Diffusion-Weighted MRI: The Way Forward for MRI in Myeloma?

Multiple myeloma and other plasma cell disorders infiltrate the bone marrow in different patterns. While some patients show a homogeneous distribution of the clonal plasma cells others present with focal accumulations, commonly called focal lesions. Novel imaging techniques can provide information on these infiltration patterns and, due to their low invasiveness, can be performed repeatedly and therefore be used for monitoring. Conventional magnetic resonance imaging (MRI) has a high sensitivity for bone marrow assessment but cannot safely differentiate between active and inactive lesions. Therefore, positron emission tomography, especially combined with computed tomography (PET/CT), has been more widely used, at least for the monitoring of treatment response. Comparative, but mostly retrospective studies, have shown that functional MRI techniques, namely diffusion-weighted imaging (DWI), which assesses the movement of water molecules, can evaluate tissue cellularity with high sensitivity, which challenges the dominance of PET/CT in treatment response assessment. This review will discuss the benefits and challenges of DWI and compare it to other available imaging techniques used in patients with monoclonal plasma cell disorder

Ascitic Fluid to Serum Bilirubin Ratio for Differentiation of Exudates From Transudates

Background:Regarding the diagnostic errors of the classic criteria including serum ascites albumin gradient (SAAG),total protein concentration and the adapted Light et al’s criteria in distinguishing transudate versus exudates, we evaluated the ascitic fluid to serum bilirubin ratio as a new criteria in this regard. We also evaluated whether the combination of bilirubin ratio with each of these classic criteria improves the diagnostic accuracy.   Methods: One-hundred ascitic fluid specimens were analysed prospectively whereas the   category of fluid was assessed according to the clinical diagnosis. Sensitivity, specificity,   positive predictive value (PPV), negative predictive value (NPV), overall accuracy, positive likelihood ratio (LR+), negative likelihood ratio (LR-) and the Youden’s index of each criterion alone and in combination with the bilirubin ratio were calculated.Results: SAAG seems to be the best criterion (specificity = 0.9090, PPV = 0.97, LR+ = 8.03, Youden’s index = 0.64). Bilirubin and LDH ratio criteria had equivalent specificity (0.8333 and 0.8205, respectively), accuracy (0.80 and 0.81, respectively), PPV (0.54 and 0.55, respectively),NPV (0.90 and 0.93, respectively) and LR+ (4.09 and 4.30, respectively)which generally were better than fluid total protein and total protein ratio but not as predictive   as SAAG. The addition of bilirubin ratio to any criterion did not make any improvement.Conclusion: Ascitic fluid to serum bilirubin ratio, although not more predictive than   SAAG, can be used as an alternative criterion in distinguishing exudative versus transudative ascitic fluid as it is more cost-effective in terms of laboratory processing and also more available.

Diffusion-Weighted MRI—The Way Forward for MRI in Myeloma?

Multiple myeloma and other plasma cell disorders infiltrate the bone marrow in different patterns. While some patients show a homogeneous distribution of the clonal plasma cells others present with focal accumulations, commonly called focal lesions. Novel imaging techniques can provide information on these infiltration patterns and, due to their low invasiveness, can be performed repeatedly and therefore be used for monitoring. Conventional magnetic resonance imaging (MRI) has a high sensitivity for bone marrow assessment but cannot safely differentiate between active and inactive lesions. Therefore, positron emission tomography, especially combined with computed tomography (PET/CT), has been more widely used, at least for the monitoring of treatment response. Comparative, but mostly retrospective studies, have shown that functional MRI techniques, namely diffusion-weighted imaging (DWI), which assesses the movement of water molecules, can evaluate tissue cellularity with high sensitivity, which challenges the dominance of PET/CT in treatment response assessment. This review will discuss the benefits and challenges of DWI and compare it to other available imaging techniques used in patients with monoclonal plasma cell disorders

Diffusion-Weighted MRI: The Way Forward for MRI in Myeloma?

Multiple myeloma and other plasma cell disorders infiltrate the bone marrow in different patterns. While some patients show a homogeneous distribution of the clonal plasma cells others present with focal accumulations, commonly called focal lesions. Novel imaging techniques can provide information on these infiltration patterns and, due to their low invasiveness, can be performed repeatedly and therefore be used for monitoring. Conventional magnetic resonance imaging (MRI) has a high sensitivity for bone marrow assessment but cannot safely differentiate between active and inactive lesions. Therefore, positron emission tomography, especially combined with computed tomography (PET/CT), has been more widely used, at least for the monitoring of treatment response. Comparative, but mostly retrospective studies, have shown that functional MRI techniques, namely diffusion-weighted imaging (DWI), which assesses the movement of water molecules, can evaluate tissue cellularity with high sensitivity, which challenges the dominance of PET/CT in treatment response assessment. This review will discuss the benefits and challenges of DWI and compare it to other available imaging techniques used in patients with monoclonal plasma cell disorder

Diffusion-Weighted MRI: The Way Forward for MRI in Myeloma?

