Role of radiography, MRI and FDG-PET/CT in diagnosing, staging and therapeutical evaluation of patients with multiple myeloma

• Published in: Annals of hematology Vol. 88; no. 12; pp. 1161 - 1168
• Main Authors: Lütje, Susanne, de Rooy, Jacky W. J, Croockewit, Sandra, Koedam, Emmeline, Oyen, Wim J. G, Raymakers, Reinier A
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Berlin/Heidelberg : Springer-Verlag 01.12.2009; Springer-Verlag; Springer Nature B.V; Springer Verlag
• Subjects: Aged; Contrast Media - metabolism; Fluorodeoxyglucose F18; Hematology; Humans; Image Enhancement - methods; Image Interpretation, Computer-Assisted - methods; Magnetic Resonance Imaging - methods; Medicine; Medicine & Public Health; Middle Aged; Multiple Myeloma - diagnosis; Multiple Myeloma - diagnostic imaging; Multiple Myeloma - pathology; Neoplasm Staging - methods; Oncology; Positron-Emission Tomography - methods; Prognosis; Radiopharmaceuticals; Review; Review Article; Tomography, X-Ray Computed - methods; X-Rays; Radiography; FDG-PET/CT; Tc-MIBI; MDCT; Multiple myeloma; WB-MRI
• ISSN: 0939-5555; 1432-0584
• DOI: 10.1007/s00277-009-0829-0

Multiple myeloma is a malignant B-cell neoplasm that involves the skeleton in approximately 80% of the patients. With an average age of 60 years and a 5-years survival of nearly 45% Brenner et al. (Blood 111:2516-2520, 35) the onset is to be classified as occurring still early in life while the disease can be very aggressive and debilitating. In the last decades, several new imaging techniques were introduced. The aim of this review is to compare the different techniques such as radiographic survey, multidetector computed tomography (MDCT), whole-body magnetic resonance imaging (WB-MRI), fluorodeoxyglucose positron emission tomography- (FDG-PET) with or without computed tomography (CT), and ⁹⁹mTc-methoxyisobutylisonitrile (⁹⁹mTc-MIBI) scintigraphy. We conclude that both FDG-PET in combination with low-dose CT and whole-body MRI are more sensitive than skeleton X-ray in screening and diagnosing multiple myeloma. WB-MRI allows assessment of bone marrow involvement but cannot detect bone destruction, which might result in overstaging. Moreover, WB-MRI is less suitable in assessing response to therapy than FDG-PET. The combination of PET with low-dose CT can replace the golden standard, conventional skeletal survey. In the clinical practise, this will result in upstaging, due to the higher sensitivity.