State of the art imaging of multiple myeloma: Comparative review of FDG PET/CT imaging in various clinical settings

Charles Mesguich, Reza Fardanesh, Lawrence Tanenbaum, Ajai Chari, Sundar Jagannath, Lale Kostakoglu

Research output: Contribution to journalReview articlepeer-review

66 Scopus citations

Abstract

18-Flurodeoxyglucose Positron Emission Tomography with computed tomography (FDG PET/CT) and Magnetic Resonance Imaging (MRI) have higher sensitivity and specificity than whole-body X-ray (WBXR) survey in evaluating disease extent in patients with multiple myeloma (MM). Both modalities are now recommended by the Durie-Salmon Plus classification although the emphasis is more on MRI than PET/CT. The presence of extra-medullary disease (EMD) as evaluated by PET/CT imaging, initial SUVmax and number of focal lesions (FL) are deemed to be strong prognostic parameters at staging. MRI remains the most sensitive technique for the detection of diffuse bone marrow involvement in both the pre and post-therapy setting. Compression fractures are best characterized with MRI signal changes, for determining vertebroplasty candidates. While PET/CT allows for earlier and more specific evaluation of therapeutic efficacy compared to MRI, when signal abnormalities persist years after treatment. PET/CT interpretation, however, can be challenging in the vertebral column and pelvis as well as in cases with post-therapy changes. Hence, a reading approach combining the high sensitivity of MRI and superior specificity of FDG PET/CT would be preferred to increase the diagnostic accuracy. In summary, the established management methods in MM, mainly relying on biological tumor parameters should be complemented with functional imaging data, both at staging and restaging for optimal management of MM.

Original languageEnglish
Pages (from-to)2203-2223
Number of pages21
JournalEuropean Journal of Radiology
Volume83
Issue number12
DOIs
StatePublished - 1 Dec 2014

Keywords

  • MRI
  • Multiple myeloma
  • PET/CT
  • Staging

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