Imaging in multiple myeloma: Current concepts and future challenges

Abstract

Bone involvement is one of the hallmarks of multiple myeloma (MM). The large majority of patients present with osteolytic lesions, either at initial diagnosis or during the course of their disease. The definition of myeloma-related bone disease as a marker of end-organ damage requiring immediate treatment has evolved over the years, chiefly as a result of important advances in cross-sectional imaging technology and the introduction of functional and molecular imaging techniques. Conventional skeletal survey is no longer considered adequate for the work-up of myeloma patients due to its low sensitivity. Whole Body Low Dose CT (WBLDCT) is currently the imaging modality of choice for detecting osteolytic lesions in newly diagnosed MM patients. Whole Body MRI (WBMRI) with Diffusion-Weighted Imaging is the gold standard for detecting bone marrow involvement, both focal and diffuse, and is also increasingly being studied as a tool for therapy response assessment. For evaluation of response to therapy and imaging-based definition of minimal residual disease (MRD) status, 18 F-FDG PET/CT is currently the preferred technique. Both WBMRI and 18F-FDG PET/CT can provide valuable prognostic information and are also excellent modalities for detecting extramedullary disease. In this review we discuss the use of these advanced imaging techniques in the management of MM patients, we outline the relevant guidelines and we address the issues that need to be further investigated.