Added Value of Contrast-Enhanced T1-Weighted and Diffusion-Weighted Sequences for Characterization of Incidental Findings on Whole Body Magnetic Resonance Imaging in Plasma-Cell Disorders

Olwen Westerland; Nishanth Sivarasan; Sarah Natas; Hema Verma; Sarah McElroy; Jessica M. Winfield; Radhouene Neji; Inas El-Najjar; Majid Kazmi; Matthew Streetly; Vicky Goh

doi:10.1016/j.clml.2018.08.006

Added Value of Contrast-Enhanced T1-Weighted and Diffusion-Weighted Sequences for Characterization of Incidental Findings on Whole Body Magnetic Resonance Imaging in Plasma-Cell Disorders

Olwen Westerland^*, Nishanth Sivarasan, Sarah Natas, Hema Verma, Sarah McElroy, Jessica M. Winfield, Radhouene Neji, Inas El-Najjar, Majid Kazmi, Matthew Streetly, Vicky Goh

^*Corresponding author for this work

Cancer Imaging

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Abstract

Incidental findings on whole body magnetic resonance imaging (WBMRI) in myeloma may necessitate additional investigations. Incidence, characterization, and significance of incidental findings at WBMRI in 100 patients with plasma-cell disorders were calculated. A total of 348 findings were detected in 97 of 100 patients; 38 of 348 findings were indeterminate, and no additional cancers were detected. Incidental findings are common, but the majority can be characterized at WBMRI and are not significant. Background: Whole body magnetic resonance imaging (WBMRI) is currently recommended by guidelines for the assessment of myeloma. This will inevitably result in incidental findings. We aimed to assess the frequency of extraskeletal incidental findings and the added value of contrast-enhanced (CE) T1-weighted (T1-W) and diffusion-weighted (DWI) sequences for their characterization in a single WBMRI examination. Patients and Methods: We performed 1.5 T WBMRI in 100 patients (53 female; median age, 65 years) with plasma-cell disorders from January 2014 to July 2017. T2-weighted sequences were reviewed initially for incidental findings, followed by sequential review of T1-W, CE T1-W, and DWI sequences for lesion characterization. Descriptive statistics were undertaken. Results: A total of 348 incidental findings were detected in 97 (97%) of 100 patients; only 38 (10.9%) of 348 findings were indeterminate. T1-W sequences increased diagnostic confidence in the characterization of 12 (31.6%) of 38; CE T1-W sequences in the characterization of 16 (50%) of 32; and DWI increased diagnostic confidence in 21 (55.3%) of 38 compared to the T2-weighted sequence alone. Conclusion: Incidental findings are common, but the majority are of no clinical consequence. No additional cancers were noted in our series. DWI and CE T1-W sequences increased diagnostic confidence in 50% of indeterminate findings and may reduce the need for further investigation.

Original language	English
Journal	Clinical Lymphoma, Myeloma and Leukemia
Early online date	13 Aug 2018
DOIs	https://doi.org/10.1016/j.clml.2018.08.006
Publication status	E-pub ahead of print - 13 Aug 2018

Keywords

Diffusion magnetic resonance imaging
Magnetic resonance imaging
Multiple myeloma
Whole body imaging

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Westerland, O., Sivarasan, N., Natas, S., Verma, H., McElroy, S., Winfield, J. M., Neji, R., El-Najjar, I., Kazmi, M., Streetly, M., & Goh, V. (2018). Added Value of Contrast-Enhanced T1-Weighted and Diffusion-Weighted Sequences for Characterization of Incidental Findings on Whole Body Magnetic Resonance Imaging in Plasma-Cell Disorders. Clinical Lymphoma, Myeloma and Leukemia. Advance online publication. https://doi.org/10.1016/j.clml.2018.08.006

