Magnetic resonance imaging as a supplement for the clinical staging system of Durie and Salmon?
Andrea Baur, MD1 *, Axel Stäbler, MD1, Dorothea Nagel, PhD2, Rolf Lamerz, MD3, Reiner Bartl, MD4, Erhard Hiller, MD4, Clemens Wendtner, MD4, Fridleif Bachner1, Maximilian Reiser, MD1
1Department of Clinical Radiology, University of Munich-Grosshadern, Munich, Germany
2Department of Clinical Chemistry, University of Munich-Grosshadern, Munich, Germany
3Department of Internal Medicine II, University of Munich-Grosshadern, Munich, Germany
4Department of Internal Medicine III, University of Munich-Grosshadern, Munich, Germany
Cancer Volume 95, Issue 6, 2002. Pages: 1334-1345
Online ISSN: 1097-0142 Print ISSN: 0008-543X
Published Online: 5 Sep 2002 Copyright © 2002 American Cancer Society
This study evaluated the prognostic value of a three-grade staging system of spinal involvement using magnetic resonance imaging (MRI) in patients with multiple myeloma and determined its usefulness as an independent parameter in the staging system of Durie and Salmon.
Seventy-seven previously untreated patients with multiple myeloma underwent MRI of the thoracic and lumbar spine with unenhanced T1-weighted spin echo and short-tau inversion time inversion recovery sequences. The patients were evaluated according to their infiltration patterns and the extent of bone marrow involvement was staged using a three-grade scale: Stage I, no focal or diffuse infiltration; Stage II, 1-10 foci or mild diffuse infiltration; Stage III, more than 10 foci or strong diffuse infiltration.
The infiltration patterns had no significant effect on survival. Of 77 patients, 25 would have been understaged using the standard staging system of Durie and Salmon without the findings of MRI and 8 patients would have been understaged if the staging was based only on MRI. The combination of the staging system of Durie and Salmon and MRI was highly significant with respect to survival (P < 0.0001, log rank analysis). MRI staging I-III was independent of the staging system of Durie and Salmon (Cox regression model).
A three-grade staging of spinal MRI provides a significant prognostic tool for patients with multiple myeloma. The authors propose including it in the staging system of Durie and Salmon. Cancer 2002;95:1334-45. © 2002 American Cancer Society.