Abstract
Bone lesion is a myeloma-defining event which is reported in 80% of multiple myeloma patients. Imaging of bone is essential in the evaluation of pattern and extent of bone involvement. Recently, whole body X ray (WBXR) has been replaced by more accurate imaging such as whole bode MRI and FDG-PET/CT scan. This review article provides the advantages and role of PET/CT scan in the diagnosis and management of multiple myeloma patients. Generally, PET/CT in diagnosis of bone involvement of newly diagnosed myeloma patients is more sensitive than WBXR. The prognostic value of PET/CT in newly diagnosed patients has been described as well. Different studies have demonstrated that several PET parameters such as the number of focal lesions (FL), SUVmax and extramedullary disease(EMD) may affect the outcome of multiple myeloma patients. Interstingely, the main role of PET/CT in myeloma patients is treatment response monitoring and to some extent assessment of MRD. PET/CT appears to be superior than MRI in evaluation of response due to its ability in differentiating active lesion from negative one.
Highlights
Infiltration and expansion of malignant monoclonal plasma cells, basically in the bone marrow causes multiple myeloma (MM) [1]
This study revealed that focal lesions (FL)≥3, SUV>4.2, and extramedullary disease (EMD) in positron emission tomography (PET)/computed tomography (CT) associated with shorter PFS and OS [31]
Caldarrela et al have confirmed the usefulness of FDG PET/CT in assessing the response to treatment in a systematic review of 10 studies involving 690 patients with multiple myeloma and solitary plasmacytoma
Summary
Infiltration and expansion of malignant monoclonal plasma cells, basically in the bone marrow causes multiple myeloma (MM) [1]. Imaging could be an essential part of the approach to multiple myeloma for detection of lytic bone lesions and identification of extramedullary disease to demonstrate the need for early treatment [12]. More sensitive imaging modalities such as CT, MRI, and PET can be used as an alternative to detect lytic bone lesions at the earlier stage of disease efficiently [15].
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