@article{b4584baa494c423dbe190168579cf433,

title = "Added Value of Contrast-Enhanced T1-Weighted and Diffusion-Weighted Sequences for Characterization of Incidental Findings on Whole Body Magnetic Resonance Imaging in Plasma-Cell Disorders",

abstract = "Incidental findings on whole body magnetic resonance imaging (WBMRI) in myeloma may necessitate additional investigations. Incidence, characterization, and significance of incidental findings at WBMRI in 100 patients with plasma-cell disorders were calculated. A total of 348 findings were detected in 97 of 100 patients; 38 of 348 findings were indeterminate, and no additional cancers were detected. Incidental findings are common, but the majority can be characterized at WBMRI and are not significant. Background: Whole body magnetic resonance imaging (WBMRI) is currently recommended by guidelines for the assessment of myeloma. This will inevitably result in incidental findings. We aimed to assess the frequency of extraskeletal incidental findings and the added value of contrast-enhanced (CE) T1-weighted (T1-W) and diffusion-weighted (DWI) sequences for their characterization in a single WBMRI examination. Patients and Methods: We performed 1.5 T WBMRI in 100 patients (53 female; median age, 65 years) with plasma-cell disorders from January 2014 to July 2017. T2-weighted sequences were reviewed initially for incidental findings, followed by sequential review of T1-W, CE T1-W, and DWI sequences for lesion characterization. Descriptive statistics were undertaken. Results: A total of 348 incidental findings were detected in 97 (97%) of 100 patients; only 38 (10.9%) of 348 findings were indeterminate. T1-W sequences increased diagnostic confidence in the characterization of 12 (31.6%) of 38; CE T1-W sequences in the characterization of 16 (50%) of 32; and DWI increased diagnostic confidence in 21 (55.3%) of 38 compared to the T2-weighted sequence alone. Conclusion: Incidental findings are common, but the majority are of no clinical consequence. No additional cancers were noted in our series. DWI and CE T1-W sequences increased diagnostic confidence in 50% of indeterminate findings and may reduce the need for further investigation.",

keywords = "Diffusion magnetic resonance imaging, Magnetic resonance imaging, Multiple myeloma, Whole body imaging",

author = "Olwen Westerland and Nishanth Sivarasan and Sarah Natas and Hema Verma and Sarah McElroy and Winfield, {Jessica M.} and Radhouene Neji and Inas El-Najjar and Majid Kazmi and Matthew Streetly and Vicky Goh",

year = "2018",

month = aug,

day = "13",

doi = "10.1016/j.clml.2018.08.006",

language = "English",

journal = "Clinical Lymphoma, Myeloma and Leukemia",

issn = "2152-2650",

publisher = "Cancer Media Group",

}

Westerland, O, Sivarasan, N, Natas, S, Verma, H, McElroy, S, Winfield, JM, Neji, R, El-Najjar, I, Kazmi, M, Streetly, M & Goh, V 2018, 'Added Value of Contrast-Enhanced T1-Weighted and Diffusion-Weighted Sequences for Characterization of Incidental Findings on Whole Body Magnetic Resonance Imaging in Plasma-Cell Disorders', Clinical Lymphoma, Myeloma and Leukemia. https://doi.org/10.1016/j.clml.2018.08.006

Added Value of Contrast-Enhanced T1-Weighted and Diffusion-Weighted Sequences for Characterization of Incidental Findings on Whole Body Magnetic Resonance Imaging in Plasma-Cell Disorders. / Westerland, Olwen; Sivarasan, Nishanth; Natas, Sarah et al.
In: Clinical Lymphoma, Myeloma and Leukemia, 13.08.2018.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Added Value of Contrast-Enhanced T1-Weighted and Diffusion-Weighted Sequences for Characterization of Incidental Findings on Whole Body Magnetic Resonance Imaging in Plasma-Cell Disorders

AU - Westerland, Olwen

AU - Sivarasan, Nishanth

AU - Natas, Sarah

AU - Verma, Hema

AU - McElroy, Sarah

AU - Winfield, Jessica M.

