Supportive Care
IMF HOTLINE COORDINATORS ANSWER YOUR QUESTIONS
The IMF Hotline 800-452-CURE (2873) consistently provides cal ers with the best information about myeloma
in a caring and compassionate manner. The Hotline is staffed by Paul Hewit , Missy Klepetar, Nancy Baxter,
and Debbie Birns. The phone lines are open Monday through Friday, 9am to 4pm (Pacific Time).
To submit your question online, please email TheIMF@myeloma.org.
Is the use of gadolinium in MRI a
"Gadolinium-containing contrast
necessary part of the imaging test
agent promotes multiple myeloma
and is it safe?
cell growth: implication for clini-
MRI (magnetic resonance imag-
cal use of MRI in myeloma" (ASH
ing) is a diagnostic test that uses
abstract 1809). Dr. Fulciniti's collabo-
magnetic energ y to produce
rators included others at Dana-Farber
detailed two- or three-dimension-
Cancer Institute and researchers at the
al images of organs and structures
Myeloma Institute at the University of
inside the body. It can provide
Arkansas (Little Rock, AR).
20-30% more information than a
The investigators involved in this study
standard x-ray (a form of electro-
of gadolinium, both in the laboratory
magnetic radiation). An MRI test is
Paul Hewitt, Missy Klepetar, Nancy Baxter, and Debbie Birns
setting and in the tissues of myeloma
useful in assessing the disease state
patients, drew the following conclu-
of a patient with multiple myeloma. It can detect the amount of myeloma
sion: "These results, confirming both in vitro and in vivo growth-promot-
cell infiltration in the bone marrow before bone destruction is evident
ing effects of Gd-containing contrast agent on multiple myeloma, suggest
on x-rays. An MRI is excellent for imaging of the axial skeleton (the
the need for further analysis of the mechanism of its action on myeloma
bones of the head and neck, rib cage, and vertebral column) and can
cells and careful analysis of its clinical impact in multiple myeloma
help distinguish between benign and malignant compression fractures.
patients undergoing MRI evaluation." To watch the video of Dr. Fulciniti's
It can illustrate spinal cord compression as well as head and neck plas-
IMF interview at ASH, read the abstract, and see the poster for this presen-
macytomas. In myeloma, MRI is considered to be more sensitive than
tation, please visit the IMF website at www.myeloma.org.
standard radiography.1
The question thus becomes: is it possible to get sufficient infor-
Gadolinium is a contrast agent a dye injected into the body
mation from MRI imaging without using gadolinium? The answer
to enhance images from the MRI. Gadolinium is a colorless, non-
appears to be yes. Large groups specializing in multiple myeloma, such
radioactive, water-like liquid. It is toxic but usually rapidly cleared by the
as the Myeloma Institute in Little Rock and others, specifically exclude
kidneys. Gadolinium is taken up by active myeloma lesions. This contrast
gadolinium from their standard MRI sequence protocols. The new
enhancement can help identify areas of myeloma involvement. However,
International Myeloma Working Group (IMWG) imaging guidelines2
there has been some debate regarding the wisdom of using gadolinium
likewise recommend imaging without gadolinium in part to avoid
in myeloma patients because of potential risks. Many myeloma patients
the risks, but also because excellent results can be obtained without
have kidneys that are compromised by their disease and their creatinine
gadolinium.
clearance is lower than in individuals with healthy kidneys. Patients with
renal dysfunction who get an MRI using gadolinium dye are at risk to
In conclusion, it is possible for an imaging specialist to perform an
develop Nephrogenic Systemic Fibrosis (NSF). NSF is a systemic disease,
MRI without the use of gadolinium and still get an accurate assess-
meaning it affects multiple systems of the body or the body as a whole.
ment of disease. This avoids any potential risks. Please discuss all
Symptoms of NFS include hard, shiny, reddened or darkened patches of
of the above with your oncologist and/or radiation oncologist prior
skin that tighten and become extremely painful; joint inflexibility; painful
to having an MRI.
joints; loss of movement; yellow-colored eyes; as well as potential lung,
Editor's Note: If you would like to obtain copies of the referenced papers,
heart, and other organ damage. This is therefore rather a serious potential
please contact IMF Hotline Coordinators at 800-452-CURE (2873).
side effect.
1 Engelhardt M, Kleber M, Frydrychowicz A, et al. "Superiority of magnetic
resonance imaging over conventional radiographs in multiple myeloma."
It is thus best to avoid use of gadolinium in the setting of known
Anticancer Research, 29:4745-4750, 2009.
renal compromise. In addition, it is worthwhile to note that at the
2 Dimopoulos M, Terpos E, Comenzo RL, et al. "International myeloma
December 2009 American Society of Hematology (ASH) meeting in
working group (IMWG) consensus statement and guidelines regarding
the current role of imaging techniques in the diagnosis and monitoring of
New Orleans, data was presented by Mariateresa Fulciniti, PhD (Dana-
multiple myeloma." Leukemia; 23:1545-1559, 2009.
Farber Cancer Institute, Harvard Medical School, Boston, MA), entitled
800-452-CURE(2873)
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