Role of dynamic contrast-enhanced sonography for characterization and monitoring of extramedullary myeloma: comparison with serologic data

TY - JOUR

T1 - Role of dynamic contrast-enhanced sonography for characterization and monitoring of extramedullary myeloma: comparison with serologic data

AU - Pintoffl, Jan P

AU - Weisel, Katja

AU - Schulze, Maximilian

AU - Maksimovic, Olga

AU - Claussen, Claus D

AU - Kramer, Ulrich

AU - Horger, Marius

PY - 2013/10

Y1 - 2013/10

N2 - OBJECTIVE: To measure blood perfusion in extramedullary myeloma by contrast-enhanced sonography, correlate it with specific hematologic parameters, and determine their utility for local and systemic response monitoring.METHODS: Twenty-five consecutive patients (14 male and 11 female; median age, 68 years) with extramedullary myeloma were included. After intravenous administration of 2.4 mL of sulfur hexafluoride, extramedullary myeloma masses were examined for 60 seconds. All patients underwent contrast-enhanced sonography at baseline, and 15 were monitored additionally (3 weeks during therapy). Average peak perfusion, regional blood flow (RBF), and regional blood volume (RBV) were calculated. Baseline perfusion parameters were compared with short-term follow-up sonographic data and serologic biomarkers (M gradient). For validation of extramedullary myeloma and systemic myeloma, patients underwent midterm (<3 months) imaging and serologic diagnosis.RESULTS: Patients with baseline β2-microglobulin (B2M) greater than 3.5 mg/L (n = 17) showed higher perfusion parameters compared with baseline B2M less than 3.5 mg/L (n = 8). At short-term follow-up, patients were classified by serologic criteria as responders (n = 9) and nonresponders (n = 6) and by sonographic criteria as responders (n = 10) and nonresponders (n = 5). In sonographic responders, mean peak, RBV, and RBF dropped from 59.13, 1446.09, and 71.52 (artificial units) at baseline to 29.30, 364.19, and 34.64 at follow-up (P < .05), whereas in nonresponders, perfusion parameters increased from 33.18, 789.82, and 36.92 at baseline to 51.14, 1491.06, and 65.34 at follow-up (P > .05). Prediction of a midterm course of systemic myeloma using serologic data yielded sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.66, 0.77, 0.66, and 0.77, whereas sonographic results (judged by RBV) yielded values of 0.66, 0.55, 0.5, and 0.71. Separate prediction of a local (extramedullary myeloma) response by sonography yielded sensitivity, specificity, PPV, and NPV of 0.8, 1.0, 1.0, and 0.71.CONCLUSIONS: Contrast-enhanced sonography is a valuable tool for short-term monitoring of the treatment response in extramedullary myeloma.

AB - OBJECTIVE: To measure blood perfusion in extramedullary myeloma by contrast-enhanced sonography, correlate it with specific hematologic parameters, and determine their utility for local and systemic response monitoring.METHODS: Twenty-five consecutive patients (14 male and 11 female; median age, 68 years) with extramedullary myeloma were included. After intravenous administration of 2.4 mL of sulfur hexafluoride, extramedullary myeloma masses were examined for 60 seconds. All patients underwent contrast-enhanced sonography at baseline, and 15 were monitored additionally (3 weeks during therapy). Average peak perfusion, regional blood flow (RBF), and regional blood volume (RBV) were calculated. Baseline perfusion parameters were compared with short-term follow-up sonographic data and serologic biomarkers (M gradient). For validation of extramedullary myeloma and systemic myeloma, patients underwent midterm (<3 months) imaging and serologic diagnosis.RESULTS: Patients with baseline β2-microglobulin (B2M) greater than 3.5 mg/L (n = 17) showed higher perfusion parameters compared with baseline B2M less than 3.5 mg/L (n = 8). At short-term follow-up, patients were classified by serologic criteria as responders (n = 9) and nonresponders (n = 6) and by sonographic criteria as responders (n = 10) and nonresponders (n = 5). In sonographic responders, mean peak, RBV, and RBF dropped from 59.13, 1446.09, and 71.52 (artificial units) at baseline to 29.30, 364.19, and 34.64 at follow-up (P < .05), whereas in nonresponders, perfusion parameters increased from 33.18, 789.82, and 36.92 at baseline to 51.14, 1491.06, and 65.34 at follow-up (P > .05). Prediction of a midterm course of systemic myeloma using serologic data yielded sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.66, 0.77, 0.66, and 0.77, whereas sonographic results (judged by RBV) yielded values of 0.66, 0.55, 0.5, and 0.71. Separate prediction of a local (extramedullary myeloma) response by sonography yielded sensitivity, specificity, PPV, and NPV of 0.8, 1.0, 1.0, and 0.71.CONCLUSIONS: Contrast-enhanced sonography is a valuable tool for short-term monitoring of the treatment response in extramedullary myeloma.

KW - Aged

KW - Antineoplastic Agents

KW - Biomarkers, Tumor

KW - Contrast Media

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Multiple Myeloma

KW - Phospholipids

KW - Reproducibility of Results

KW - Sensitivity and Specificity

KW - Sulfur Hexafluoride

KW - Treatment Outcome

KW - Ultrasonography

KW - Comparative Study

KW - Controlled Clinical Trial

KW - Journal Article

U2 - 10.7863/ultra.32.10.1777

DO - 10.7863/ultra.32.10.1777

M3 - SCORING: Journal article

C2 - 24065259

VL - 32

SP - 1777

EP - 1788

JO - J ULTRAS MED

JF - J ULTRAS MED

SN - 0278-4297

IS - 10

ER -