Modern imaging techniques for monitoring patients with multiple myeloma

Abstract

Bone disease is a serious problem for many patients, often causing pathological bone fractures. A spinal collapse is a condition that affects the quality of life. It is the most frequent feature of multiple myeloma (MM), used in establishing the diagnosis and the need to start treatment. Because of these complications, imaging plays a vital role in the diagnosis and workup of myeloma patients. For many years, conventional radiography has been considered the gold standard for detecting bone lesions. The main reasons are the wide availability, low cost, the relatively low radiation dose and the ability of this imaging method to cover the entire bone system. Because of its incapacity to evaluate the response to therapy, more sophisticated techniques such as whole-body low-dose computed tomography (WBLDCT), whole-body magnetic resonance imaging, and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) are used. In this review, some of the advantages, indications and applications of the three techniques in managing patients with MM will be discussed. The European Myeloma Network guidelines have recommended WBLDCT as the imaging modality of choice for the initial assessment of MM-related lytic bone lesions. Magnetic resonance imaging is the gold-standard imaging modality for the detection of bone marrow involvement. One of the modern imaging methods and PET/CT can provide valuable prognostic data and is the preferred technique for assessing response to therapy.

Keywords: 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT); MRI; multiple myeloma; skeletal survey; whole-body low-dose computed tomography (WBLDCT).

Figure 1

Osteolytic lesion of the spine T2–T3 – anterior view. Medical Radiology-Imaging department of the “Prof. Dr. Ion Chiricuta” Oncological Institute archive.

Figure 2

Osteolytic lesion located in the sternal body. Medical-Imaging Radiology department of the “Prof. Dr. Ion Chiricuta” Oncological Institutearchive.

Figure 3

Multiple subcutaneous lesions in the left iliac region and multiple metabolically active lytic bone lesions: femur, iliac bone, skull, spine. Medical Radiology-Imaging department of the “Prof. Dr. Ion Chiricuta” Oncological Institute archive.

Figure 4

Osteolytic lesion in the lumbar spinal canal, posterior to the L4 vertebral body. Medical Radiology-Imaging department of the “Prof. Dr. Ion Chiricuta” Oncological Institute archive.