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@ARTICLE{Wennmann:163053,
      author       = {M. Wennmann$^*$ and T. Hielscher$^*$ and L. Kintzelé and
                      B. H. Menze and G. Langs and M. Merz and S. Sauer and H.-U.
                      Kauczor and H.-P. Schlemmer$^*$ and S. Delorme$^*$ and H.
                      Goldschmidt and N. Weinhold and J. Hillengass and M.-A.
                      Weber},
      title        = {{S}patial {D}istribution of {F}ocal {L}esions in
                      {W}hole-{B}ody {MRI} and {I}nfluence of {MRI} {P}rotocol on
                      {S}taging in {P}atients with {S}moldering {M}ultiple
                      {M}yeloma {A}ccording to the {N}ew
                      {SL}i{M}-{CRAB}-{C}riteria.},
      journal      = {Cancers},
      volume       = {12},
      number       = {9},
      issn         = {2072-6694},
      address      = {Basel},
      publisher    = {MDPI},
      reportid     = {DKFZ-2020-01839},
      pages        = {2537},
      year         = {2020},
      note         = {#EA:E010#},
      abstract     = {The purpose of this study was to assess how different MRI
                      protocols (spinal vs. spinal plus pelvic vs. whole-body
                      (wb)-MRI) affect staging in patients with smoldering
                      multiple myeloma (SMM), according to the SLiM-CRAB-criterion
                      '>1 focal lesion (FL) in MRI'. In this retrospective study,
                      a baseline cohort of 147 SMM patients with wb-MRI at initial
                      diagnosis was investigated, including prognostic data
                      regarding development of CRAB-criteria. Fifty-two patients
                      formed a follow-up cohort with a median of three wb-MRIs.
                      The locations of all FLs were determined and it was
                      calculated how staging decisions regarding the criterion '>1
                      FL in MRI' would have been made if only a limited anatomic
                      area (spine vs. spine plus pelvis) would have been covered
                      by the MRI protocol. Furthermore, subgroups of patients
                      selected by different cutoff-protocol-combinations were
                      compared regarding their prognosis for development of
                      CRAB-criteria. With an MRI protocol limited to spine/spine
                      plus pelvis, only $28\%/64\%$ of patients who actually had
                      >1 FL in wb-MRI would have been rated correctly as having
                      '>1 FL in MRI'. Fifty-four $percent/36\%$ of patients with
                      exactly 1 FL in spine/spine plus pelvis revealed >1 FL when
                      the entire wb-MRI was analyzed. During follow-up, four more
                      patients developed >1 FL in wb-MRI; both limited MRI
                      protocols would have detected only one of these four
                      patients as having >1 FL at the correct timepoint. Having >1
                      FL in spine/in spine plus pelvis/in the whole body was
                      associated with a $43\%/57\%/49\%$ probability of developing
                      CRAB-criteria within 2 years. Patients with >3 FL in spine
                      plus pelvis and patients with >4 FL in the whole body had an
                      $80\%$ probability to develop CRAB-criteria within 2 years.
                      MRI protocols limited to the spine or to spine plus pelvis
                      lead to substantial underdiagnoses of patients who actually
                      have >1 FL in wb-MRI at baseline and during follow-up, which
                      influences staging and treatment decisions according to the
                      current SLiM-CRAB criteria. However, given the spatial
                      distribution of FLs and the analysis on clinical course of
                      patients indicates that the cutoff for the number of FLs
                      should be adopted according to the MRI protocol when using
                      MRI for staging in SMM.},
      cin          = {E010 / C060},
      ddc          = {610},
      cid          = {I:(DE-He78)E010-20160331 / I:(DE-He78)C060-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:32906608},
      doi          = {10.3390/cancers12092537},
      url          = {https://inrepo02.dkfz.de/record/163053},
}