Stage III multiple myeloma: clinical and prognostic value of spinal bone marrow MR imaging.

PURPOSE: To determine the clinical and prognostic value of spinal bone marrow magnetic resonance (MR) imaging in stage III multiple myeloma. MATERIALS AND METHODS: In 80 patients with untreated, newly diagnosed stage III multiple myeloma, initial MR imaging patterns of spinal bone marrow involvement were correlated with hematologic parameters and response to induction chemotherapy. The influence of these patterns on survival was studied in 57 patients who did not undergo cytotoxic therapy with stem cell transplantation. RESULTS: MR imaging patterns of marrow involvement were normal in 19 (24%) patients, focal in 35 (44%), and diffuse in 26 (32%). Patients with the diffuse pattern had higher marrow plasmacytosis (P < or = .003) and cellularity (P < or = .001), higher serum calcium (P < or = .005) and beta 2-microglobulin (P < or = .008) levels, and lower hemoglobin values (P < or = .001) than did those with the normal or focal patterns. Patients with the normal pattern responded better to therapy (P = .007) and survived longer than patients with an abnormal pattern (P = .026). MR imaging findings and C-reactive protein level were the best independent prognostic indicators of survival. CONCLUSION: MR imaging patterns of spinal bone marrow involvement are correlated with several clinical parameters of disease severity and have prognostic value in stage III multiple myeloma.