Prospective Evaluation of Whole-Body MRI versus FDG PET/CT for Lesion Detection in Participants with Myeloma

Abstract

A dvances in therapeutics that improve outcomes of patients with myeloma are key drivers for imaging developments. If bone marrow disease is detected early, and patients are treated according to clinical risk, then survival advantages are conferred (1-8). Histologic confirmation of clonal bone marrow plasma cells of greater than 10% in bone marrow or biopsy-proven plasmacytoma is a core requirement of diagnosis that is related to disease burden. However, for a diagnosis of multiple myeloma requiring treatment, biopsy results must be supplemented with evidence of a myeloma-defining event (hypercalcemia, renal failure, anemia, or bone disease) or a biomarker of malignancy (clonal marrow plasma cell percentage  60%, involved:uninvolved serum free light chain ratio  100, or a positive finding at MRI) (9). Although the International Myeloma Working Group (IMWG) recommends a range of imaging investigations for bone disease (including low-dose CT, fluorine 18 [ 18 F] fluorodeoxyglucose [FDG] PET/CT, and MRI), the high sensitivity of whole-body (WB) MRI is recognized (10,11), and it is recommended for all patients suspected of having myeloma and who underwent low-dose WB CT or FDG PET/CT with negative findings (12). The IMWG definition of bone involvement as a myeloma-defining event remains the presence of more This copy is for personal use only. To order printed copies, contact

18F-FDG PET/CT and MRI in the Management of Multiple Myeloma: A Comparative Review

“…It was also shown that CT helps improve the diagnosis of bone involvement in patients with a low 18 F-FDG uptake (44,45). Comparison of the detectability of FLs showed that, overall, DW-MRI detects more FLs than does 18 F-FDG PET/CT (44)(45)(46). Reports agree that 18 F-FDG PET/CT appears to be superior for the detection of upper limb FLs, while DW-MRI seems better at analyzing the skull, the spine, and the pelvis (44,46).…”

“…Comparison of the detectability of FLs showed that, overall, DW-MRI detects more FLs than does 18 F-FDG PET/CT (44)(45)(46). Reports agree that 18 F-FDG PET/CT appears to be superior for the detection of upper limb FLs, while DW-MRI seems better at analyzing the skull, the spine, and the pelvis (44,46). A prospective study found that, although DW-MRI detected more FLs compared to 18 F-FDG PET/CT, there was no difference regarding bone disease diagnosis on a per patient basis, with an agreement of 1.0 (44).…”

The potential role of mass spectrometry for the identification and monitoring of patients with plasma cell disorders: Where are we now and which questions remain unanswered?

“…In addition, PET-CT is not uniformly applicable as approximately 10% of patients may have false negative results due to hexokinase deficiency. 32 Diffusion-weighted magnetic resonance imaging (MRI) is a more sensitive imaging modality for monitoring [33][34][35] but its widespread use is limited by capacity issues. 36 Extensive research has therefore been undertaken to identify more sensitive, non-invasive and practical ways to monitor therapeutic responses in the peripheral blood.…”

“…In addition, PET‐CT is not uniformly applicable as approximately 10% of patients may have false negative results due to hexokinase deficiency 32 . Diffusion‐weighted magnetic resonance imaging (MRI) is a more sensitive imaging modality for monitoring 33–35 but its widespread use is limited by capacity issues 36 …”

Development of machine learning support for reading whole body diffusion-weighted MRI (WB-MRI) in myeloma for the detection and quantification of the extent of disease before and after treatment (MALIMAR): protocol for a cross-sectional diagnostic test accuracy study

“… 2 3 Evidence suggests that diffusion-weighted (DW) WB-MRI (WB-DW-MRI) is the most sensitive magnetic resonance technique for detecting marrow disease 4–8 and superior to fluorodeoxyglucose positron emission tomography/CT for the detection of small sites of disease and diffuse infiltration. 9 10 Therefore, WB-MRI is increasingly being adopted at centres worldwide for patients with myeloma. Treatment of high-risk patients is known to improve overall survival, 11 therefore improved diagnostic accuracy is likely to translate into improved patient selection for treatment and prolonged survival.…”