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Review
. 2025 Feb 28:51:100669.
doi: 10.1016/j.jbo.2025.100669. eCollection 2025 Apr.

Diagnostic Innovations: Advances in imaging techniques for diagnosis and follow-up of multiple myeloma

M Talarico  1   2 , S Barbato  1   2 , A Cattabriga  2   3 , I Sacchetti  1   2 , E Manzato  1   2 , R Restuccia  1   2 , S Masci  1   2 , F Bigi  1   2 , M Puppi  1   2 , M Iezza  1   2 , I Rizzello  1   2 , K Mancuso  1   2 , L Pantani  1 , P Tacchetti  1 , C Nanni  4 , M Cavo  2 , E Zamagni  1   2
Affiliations
Review

Diagnostic Innovations: Advances in imaging techniques for diagnosis and follow-up of multiple myeloma

M Talarico et al. J Bone Oncol. .

Abstract

Introduction: The International Myeloma Working Group (IMWG) defines myeloma related bone disease (MBD) as a diagnostic criterion for symptomatic multiple myeloma (MM) as the presence of osteolytic lesions ≥ 5 mm or more than one focal lesion (FL) ≥ 5 mm by magnetic resonance imaging (MRI). Whole-body low-dose CT (WBLDCT) is recommended as the first-choice imaging technique for the diagnosis of MBD with 18F-fluorodeoxyglucose-positron emission tomography/CT (18F-FDG-PET/CT) being considered a possible alternative at staging, whereas use of MRI studies is recommended in cases without myeloma-defining events (MDEs) in order to exclude the presence of FLs. Furthermore, use of 18F-FDG-PET/CT is recommended in response assessment, to be integrated with hematologic response and bone marrow minimal residual disease (MRD).

Areas covered: In this paper, we review novel functional imaging techniques in MM, particularly focusing on their advantages, limits, applications and comparisons with 18F-FDG-PET/CT or other standardized imaging techniques.

Conclusions: Combining both morphological and functional imaging, 18F-FDG-PET/CT is currently considered a standard imaging technique in MM for staging (despite false positive or negative results) and response assessment. The introduction of novel functional imaging techniques, as whole-body diffusion-weighted magnetic resonance imaging (WB-DWI-MRI), or novel PET tracers might be useful in overcoming these limits. Future studies will give more information on the complementarity of these imaging techniques or whether one of them might become a new gold standard in MM.

Keywords: 18F-FDG-PET/CT; Bone disease; DCE-MRI; Imaging; Multiple Myeloma; WB-DWI-MRI.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. IR has received honoraria from Amgen, GlaxoSmithKline and Sanofi and advisory role for GlaxoSmithKline; KM has received honoraria from Celgene, Takeda, Amgen, Sanofi and Janssen; LP has received honoraria from GlaxoSmithKline, Sanofi and Pfizer; PT has received honoraria from Amgen, Bristol-Myers Squibb/Celgene, Janssen, Takeda, AbbVie, Sanofi, GlaxoSmithKline and Pfizer; CN has received consultant honoraria from Keosys and funding from Radius, Immedica, Thema Sinergie; MC has served as Consulting/advisory role for and has received honoraria from Amgen, AbbVie, Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Menarini Stemline, Sanofi, and Karyopharm Therapeutics; EZ has received honoraria from Janssen, Bristol-Myers Squibb, Amgen, Takeda. MT, SB, AC, IS, EM, RR, SM, FB, MP, and MI declare no potential conflict of interest.

Figures

Fig. 1
Fig. 1
Imaging algorithm for patients with suspected NDMM and for response evaluation during therapy; adapted from . Abbreviations: NDMM = newly diagnosed multiple myeloma; WBLDCT = whole-body low dose computed tomography; 18F-FDG-PET/CT = 18F-fluorodeoxyglucose-positron emission tomography/computed tomography; WB-MRI = whole-body magnetic resonance imaging; AS-MRI = axial skeleton MRI; MDE = myeloma defining event; SMM = smoldering MM.
Fig. 2
Fig. 2
Types of TICs by DCE-MRI; adapted from . Abbreviations: TICs = time-intensity curves; DCE-MRI = dynamic contrast-enhanced magnetic resonance imaging.
Fig. 3
Fig. 3
Relation between ADC values, signal intensity in DWI sequences and bone marrow cellular density during disease course and response to therapy; adapted from and . Abbreviations: ADC = apparent diffusion coefficient; DWI = diffusion-weighted imaging; MGUS = monoclonal gammopathy of undetermined significance; MM = multiple myeloma.
See this image and copyright information in PMC

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