, and two stage II to III. In 18.5% of the patients, the MRI was positive while the radiographs were normal and these discrepancies were most often located in sites poorly explored by X-ray (spine, pelvis and ribs). In one patient (4%), the MRI provided a stage lower than that of the X-rays (stage II vs. III). In this case, the X-rays were positive at the humerus and femur, unlike the DWIBS sequence. Our per site analysis confirmed the clear superiority of the DWIBS sequence when compared with X-rays in the exploration of the cervical spine (56 vs. 0%, P P P P P Conclusion The DWIBS MRI leads to an increase in the final Durie-Salmon stage. Although its place in the preoperative treatment of multiple myeloma still has to be assessed, this study suggests its potential interest.

Comparison of whole-body diffusion MRI and conventional radiological assessment in the staging of myeloma.

Bent spine syndrome (BSS), defined as an abnormal forward flexion of the trunk resolving in supine position, is usually related to parkinsonism, but can also be encountered in myopathies. This study evaluates whole-body muscle MRI (WB-mMRI) as a tool for detecting underlying myopathy in non-extrapyramidal BSS. Forty-three patients (90 % women; 53–86 years old) with a non-extrapyramidal BSS were prospectively included. All underwent a 1.5-T WB-mMRI and a nerve conduction study. Muscle biopsy was performed if a myopathy could not be eliminated based on clinical examination and all tests. Systematic MRI interpretation focused on peripheral and axial muscle injury; spinal posture and incidental findings were also reported. WB-mMRI was completed for all patients, with 13 muscle biopsies ultimately needed and myopathy revealed as the final etiological diagnosis in five cases (12 %). All biopsy-proven myopathies were detected by the WB-mMRI. Relevant incidental MRI findings were made in seven patients. This study supports WB-mMRI as a sensitive and feasible tool for detecting myopathy in BSS patients. Associated with electroneuromyography, it can better indicate when a muscle biopsy is needed and guide it when required. Rigorous radiological interpretation is mandatory, so as not to miss incidental findings of clinical consequence.

Whole-body muscle MRI to detect myopathies in non-extrapyramidal bent spine syndrome.

Resume Le myelome multiple (MM) est une hemopathie maligne caracterisee par une proliferation tumorale de plasmocytes intramedullaires. La mise en evidence de lesions osseuses est capitale dans le bilan d’extension initial et dans le suivi du MM, car elle conditionne la prise en charge therapeutique. Les radiographies standard sont d’un pietre rendement pour la mise en evidence de ces lesions. L’imagerie par resonance magnetique (IRM) est un examen interessant dans la detection de l’infiltration medullaire diffuse. Nous proposons, a travers l’experience de notre centre et une revue large de la litterature, de presenter le potentiel de la tomographie par emission de positons couplee a la tomodensitometrie (TEP/TDM) au fluoro-deoxy-glucose [18F]-FDG pour la mise en evidence et la prise en charge therapeutique des lesions osseuses dans le MM.

Intérêt de la TEP/TDM dans le bilan d’extension et le suivi des lésions osseuses du myélome multiple

Objectif : le traitement standard des glioblastomes repose sur l'association Temozolomide et radiotherapie (protocole STUPP). L'IRM realisee dans les 12 semaines suivant la radiotherapie peut objectiver une majoration de la prise de contraste, appelee pseudoprogression (PsP) pouvant evoquer parfois a tort une reprise evolutive. 
Lors du suivi, cette PsP peut se confirmer en une vraie progression tumorale (VPT) ou se stabiliser (PsP vraie= PsPV). 
L'objectif de ce travail est d'identifier des parametres d'imagerie permettant des l'IRM initiale de distinguer les patients presentant une vraie progression (VPT) des patients stables (PsPV). 
Materiel et methodes : etude retrospective de glioblastomes traites consecutivement entre mars 2009 a janvier 2012. Tous ont ete traites selon le protocole standard et ont eu une IRM multimodale en preoperatoire, un mois apres la radiotherapie (RT+1) et a 3 mois de la radiotherapie. La reponse therapeutique a ete evaluee selon les criteres de RANO. Sur l'IRM RT+1, nous avons etudie le coefficient apparent de diffusion (ADC), les volumes sanguins cerebraux relatifs (VSCr), les rapports choline/NAA, choline/creatinine et NAA/creatinine.
Resultats : sur 69 patients inclus, 38 (55%) ont presente une imagerie compatible avec une pseudoprogression selon les criteres RANO sur l'IRM RT +1. L'IRM de controle a 3 mois a confirme la progression chez 18 patients (VPT) alors que 20 ont finalement ete consideres comme stable (PsPV). La survie mediane des PsPV etait de 661 jours contre 374 pour les VPT (p=0.014). Sur l'IRM RT +1, les PsPV avaient des rapports choline/NAA inferieurs aux patients en VPT. La diminution du VSCr entre l'IRM preoperatoire et l'IRM RT +1 etait plus importante dans le groupe PsPV que dans le groupe VPT (p=0,019).
Conclusion : les rapports choline/NAA en association avec la chute du VSCr semblent etre des criteres qui, des l'IRM realisee 1 mois apres la radiotherapie, pourraient distinguer les pseudoprogressions des progressions precoces vraies.

IRM de diffusion dans la maladie de Legg-Perthes-Calve : facteur pronostic précoce ?

Comparaison de l’IRM de diffusion corps entier et du bilan radiologique standard dans le staging du myélome

Whole body functional MR imaging: hemato-oncologic applications Hemato-oncologic imaging combines anatomical and functional imaging data for optimal staging and follow-up of patients. It is currently possible to achieve high spatial resolution and functional evaluation at whole body MR imaging. Functional imaging may be achieved with two techniques: dynamic imaging following intravenous contrast injection and diffusion-weighted imaging. The purpose of this article is to demonstrate how both functional imaging techniques can be combined with whole body MR imaging for the evaluation of multiple myeloma and lymphomas.

http://irm-francophone.info/pdf/IRM_corps_entier.pdf

IRM fonctionnelle corps entier : applications hématologiques

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IRM fonctionnelle corps entier : applications hématologiques