AU - Neji, Radhouene

AU - El-Najjar, Inas

AU - Kazmi, Majid

AU - Streetly, Matthew

AU - Goh, Vicky

PY - 2018/8/13

Y1 - 2018/8/13

N2 - Incidental findings on whole body magnetic resonance imaging (WBMRI) in myeloma may necessitate additional investigations. Incidence, characterization, and significance of incidental findings at WBMRI in 100 patients with plasma-cell disorders were calculated. A total of 348 findings were detected in 97 of 100 patients; 38 of 348 findings were indeterminate, and no additional cancers were detected. Incidental findings are common, but the majority can be characterized at WBMRI and are not significant. Background: Whole body magnetic resonance imaging (WBMRI) is currently recommended by guidelines for the assessment of myeloma. This will inevitably result in incidental findings. We aimed to assess the frequency of extraskeletal incidental findings and the added value of contrast-enhanced (CE) T1-weighted (T1-W) and diffusion-weighted (DWI) sequences for their characterization in a single WBMRI examination. Patients and Methods: We performed 1.5 T WBMRI in 100 patients (53 female; median age, 65 years) with plasma-cell disorders from January 2014 to July 2017. T2-weighted sequences were reviewed initially for incidental findings, followed by sequential review of T1-W, CE T1-W, and DWI sequences for lesion characterization. Descriptive statistics were undertaken. Results: A total of 348 incidental findings were detected in 97 (97%) of 100 patients; only 38 (10.9%) of 348 findings were indeterminate. T1-W sequences increased diagnostic confidence in the characterization of 12 (31.6%) of 38; CE T1-W sequences in the characterization of 16 (50%) of 32; and DWI increased diagnostic confidence in 21 (55.3%) of 38 compared to the T2-weighted sequence alone. Conclusion: Incidental findings are common, but the majority are of no clinical consequence. No additional cancers were noted in our series. DWI and CE T1-W sequences increased diagnostic confidence in 50% of indeterminate findings and may reduce the need for further investigation.

AB - Incidental findings on whole body magnetic resonance imaging (WBMRI) in myeloma may necessitate additional investigations. Incidence, characterization, and significance of incidental findings at WBMRI in 100 patients with plasma-cell disorders were calculated. A total of 348 findings were detected in 97 of 100 patients; 38 of 348 findings were indeterminate, and no additional cancers were detected. Incidental findings are common, but the majority can be characterized at WBMRI and are not significant. Background: Whole body magnetic resonance imaging (WBMRI) is currently recommended by guidelines for the assessment of myeloma. This will inevitably result in incidental findings. We aimed to assess the frequency of extraskeletal incidental findings and the added value of contrast-enhanced (CE) T1-weighted (T1-W) and diffusion-weighted (DWI) sequences for their characterization in a single WBMRI examination. Patients and Methods: We performed 1.5 T WBMRI in 100 patients (53 female; median age, 65 years) with plasma-cell disorders from January 2014 to July 2017. T2-weighted sequences were reviewed initially for incidental findings, followed by sequential review of T1-W, CE T1-W, and DWI sequences for lesion characterization. Descriptive statistics were undertaken. Results: A total of 348 incidental findings were detected in 97 (97%) of 100 patients; only 38 (10.9%) of 348 findings were indeterminate. T1-W sequences increased diagnostic confidence in the characterization of 12 (31.6%) of 38; CE T1-W sequences in the characterization of 16 (50%) of 32; and DWI increased diagnostic confidence in 21 (55.3%) of 38 compared to the T2-weighted sequence alone. Conclusion: Incidental findings are common, but the majority are of no clinical consequence. No additional cancers were noted in our series. DWI and CE T1-W sequences increased diagnostic confidence in 50% of indeterminate findings and may reduce the need for further investigation.

KW - Diffusion magnetic resonance imaging

KW - Magnetic resonance imaging

KW - Multiple myeloma

KW - Whole body imaging

UR - http://www.scopus.com/inward/record.url?scp=85053144294&partnerID=8YFLogxK

U2 - 10.1016/j.clml.2018.08.006

DO - 10.1016/j.clml.2018.08.006

M3 - Article

AN - SCOPUS:85053144294

SN - 2152-2650

JO - Clinical Lymphoma, Myeloma and Leukemia

JF - Clinical Lymphoma, Myeloma and Leukemia

ER -

Added Value of Contrast-Enhanced T1-Weighted and Diffusion-Weighted Sequences for Characterization of Incidental Findings on Whole Body Magnetic Resonance Imaging in Plasma-Cell Disorders

Abstract

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