MRI in plasmocytoma: Ranking of various sequences in various infiltration patterns.

Purpose: The aim of this study was to compare various pulse-sequences employing the spine array coil while considering the different infiltration patterns in multiple myeloma, in order to develop a fast and cost effective screening method. Materials and methods: In a prospective study, 50 patients with histologically proven multiple myeloma were examined with the following standardised sequences: T-1-weighted SE, T-2-weighted FSE, opposed phase GRE, FSE STIR, T-1-weighted SE post gadopentate dimeglumine without and with fat saturation. The images were evaluated in a ROC analysis by three radiologists in consensus with a 5-grade scale separatively for diffuse and focal involvement. The gold standard was bone marrow histology in cases of diffuse infiltration and the combination of all sequences with the staging system according to Durie and Salmon. Results: For focal bone marrow involvement the area under curve was greatest for FSE STIR sequences, in cases of diffuse infiltration the area under curve was superior for unenhanced T-1-w SE-Sequent images. The sensitivity can be increased by contrast material application and signal intensity measurements; A combined focal and diffuse infiltration and a "salt and pepper" pattern can be diagnosed with the combination of T-1-w SE-Sequent and FSE STIR sequences. Conclusion: With T-1-weighted SE-Sequent sequences pre-and post-contrast and FSE STIR all therapeutical relevant infiltration patterns of plasmocytoma can be identified and bone marrow screening of the spine can be carried out with an acquisition time of 5.58 minutes.