Multiple myeloma and other plasma cell disorders infiltrate the bone marrow in different patterns. While some patients show a homogeneous distribution of the clonal plasma cells others present with focal accumulations, commonly called focal lesions. Novel imaging techniques can provide information on these infiltration patterns and, due to their low invasiveness, can be performed repeatedly and therefore be used for monitoring. Conventional magnetic resonance imaging (MRI) has a high sensitivity for bone marrow assessment but cannot safely differentiate between active and inactive lesions. Therefore, positron emission tomography, especially combined with computed tomography (PET/CT), has been more widely used, at least for the monitoring of treatment response. Comparative, but mostly retrospective studies, have shown that functional MRI techniques, namely diffusion-weighted imaging (DWI), which assesses the movement of water molecules, can evaluate tissue cellularity with high sensitivity, which challenges the dominance of PET/CT in treatment response assessment. This review will discuss the benefits and challenges of DWI and compare it to other available imaging techniques used in patients with monoclonal plasma cell disorder

Advanced Imaging in Multiple Myeloma: New Frontiers for MRI

Plasma cell dyscrasias are estimated to newly affect almost 40,000 people in 2022. They fall on a spectrum of diseases ranging from relatively benign to malignant, the malignant end of the spectrum being multiple myeloma (MM). The International Myeloma Working Group (IMWG) has traditionally outlined the diagnostic criteria and therapeutic management of MM. In the last two decades, novel imaging techniques have been employed for MM to provide more information that can guide not only diagnosis and staging, but also treatment efficacy. These imaging techniques, due to their low invasiveness and high reliability, have gained significant clinical attention and have already changed the clinical practice. The development of functional MRI sequences such as diffusion weighted imaging (DWI) or intravoxel incoherent motion (IVIM) has made the functional assessment of lesions feasible. Moreover, the growing availability of positron emission tomography (PET)–magnetic resonance imaging (MRI) scanners is leading to the potential combination of sensitive anatomical and functional information in a single step. This paper provides an organized framework for evaluating the benefits and challenges of novel and more functional imaging techniques used for the management of patients with plasma cell dyscrasias, notably MM

What Is the Most Appropriate Test in Detecting Prostate Cancer in Patients With Intermediate Prostate Specific Antigen Levels?

Background: Regarding the variety of tests present for detecting and also screening   prostate cancer and also bearing in mind the advantages and disadvantages of   these tests we decided to re-evaluate these tests (total prostate specific antigen and all   of its modifications) in detecting prostate cancer in men with intermediate serum   PSAlevels. Methods: Following a cross sectional study, 100 consecutive men with intermediate   serum PSA levels and normal digital rectal examination (DRE) were incorporated. Total and free PSA levels and TRUS-guided systematic prostate biopsy were   performed. PSA density, percent free PSA and percent free PSA density were calculated and compared. Statistical analysis was carried out using STATA8 SE. Results: Overall, 27 patients had prostate cancer and 73 had benign prostate pathology. PSA density had the greatest area under the curve (AUC) which was significantly higher than percent free PSA density (0.685 vs. 0.448, p<0.001). The AUC of percent free PSA density was not different between benign and malignant biopsy results nor was significantly higher than the AUC of percent free PSA (0.308) or any other screening tests. Conclusion: PSAdensity was the most accurate screening test for prostate cancer in patients with PSA levels of 4-10 ng/ml and normal DRE. The percent free PSA density was not significantly more accurate than percent free PSA and regarding the costs of transrectal ultrasonography, it can be concluded that the percent free PSA is more cost-effective and hence more appropriate than percent free PSA density to screen prostate cancer

Advantages of time-resolved contrast-enhanced 4D MR angiography in splenic arterial steal syndrome.

Splenic artery steal syndrome (SASS) is a severe complication affecting up to 10% of orthotopic liver transplant (OLT) patients. In this case report, we present a 35-year-old male with OLT secondary to liver failure due to hemochromatosis, who developed SASS. We describe potential application of different imaging techniques for diagnosis of SASS with focus on the value of time-resolved contrast enhanced 4D magnetic resonance angiography (MRA)

Emerging Targets for the Treatment of Osteoarthritis: New Investigational Methods to Identify Neo-Vessels as Possible Targets for Embolization

Osteoarthritis (OA) is the major cause of disability, affecting over 30 million US adults. Continued research into the role of neovascularization and inflammation related to osteoarthritis in large-animal models and human clinical trials is paramount. Recent literature on the pathogenetic model of OA has refocused on low-level inflammation, resulting in joint remodeling. As a result, this has redirected osteoarthritis research toward limiting or treating joint changes associated with persistent synovitis. The overall goal of this review is to better understand the cellular and tissue-specific mechanisms of inflammation in relation to a novel OA treatment modality, Genicular Artery Embolization (GAE). This article also assesses the utility and mechanism of periarticular neovascular embolization for the treatment of OA with a particular emphasis on the balance between pro-angiogenic and anti-angiogenic cytokines, inflammatory biomarkers, and imaging changes