Stage III multiple myeloma: Clinical and prognostic value of spinal bone marrow MR imaging

PURPOSE: To determine the clinical and prognostic value of spinal bone marrow magnetic resonance (MR) imaging in stage III multiple myeloma. MATERIALS AND METHODS: In 80 patients with untreated, newly diagnosed stage III multiple myeloma, initial MR imaging patterns of spinal bone marrow involvement were correlated with hematologic parameters and response to induction chemotherapy. The influence of these patterns on survival was studied in 57 patients who did not undergo cytotoxic therapy with stem cell transplantation. RESULTS: MR imaging patterns of marrow involvement were normal in 19(24%) patients, focal in 35(44%), and diffuse in 26 (32%). Patients with the diffuse pattern had higher marrow plasmacytosis (P less than or equal to .003) and cellularity(P less than or equal to .001), higher serum calcium (P less than or equal to .005) and beta 2-microglobulin (P less than or equal to .008) levels, and lower hemoglobin values (P less than or equal to .001) than did those with the normal or focal patterns. Patients with the normal pattern responded better to therapy(P = .007) and survived longer than patients with an abnormal pattern (P = .026). MR imaging findings and C-reactive protein level were the best independent prognostic indicators of survival. CONCLUSION: MR imaging patterns spinal bone marrow involvement are correlated with several clinical parameters of disease severity and have prognostic valve in stage III multiple myeloma.