Kerstin Fechtner, Presenter: Nothing to Disclose

Jens Hillengass MD, Abstract Co-Author: Nothing to Disclose

Lars Grenacher MD, Abstract Co-Author: Nothing to Disclose

Stefan Delorme MD, Abstract Co-Author: Nothing to Disclose

Hans-Ulrich Kauczor MD, Abstract Co-Author: Research grant, Siemens AG Research grant, Toshiba Corporation Research Consultant, Boehringer Ingelheim GmbH Speakers Bureau, Boehringer Ingelheim GmbH Research grant, Boehringer Ingelheim GmbH Speakers Bureau, Novartis AG

Marc-Andre Weber MD, Abstract Co-Author: Nothing to Disclose

The concordance of the Durie/Salmon (D/S) with the Durie/Salmon PLUS (D/S PLUS) staging system was investigated by means of whole-body MRI (wb-MRI) regarding focal or diffuse infiltration in all stages of monoclonal plasma cell disease.

Wb-MRI was used to examine a total of 403 untreated patients with monoclonal plasma cell disease, including patients with monoclonal gammopathy of undetermined significance (MGUS, n=84), plasmacytoma (n=17), amyloidosis (n=12) and multiple myeloma in all stages (MM, n=290). Head, thorax, abdomen, legs, and spine were examined on a 1.5T-system using T1 and fat-suppressed T2-weighted sequences. Two blinded radiologists assessed in consensus the bone marrow infiltration pattern and focal lesions, additionally distinguishing between intraosseous, corticalis-exceeding, and soft tissue lesions with regard to D/S and D/S PLUS.

In our cohort of 84 MGUS patients 33 patients (39%) would have been upstaged (MM stage I (36%), MM stage II (1%) and MM stage III (2%)) according to D/S PLUS. In 17 plasmacytoma patients all patients (100%) showed focal lesions or a diffuse infiltration leading to an upgrading as MM stage I (76%), MM stage II (12%) or even MM stage III (12%) in D/S PLUS. In 149 MM stage I only 11 patients (8%) would have been staged higher in D/S PLUS in comparison to D/S. In 21 MM stage II 13 patients (62%) would have been downstaged leading to MM stage I according to D/S PLUS. In this cohort 6 patients (29%) would have been upgraded to MM stage III in D/S PLUS. In 120 patients with MM stage III 72 patients (60%) would have been downstaged in D/S PLUS. MGUS in association with amyloidosis was not taken into account.

The new D/S PLUS Staging System shows no concordance with the classical D/S staging system (asymptomatic marginal-homogeneity test p= 4,441e-16. In case of limited disease (MGUS, plasmacytoma) wb-MRI reveals more lesions and thus yields a higher, potentially more accurate classification.

Focal lesions have an adverse prognostic significance in plasma cell disease. According to D/S PLUS wb-MRI reveals more lesions and thus yields a more accurate classification in MGUS and plasmacytoma.

Fechtner, K, Hillengass, J, Grenacher, L, Delorme, S, Kauczor, H, Weber, M, Staging of Monoclonal Plasma Cell Disease with Whole-body MRI: Comparison of the Durie/Salmon and the Durie/Salmon PLUS Staging System.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8003710.html