Nuclear medicine in multiple myeloma -- more than diagnosis

Multiple myeloma (MM) is a neoplastic monoclonal proliferation of plasma cells, mainly involving bone marrow. To properly stage and manage patients with MM the clinician needs, at first, a complete skeletal survey, being more rarely present also extra skeletal locations. Today none of the available diagnostic imaging methods is able alone to answer to all the questions regarding staging, treatment, and follow up. Continuing to be alive the role of traditional radiology, implemented information can be added by CT and MRI. Concerning nuclear medicine, bone scintigraphy is affected by its low sensitivity. Tc-99m MIBI has been proposed in staging and in follow up, with most relevant clinical information deriving from the correlation of its whole body uptake's distribution with extent and activity of the disease. The prognostic value of MIBI has also been demonstrated. PET-FDG has been proposed in MM for its ability to detect whole-body metabolic active disease, giving relevant information in staging and prognosis. First studies have demonstrated that PET-FDG is more sensitive than other imaging modalities for localizing extra medullary sites of disease.