Prognostic value of vertebral lesions detected by magnetic resonance imaging in patients with stage I multiple myeloma

We assessed the role of spinal magnetic resonance imaging (MRI) and bone de nsitometry as prognostic factors in patients with asymptomatic stage I mult iple myeloma (MM) and negative skeletal survey 55 consecutive patients unde rwent spinal MRI and 41 of them underwent bone densitometry by dual-energy X-ray absorptiometry (DEXA). Spinal MRT studies showed evidence of bone marrow involvement in 17/55 pati ents (31%). A diffuse pattern was present in three patients and a focal pat tern in 14 patients, nine of them with only one nodular lesion. During a me dian follow-up of 25 months, 10 patients had disease progression 8/17 patie nts with abnormal MRI and 2/38 patients with normal MRI. Median time to dis ease progression was not reached in both groups but was significantly diffe rent for patients with normal and those with abnormal patterns on MRI (P < 0.0001). Lumbar BMD was only slightly decreased compared with normal people (median lumbar Z score -0.43) and was not of prognostic value. Using a mul ti-variate analysis the only two independent significant prognostic paramet ers were abnormal MRI (P < 0.001, HR 30.4, 95% CI 4.3-213) and bone marrow plasmacytosis > 20% (P = 0.004, HR 16.4, 95% CI 2.6-104). Thus, spinal MRI but not bone densitometry, appeared to be justified in pat ients with stage I asymptomatic MM and negative skeletal survey.