Dynamic Contrast-Enhanced Magnetic Resonance Imaging Identifies a Subgroup of Patients with Asymptomatic Monoclonal Plasma Cell Disease and Pathological Microcirculation

The aim of the present study was to investigate whether dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) allows visualization of a change in microcirculation between healthy controls on the one side and early/advanced stages of plasma cell disease on the other. We examined a group of 222 individuals consisting of 60 patients with monoclonal gammopathy of undetermined significance (MGUS), 65 patients with asymptomatic multiple myeloma (aMM), 75 patients with newly diagnosed symptomatic MM (sMM) and 22 healthy controls with DCE-MRI of the lumbar spine. A continuous increase in the microcirculation parameter amplitude A reflecting vascular volume was detected from normal controls over MGUS and asymptomatic to symptomatic MM. Significant differences were found between controls and aMM (p = 0.03), controls and sMM (p = 0.001) and between asymptomatic and symptomatic MM (p = 0.02) respectively. While diffuse microcirculation patterns were found in healthy controls as well as MGUS and MM, a pattern with focal hot spots was exclusively detected in 42.6 % of sMM and in 3 patients with MGUS and 3 patients with aMM. Patients with MGUS and aMM with increased microcirculation patterns showed a significantly higher bone marrow plasmocytosis compared to patients with a low microcirculation pattern. Our investigations substantiate by means of a non invasive assessment of bone marrow microcirculation the concept of an angiogenic switch from early plasma cell disorders to symptomatic MM. Pathological DCE-MRI findings can be identified and correlate with an adverse prognostic parameter.