Abstract
ObjectivesWhole-body MRI (WB-MRI) is recommended by the International Myeloma Working Group for all patients with asymptomatic myeloma and solitary plasmacytoma and by the UK NICE guidance for all patients with suspected myeloma. Some centres unable to offer WB-MRI offer low-dose whole-body CT (WB-CT). There are no studies comparing interobserver agreement and disease detection of contemporary WB-MRI (anatomical imaging and DWI) versus WB-CT. Our primary aim is to compare the interobserver agreement between WB-CT and WB-MRI in the diagnosis of myeloma.MethodsConsecutive patients with newly diagnosed myeloma imaged with WB-MRI and WB-CT were prospectively reviewed. For each body region and modality, two experienced and two junior radiologists scored disease burden with final scores by consensus. Intraclass correlation coefficients (ICC), median scores, Wilcoxon signed-rank test and Spearman’s correlation coefficients were calculated.ResultsThere was no significant difference in overall observer scores between WB-MRI and WB-CT (p = 0.87). For experienced observers, interobserver agreement for WB-MRI was superior to WB-CT overall and for each region, without overlap in whole-skeleton confidence intervals (ICC 0.98 versus 0.77, 95%CI 0.96–0.99 versus 0.45–0.91). For inexperienced observers, although there is a trend for a better interobserver score for the whole skeleton on WB-MRI (ICC 0.95, 95%CI 0.72–0.98) than on WB-CT (ICC 0.72, 95%CI 0.34–0.88), the confidence intervals overlap.ConclusionsWB-MRI offers excellent interobserver agreement which is superior to WB-CT for experienced observers. Although the overall burden was similar across both modalities, patients with lower disease burdens where MRI could be advantageous are not included in this series.Key Points• Whole-body MRI is recommended by the International Myeloma Working Group for patients with multiple myeloma and solitary plasmacytoma and by the NICE guidance for those with suspected multiple myeloma.• Some centres unable to offer whole-body MRI (WB-MRI) offer low-dose whole-body CT (WB-CT).• This prospective study demonstrates that contemporary WB-MRI (with anatomical sequences and DWI) provides better interobserver agreement in assessing myeloma disease burden for the whole skeleton and across any individual body region in myeloma patients when compared with low-dose whole-body CT.
Highlights
Materials and methodsRadiographic skeletal survey (SS), which has been in widespread use for decades, only offers a very crude assessment of bone involvement in multiple myeloma
Some centres unable to offer whole-body MRI (WB-MRI) offer low-dose whole-body CT (WB-CT). This prospective study demonstrates that contemporary WB-MRI provides better interobserver agreement in assessing myeloma disease burden for the whole skeleton and across any individual body region in myeloma patients when compared with low-dose whole-body CT
A total of 22 patients with treatment-naïve symptomatic myeloma were included. (Please see supplemental information for clinical details of the patient population.) A total of 154 body regions were scored for the presence of disease on CT and MRI
Summary
Materials and methodsRadiographic skeletal survey (SS), which has been in widespread use for decades, only offers a very crude assessment of bone involvement in multiple myeloma. Some centres have replaced skeletal survey with low-dose wholebody CT (WB-CT), which has been shown to have greater sensitivity [1,2,3]. Because both skeletal survey and CT predominantly detect the destructive and/or reactive effects of myeloma disease on trabecular and cortical bone rather than disease within the bone marrow space, the sensitivity is inherently limited [4, 5]. The excellent soft tissue contrast of whole-body MRI (WB-MRI) allows direct imaging of the bone marrow, resulting in higher sensitivity and earlier detection.
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