@article{3108875,
    title = "Quantitative diffusion-weighted imaging of the bone marrow: An adjunct tool for the diagnosis of a diffuse MR imaging pattern in patients with multiple myeloma",
    author = "Koutoulidis, V. and Fontara, S. and Terpos, E. and Zagouri, F. and Matsaridis, D. and Christoulas, D. and Panourgias, E. and Kastritis, E. and Dimopoulos, M.A. and Moulopoulos, L.A.",
    journal = "Dentomaxillofacial Radiology",
    year = "2017",
    volume = "282",
    number = "2",
    pages = "484-493",
    publisher = "Radiological Society of North America Inc.",
    doi = "10.1148/radiol.2016160363",
    keywords = "adult;  aged;  apparent diffusion coefficient;  Article;  bone marrow;  cancer staging;  controlled study;  diagnostic accuracy;  diffusion weighted imaging;  female;  human;  major clinical study;  male;  multiple myeloma;  nuclear magnetic resonance imaging;  nuclear magnetic resonance scanner;  prospective study;  receiver operating characteristic;  sensitivity and specificity;  bone marrow;  case control study;  diagnostic imaging;  diffusion weighted imaging;  middle aged;  multiple myeloma;  pathology;  procedures;  very elderly, Adult;  Aged;  Aged, 80 and over;  Bone Marrow;  Case-Control Studies;  Diffusion Magnetic Resonance Imaging;  Female;  Humans;  Male;  Middle Aged;  Multiple Myeloma;  Prospective Studies",
    abstract = "Purpose: To evaluate the apparent diffusion coeffcients (ADCs) of magnetic resonance (MR) imaging patterns in the bone marrow of patients with multiple myeloma (MM) and to determine a threshold ADC that may help distinguish a diffuse from a normal pattern with high accuracy. Materials and Methods: This prospective study was approved by the ethics review board, and informed consent was obtained. Ninety-nine patients with newly diagnosed, untreated MM and 16 healthy control subjects underwent spinal MR imaging including diffusion-weighted imaging, and bone marrow ADCs were calculated. Pattern assignment was based on visual assessment of conventional MR images. The Kruskal-Wallis H test, the Mann-Whitney test, and the oneway analysis of variance were used to compare ADCs between patient subsets and control subjects, and a receiver operating characteristic analysis was performed. Results: Mean ADCs ± standard deviation in patients with MM for the normal, focal, and diffuse MR imaging patterns were 0.360 × 1023 mm2/sec ± 0.110, 1.046 × 1023 mm2/sec ± 0.232, and 0.770 × 1023 mm2/sec ± 0.135, respectively. There were signifcant differences in ADCs between diffuse and normal (P <.001), diffuse and focal (P <.001), and focal and normal (P <.001) patterns. Patients with a diffuse pattern had more features of advanced disease, higher international staging system score, increased incidence of high-risk cytogenetics, and higher revised international staging system score. ADCs greater than 0.548 × 1023 mm2/sec showed 100% sensitivity (26 of 26) and 98% specifcity (48 of 49) for the diagnosis of a diffuse (vs normal) MR imaging pattern, whereas an ADC greater than 0.597 × 1023 mm2/sec showed 96% sensitivity (25 of 26) and 100% specifcity (49 of 49). Conclusion: ADCs of MR imaging patterns in patients with MM differ signifcantly. A diffuse MR imaging pattern can be distinguished more objectively from a normal MR imaging pattern by adding quantitative diffusion-weighted imaging to standard MR imaging protocols. © 2016 RSNA."
}