The Clinical Value Of Whole Body Diffusion Weighted Image In The Diagnosis And Evaluating Therapy Efficacy Of Multiple Myeloma

Objective:To investigate the clinical value of whole body diffusion weighted image?WB-DWI?in the diagnosis and evaluating therapy efficacy of multiple myelomaMethods:The clinical data of 28 patients with multiple myeloma admitted to the Department of Hematology of Cancer Center from January 2016 to September 2017 were collected.All patients were diagnosed according to clinical manifestations,image examinations,bone marrow biopsy and other related laboratory examinations.And WB-DWI was performed before treatment.Five patients received WB-DWI after 3 to 5 cycles of chemotherapy.WB-DWI uses the Philip Ingenia 3.0T magnetic resonance scanner and internal coils in the magnet with diffusion weighted imaging?DWI?,short TI inversion recovery?STIR?,and echoplane imaging?EPI?sequence.The scan was completed in 7phases,taking 2 minutes and 57 seconds every phase.There was continuity scanning from the skull head to the sole.The whole body image was spliced in Mobilview software,and we selected the ADC image with b=800s/mm²and measured the ADC value on the Philip workstation.All images were read independently by two radiologists?with MRI diagnosis experience for more than 3 years?,and the region of interest?ROI?was selected with the elliptical outline of the largest area of the lesion.The ROI was centered as much as possible and covered approximately 80%of the lesion area.Apparent signal at the edge of the lesion was avoided and then the apparent diffusion coefficient?ADC?value?unit:mm²/s?was recorded.The same part of the ROI was selected to measure the average value 3 times,and the average of the results measured by the two physicians was taken as the test results.SPSS11.0 software was used for statistical analysis.Paired-sample t-test was used to compare whether the ADC value of the largest lesion before and after chemotherapy was different.Spearman correlation test was used to analyze the correlation between mean ADC value of ilium lesion and the level of infiltration of bone marrow plasmacyte in bone marrow puncture site.Results:1.Five patients received WB-DWI after 3 to 5 courses of chemotherapy.The median between days of check was 138?79-172?days.Among them,bortezomib,thalidomide and dexamethasone combined chemotherapy?VTD?were used in 2 patients;bortezomib,cyclophosphamide,and dexamethasone combined chemotherapy?VCD?were used in 2patients.One person underwent bortezomib,epirubicin and dexamethasone combined chemotherapy?PAD?.WB-DWI examination showed that the number of systemic lesions of5 patients was reduced,and the diameter of some lesions was smaller than that before treatment.ADC value of the largest diameter lesion responding to chemotherapy was measured,and the median ADC value of the largest lesion before treatment was1.2726×10^-3mm²/s;The median ADC value after treatment was 1.8135×10^-3mm²/s,and the ADC values of the largest lesion responding to chemotherapy were all increased after treatment.Paired-samplet-test was used to compare the difference in ADC values before and after treatment.The P-value was statistically significant,so it can be considered that there was a difference in the ADC value of the largest lesion before and after treatment in the same patient.2.23 cases of untreated MM patients underwent the bone marrow puncture to show the proportion of the original and immature plasma cells,and this test represented the level of infiltration of the patient's bone marrow plasma cell.The bone marrow puncture site was the posterosuperior part of the right anterior superior iliac,and the time between the puncture and WB-DWI interval was not more than 3 days.We chose the mean value of the ADC of bone lesions and bone marrow puncture results for analysis.Spearman correlation test results showed that there was a correlation between ADC mean of tibial lesions and the degree of bone marrow plasma cell infiltration?P<0.001?.Spesrman correlation coefficient was statistically significant,and it was considered that the mean value of ADC of tibial lesions and the degree of bone marrow plasma cell infiltration were negative.For correlation,the correlation coefficient was-0.987,which means that the higher the degree of bone marrow plasma cell infiltration,the lower the ADC mean value of tibial lesions.Conclusion:1.ADC value can reflect the change of multiple myeloma intramedullary lesions after treatment.It has a certain correlation with clinical treatment effect and can be used to evaluate the therapeutic effect of MM patients initially.2.The ADC value was negatively correlated with the degree of infiltration of the bone marrow plasma celland could reflect the proliferation situation of bone marrow.3.WB-DWI has broad application prospects in the detection of MM lesions,efficacy evaluation,and disease surveillance.