Abstract
The identification of bone lesions and extramedullary disease is crucial in the diagnosis of myeloma. Whole-body X-ray (WBXR) is considered the gold standard for the detection of myeloma bone lesions. Nevertheless, the International Myeloma Working Group recently updated the disease definition and emphasised the value of magnetic resonance imaging (MRI), computed tomography (CT) alone or combined with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). The presence of more than one focal lesion with MRI or the presence of one or more lytic bone lesion with CT (including low dose CT alone or combined with FDG PET) is considered as myeloma defining events (if 5 mm or more in size). Due to its higher sensitivity to detect bone lesions (in comparison with WBXR), MRI of spine and pelvis is mandatory for patients with solitary plasmacytoma as additional bone lesions can be detected in approximately one-third of cases. MRI is also recommended in patients with smouldering myeloma and may be considered for the staging of multiple myeloma (MM). Moreover, accurate imaging of MM and related plasma cell disorders using MRI and/or FDG PET/CT may provide information on tumour burden, aggressiveness and tumour heterogeneity. Nonetheless, inclusion of MRI and FDG PET/CT for MM patient stratification and therapeutic decisions remains to define.
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