How do we image patients with multiple myeloma and precursor states?

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Morphological and functional imaging advancements improve early detection of multiple myeloma (MM) bone disease and involvement.
• 18F-fluorodeoxyglucose-Positron emission tomography/computed tomography (FDG PET/CT) and whole-body MRI with diffusion-weighted imaging (WB DW-MRI) are key functional imaging modalities for MM.

Observation:

• WB DW-MRI demonstrates higher sensitivity than FDG PET/CT in detecting baseline tumor burden and assessing therapeutic response in MM.
• WB DW-MRI is the preferred method for ruling out myeloma-defining events in smouldering multiple myeloma (SMM) based on updated International Myeloma Working Group (IMWG) criteria.

Findings:

• Both FDG PET/CT and WB DW-MRI effectively monitor treatment response and provide complementary data for IMWG assessment and minimal residual disease evaluation.
• Recent data since the IMWG consensus guideline highlight the evolving role of modern imaging in MM management.

Implications:

• WB DW-MRI is becoming the gold standard for initial staging and response assessment in multiple myeloma.
• Further research is needed to address knowledge gaps in utilizing advanced imaging for MM and precursor states.