Abstract
Bone imaging has been intimately associated with the diagnosis and staging of multiple myeloma (MM) for more than 5 decades, as the presence of bone lesions indicates advanced disease and dictates treatment initiation. The methods used have been evolving, and the historical radiographic skeletal survey has been replaced by whole body CT, whole body MRI (WB-MRI) and [18F]FDG-PET/CT for the detection of bone marrow lesions and less frequent extramedullary plasmacytomas.Beyond diagnosis, imaging methods are expected to provide the clinician with evaluation of the response to treatment. Imaging techniques are consistently challenged as treatments become more and more efficient, inducing profound response, with more subtle residual disease. WB-MRI and FDG-PET/CT are the methods of choice to address these challenges, being able to assess disease progression or response and to detect “minimal” residual disease, providing key prognostic information and guiding necessary change of treatment.This paper provides an up-to-date overview of the WB-MRI and PET/CT techniques, their observations in responsive and progressive disease and their role and limitations in capturing minimal residual disease. It reviews trials assessing these techniques for response evaluation, points out the limited comparisons between both methods and highlights their complementarity with most recent molecular methods (next-generation flow cytometry, next-generation sequencing) to detect minimal residual disease. It underlines the important role of PET/MRI technology as a research tool to compare the effectiveness and complementarity of both methods to address the key clinical questions.
Highlights
Multiple myeloma (MM) is the second most common adult haematologic malignancy, accounting for 10% of all haematological cancers, with an incidence of about 4/100.000/ year and a median age at diagnosis of 70 years [1]
Prolonged survival with modern treatments of the disease leads to a higher proportion of patients with evolution to extramedullary or non-secretory MM cell clones which cannot be followed with haematological markers and need dedicated imaging solutions [7]
Postconsolidation concordance between minimal residual disease (MRD) and PET-Computed tomography (CT) was observed in 109/176 (62%) patients with 102 patients being double negative and 7 double positive. These results demonstrate the complementarity between PET and MRD bone marrow techniques and suggest that concordant negativity should be evaluated as a surrogate for outcome prediction
Summary
Multiple myeloma (MM) is the second most common adult haematologic malignancy, accounting for 10% of all haematological cancers, with an incidence of about 4/100.000/ year and a median age at diagnosis of 70 years [1]. Bone marrow infiltration by MM may present a focal, a diffuse and a “salt and pepper” patterns, the bone marrow may keep a normal appearance [50, 72] These patterns and lesion number and size should be carefully evaluated on anatomic fat and fluid sensitive sequences and on morphologic high b value DWI images, and compared between pre- and post-treatment examinations. The Myeloma Response Assessment and Diagnosis System (MY-RADS) provides guidelines regarding the choice, acquisition and interpretation of WB-MRI [71] It proposes a structured reporting for each individual WB-MRI examination, which should describe the indication (MM, ND or follow-up), the acquisition protocol, the marrow infiltration pattern (normal, focal, focal and diffuse, diffuse, variegated), the location and size of five “dominant” focal bone lesions and of paramedullary or extramedullary sites. Fracture on CT Para-medullary lesions Extra-medullary lesions “A” if hypermetabolism in ribs and limbs Skull Spine Extraspinal
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
