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- Title
Application of diffusion-weighted whole-body MRI for response monitoring in multiple myeloma after chemotherapy: a systematic review and meta-analysis.
- Authors
Wang, Kaiwen; Lee, Elsa; Kenis, Shedrack; Hallam, Simon; Haroon, Athar; Wan, Simon; Rabin, Neil; Rojas-Garcia, Antonio; Padhani, Anwar; Adeleke, Sola
- Abstract
<bold>Objective: </bold>Myeloma Response Assessment and Diagnosis System recently published provides a framework for the standardised interpretation of DW-WBMRI in response assessment of multiple myeloma (MM) based on expert opinion. However, there is a lack of meta-analysis providing higher-level evidence to support the recommendations. In addition, some disagreement exists in the literature regarding the effect of timing and lesion subtypes on apparent diffusion coefficient (ADC) value changes post-treatment.<bold>Method: </bold>Medline, Cochrane and Embase were searched from inception to 20th July 2021, using terms reflecting multiple myeloma and DW-WBMRI. Using PRISMA reporting guidelines, data were extracted by two investigators. Quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 method.<bold>Results: </bold>Of the 74 papers screened, 10 studies were included comprising 259 patients (127 males and 102 females) and 1744 reported lesions. Responders showed a significant absolute ADC change of 0.21×10-3 mm/s2 (95% CI, 0.01-0.41) with little evidence of heterogeneity (Cochran Q, p = 0.12, I2 = 45%) or publication bias (p = 0.737). Non-responders did not show a significant absolute difference in ADC (0.06 ×10-3 mm/s2, 95% CI, -0.07 to 0.19). A percentage ADC increase of 34.78% (95% CI, 10.75-58.81) was observed in responders. Meta-regression showed an inverse trend between ADC increases and time since chemotherapy initiation which did not reach statistical significance (R2 = 20.46, p = 0.282).<bold>Conclusions: </bold>This meta-analysis supports the use of the DW-WBMRI as an imaging biomarker for response assessment. More evidence is needed to further characterise ADC changes by lesion subtypes over time.<bold>Key Points: </bold>• In multiple myeloma patients who received chemotherapy, responders have a significant absolute increase in ADC values that is not seen in non-responders. • A 35% increase in ADC from baseline values is found to classify response post-induction chemotherapy which corroborates with expert opinion from the Myeloma Response Assessment and Diagnosis System. • More evidence is needed to further characterise ADC changes by lesion subtypes over time after induction of therapy.
- Subjects
META-analysis; SYSTEMATIC reviews; MULTIPLE myeloma
- Publication
European Radiology, 2022, Vol 32, Issue 4, p2135
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-021-08311-z