Molecular imaging in myeloma precursor disease

Area of Science:

• Oncology
• Radiology
• Hematology

Background:

• Multiple myeloma (MM) develops from precursor conditions: monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM).
• Current risk stratification for MGUS/SMM relies on clinical markers, lacking individual prediction of progression to MM.
• Early end-organ damage, particularly bone lesions, is a hallmark of MM, suggesting subtle bone changes in precursor states may indicate higher risk.

Purpose of the Study:

• To review current and emerging imaging techniques for detecting early signs of MM in MGUS/SMM patients.
• To explore how advanced imaging can improve risk stratification of MGUS/SMM.
• To assess the potential of imaging in guiding tailored clinical management and future treatment strategies for high-risk precursor disease.

Main Methods:

• Review of current literature on imaging modalities for MM precursor states.
• Emphasis on advanced techniques: whole-body low-dose CT, MRI, and PET scans.
• Comparison of newer imaging sensitivities against traditional skeletal surveys for detecting bone lesions and extra-osseous disease.

Main Results:

• Traditional skeletal surveys underestimate bone lesions and marrow involvement in early MM precursor stages.
• Advanced imaging modalities (CT, MRI, PET) show higher sensitivity in detecting subtle bone changes and extra-osseous disease.
• Emerging imaging methods offer potential for improved identification of high-risk MGUS/SMM patients.

Conclusions:

• Advanced imaging techniques are crucial for detecting early bone involvement in MGUS/SMM, which may predict progression to multiple myeloma.
• Improved imaging can refine risk stratification, moving beyond current clinical markers.
• Tailored management and future treatment strategies for high-risk precursor MM may be developed based on enhanced imaging insights.