Positron emission tomography/computed tomography (PET/CT) in multiple myeloma

Abstract

Imaging plays apivotal role in the management of multiple myeloma (MM). Besides morphological imaging methods, such as whole-body X‑ray, computed tomography (CT) and magnetic resonance imaging (MRI), the hybrid modality positron emission tomography/CT (PET/CT) using the glucose analogue 18F‑fluorodeoxyglucose (18F‑FDG) as radiotracer is increasingly used. Aim of this review article is to outline the major applications of PET/CT in the diagnosis and management of MM, and to provide hints on the reading and interpretation. Background knowledge and guideline recommendations on imaging of MM are outlined and complemented by recent study results. Although 18F‑FDG PET/CT is not currently considered astandard method for the diagnosis of MM, it is avery powerful diagnostic tool for the detection of medullary and extramedullary disease, areliable predictor of survival and the most robust modality for treatment response evaluation. Moreover, it plays a significant role in minimal residual disease (MRD) assessment. On the other hand, practical considerations on local availability and costs limit the widespread use of PET/CT. In addition, false-negative and the seldom false-positive results and the heterogeneity of MM presentation inevitably make interpretation of PET/CT images challenging. PET/CT has ahigh value in the diagnosis, prognosis, and assessment of treatment response in patients with MM. Therefore, the role of the modality in the management of the disease is expected to increase in the near future.