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Updated: Jun 24, 2026
Identifying Bone Marrow Microenvironmental Populations in Myelodysplastic Syndrome and Acute Myeloid Leukemia
Published on: November 10, 2023
Dynamic contrast-enhanced magnetic resonance imaging identifies a subgroup of patients with asymptomatic monoclonal
Jens Hillengass1, Christian Zechmann, Tobias Bäuerle
1German Cancer Research Center, Department of Radiology; University of Heidelberg, Department of Hematology, Oncology and Rheumatology, Heidelberg, Germany. Jens.Hillengass@med.uni-heidelberg.de
Purpose:
The aim of our study was to investigate whether dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) allows visualization of changes in microcirculation between healthy controls on the one side and early/advanced stages of plasma cell disease on the other.
Experimental Design:
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.
Results:
A continuous increase in microcirculation parameters amplitude A and exchange rate constant kep reflecting vascular volume and permeability, respectively, was detected from normal controls over MGUS and aMM to sMM. For A and kep, significant differences were found between controls and aMM (P = 0.03 and P = 0.004, respectively) as well as controls and sMM (P = 0.001 and P < 0.001, respectively). Although diffuse microcirculation patterns were found in healthy controls as well as MGUS and MM, a pattern with focal hotspots was exclusively detected in 42.6% of sMM and in 3 MGUS and 3 aMM patients. MGUS and aMM patients with increased microcirculation patterns showed significantly higher bone marrow plasmocytosis compared with patients with a low microcirculation pattern.
Conclusions:
Our investigations substantiate the concept of an angiogenic switch from early plasma cell disorders to sMM. Pathologic DCE-MRI findings correlate with adverse prognostic factors and DCE-MRI identifies a distinct group of patients with increased microcirculation parameters in aMM and MGUS patients.
Insights
Dynamic contrast-enhanced MRI reveals increasing microcirculation in plasma cell diseases. This imaging technique can identify patients with early or advanced multiple myeloma and monoclonal gammopathy of undetermined significance who may have poorer prognoses.
Area of Science:
- Biomedical Imaging
- Oncology
- Radiology
Background:
- Plasma cell disorders, including monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM), are characterized by the proliferation of malignant plasma cells.
- Understanding the microcirculatory changes associated with disease progression is crucial for diagnosis and prognosis.
Purpose of the Study:
- To evaluate the utility of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in visualizing microcirculatory alterations.
- To differentiate between healthy individuals and patients with early (MGUS, asymptomatic MM) and advanced (symptomatic MM) plasma cell diseases based on microcirculation parameters.
Main Methods:
- A cohort of 222 individuals, including healthy controls and patients with MGUS, asymptomatic MM (aMM), and symptomatic MM (sMM), underwent lumbar spine DCE-MRI.
- Microcirculation parameters, specifically amplitude A (vascular volume) and exchange rate constant kep (permeability), were quantified.
Main Results:
- A continuous increase in microcirculation parameters (A and kep) was observed from healthy controls to MGUS, aMM, and sMM.
- Significant differences in A and kep were found between controls and aMM/sMM (P < 0.05).
- Focal hotspots in microcirculation patterns were exclusively detected in sMM (42.6%) and rarely in MGUS/aMM, correlating with higher bone marrow plasmocytosis.
Conclusions:
- DCE-MRI findings support the concept of an angiogenic switch during plasma cell disease progression.
- Pathologic DCE-MRI findings correlate with adverse prognostic factors.
- DCE-MRI can identify a distinct subgroup of MGUS and aMM patients with increased microcirculation, suggesting potential for early risk stratification.
