State of the art imaging of multiple myeloma: Comparative review of FDG PET/CT imaging in various clinical settings |
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| Affiliation: | 1. Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States;2. Department of Medicine Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States;1. Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Germany;2. Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Germany;1. Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany;2. Institute of Pathology and Neuropathology, University Hospital Tübingen, Liebermeisterstraße 8, 72076 Tübingen, Germany;1. Institut und Poliklinik für Diagnostische Radiologie, Uniklinik Köln, Germany;2. Sektion für Biomedizinische Bildgebung, Universitätsklinikum Schleswig Holstein, Campus Kiel, Germany;3. Universidad Nacional del Sur, Bahía Blanca, Argentina;4. Sektion für Immun- und Stammzelltransplantation, Klinik für Innere Medizin, Universitätsklinikum Schleswig Holstein, Campus Kiel, Germany;5. Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Germany;6. Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig Holstein, Campus Kiel, Germany;1. Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi–Mathura Road, New Delhi 110076, India;2. Department of Surgical Oncology, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi––Mathura Road, New Delhi 110076, India;3. Department of Pathology, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi–Mathura Road, New Delhi 110076, India |
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| Abstract: | 18-Flurodeoxyglucose Positron Emission Tomography with computed tomography (FDG PET/CT) and Magnetic Resonance Imaging (MRI) have higher sensitivity and specificity than whole-body X-ray (WBXR) survey in evaluating disease extent in patients with multiple myeloma (MM). Both modalities are now recommended by the Durie–Salmon Plus classification although the emphasis is more on MRI than PET/CT. The presence of extra-medullary disease (EMD) as evaluated by PET/CT imaging, initial SUVmax and number of focal lesions (FL) are deemed to be strong prognostic parameters at staging. MRI remains the most sensitive technique for the detection of diffuse bone marrow involvement in both the pre and post-therapy setting. Compression fractures are best characterized with MRI signal changes, for determining vertebroplasty candidates. While PET/CT allows for earlier and more specific evaluation of therapeutic efficacy compared to MRI, when signal abnormalities persist years after treatment. PET/CT interpretation, however, can be challenging in the vertebral column and pelvis as well as in cases with post-therapy changes. Hence, a reading approach combining the high sensitivity of MRI and superior specificity of FDG PET/CT would be preferred to increase the diagnostic accuracy. In summary, the established management methods in MM, mainly relying on biological tumor parameters should be complemented with functional imaging data, both at staging and restaging for optimal management of MM. |
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| Keywords: | Multiple myeloma Staging PET/CT MRI |
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