Whole body diffusion weighted MRI – a new view of myeloma

Abstract

SummaryThe recent consensus statement from the International Myeloma Working Group has introduced the role of whole body (WB) magnetic resonance imaging (MRI) into the management pathway for patients with multiple myeloma. The speed, coverage and high sensitivity of WB diffusion weighted (DW)‐MRI and the unique capability to quantify both burden of disease and response to treatment has led to increasing implementation at leading centres worldwide for imaging malignant marrow disease, both primary and metastatic. WB DW‐MRI is likely to have a significant impact on management decisions and pathways for patients with multiple myeloma. This review will introduce the basic principles of DW‐MRI, present current evidence for patients with myeloma and will discuss practicalities and exciting future applications.

Neurological signs and MRI findings in 12 dogs with multiple myeloma

“…Based on operator experience in the current study along with previous literature, a minimum of T2-weighted, STIR, T1weighted, and T1-weighted gadolinium sequences should be utilized as standard when performing MRI examination of cases with suspected multiple myeloma. 12,24 In conclusion, the majority of dogs affected by multiple myeloma with vertebral involvement present with a chronic, progressive, painful T3-L3 myelopathy. The degree of spinal cord compression did not reflect the neurological grade of dogs affected.…”

“…Future work utilizing a larger study population with standardized diagnostic evaluation and imaging protocol would be of benefit. Based on operator experience in the current study along with previous literature, a minimum of T2‐weighted, STIR, T1‐weighted, and T1‐weighted gadolinium sequences should be utilized as standard when performing MRI examination of cases with suspected multiple myeloma …”

Frequency, distribution and clinical management of incidental findings and extramedullary plasmacytomas in whole body diffusion weighted magnetic resonance imaging in patients with multiple myeloma

“…1 The speed, coverage and high sensitivity of WB DW-MRI, with its ability to quantify both the burden of disease and response to treatment, has made it the sequence of choice at several leading centers worldwide. 2 DW-MRI is the most sensitive sequence for lesion detection in bone marrow 3 and it is also highly sensitive in soft tissues. 3,4 Incidental findings are, therefore, inevitable, and a potential trigger for costly and sometimes invasive investigation and a source of anxiety for patients and clinicians.…”

“…When it does occur, the incidental finding is a problem for clinicians and radiologists, and communication between them is essential. 9 Anita Wale, 1 Charlotte Pawlyn, 2 Martin Kaiser, 2 and Christina Messiou 1,2 …”

New horizons in multimodality molecular imaging and novel radiotracers

“…9 So far, the potential added value of functional capabilities of MRI has not been adequately assessed. However, with increased use of diffusion-weighted imaging, DCE-MRI and magnetic resonance spectroscopy in clinical applications, such as for whole-body skeletal imaging in myeloma 10 or assessing prostate cancer, 11 ( Fig 2) this will need to be tested. In the short term, it is expected that PET/MRI will be suitable for patients requiring both PET and MRI scans at similar points in their diagnostic pathway, eg biochemical recurrence of prostate cancer, recurrent brain tumours and investigation of dementia.…”