Semin Musculoskelet Radiol 2010; 14(1): 037-046
DOI: 10.1055/s-0030-1248705
© Thieme Medical Publishers

The Role of Whole-Body Imaging in the Diagnosis, Staging, and Follow-Up of Multiple Myeloma

Conor P. Shortt1 , Fiona Carty2 , John G. Murray3
  • 1Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
  • 2Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland
  • 3Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
Further Information

Publication History

Publication Date:
12 March 2010 (online)

ABSTRACT

Multiple myeloma is one of the most common hematological malignancies and accounts for significant morbidity and mortality. In the past, detection of myelomatous deposits by radiography was the main method of radiological assessment in this disease. However, in recent years the introduction of whole-body imaging techniques, specifically low-dose whole-body computed tomography, whole-body magnetic resonance imaging, and positron emission tomography, has facilitated a more comprehensive assessment of this heterogeneous and often diffuse disease. Each of these whole-body imaging techniques has specific applications and limitations in the assessment of multiple myeloma that the interpreting radiologist and referring clinician need to be aware of. As these techniques gain further acceptance in the radiology and hematology communities, their use in the assessment of multiple myeloma is likely to increase further.

REFERENCES

  • 1 Parkin D M, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002.  CA Cancer J Clin. 2005;  55(2) 74-108
  • 2 Durie B G, Kyle R A, Belch A Scientific Advisors of the International Myeloma Foundation et al. Myeloma management guidelines: a consensus report from the Scientific Advisors of the International Myeloma Foundation.  Hematol J. 2003;  4(6) 379-398
  • 3 International Myeloma Working Group . Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group.  Br J Haematol. 2003;  121(5) 749-757
  • 4 Dimopoulos M, Terpos E, Comenzo R L IMWG et al. International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple myeloma.  Leukemia. 2009;  23(9) 1545-1556
  • 5 D'Sa S, Abildgaard N, Tighe J, Shaw P, Hall-Craggs M. Guidelines for the use of imaging in the management of myeloma.  Br J Haematol. 2007;  137(1) 49-63
  • 6 Durie B G, Salmon S E. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival.  Cancer. 1975;  36(3) 842-854
  • 7 Durie B G. The role of anatomic and functional staging in myeloma: description of Durie/Salmon plus staging system.  Eur J Cancer. 2006;  42(11) 1539-1543
  • 8 Richardson P G, Sonneveld P, Schuster M W Assessment of Proteasome Inhibition for Extending Remissions (APEX) Investigators et al. Bortezomib or high-dose dexamethasone for relapsed multiple myeloma.  N Engl J Med. 2005;  352(24) 2487-2498
  • 9 Mulligan M, Smith S, Talmi D. Whole body radiography for bone survey screening of cancer and myeloma patients.  Cancer Invest. 2008;  26(9) 916-922
  • 10 Dinter D J, Neff W K, Klaus J et al.. Comparison of whole-body MR imaging and conventional X-ray examination in patients with multiple myeloma and implications for therapy.  Ann Hematol. 2009;  88(5) 457-464
  • 11 Baur A, Stäbler A, Nagel D et al.. Magnetic resonance imaging as a supplement for the clinical staging system of Durie and Salmon?.  Cancer. 2002;  95(6) 1334-1345
  • 12 Tertti R, Alanen A, Remes K. The value of magnetic resonance imaging in screening myeloma lesions of the lumbar spine.  Br J Haematol. 1995;  91(3) 658-660
  • 13 Gleeson T G, Moriarty J, Shortt C P et al.. Accuracy of whole-body low-dose multidetector CT (WBLDCT) versus skeletal survey in the detection of myelomatous lesions, and correlation of disease distribution with whole-body MRI (WBMRI).  Skeletal Radiol. 2009;  38(3) 225-236
  • 14 Mahnken A H, Wildberger J E, Gehbauer G et al.. Multidetector CT of the spine in multiple myeloma: comparison with MR imaging and radiography.  AJR Am J Roentgenol. 2002;  178(6) 1429-1436
  • 15 Horger M, Kanz L, Denecke B et al.. The benefit of using whole-body, low-dose, nonenhanced, multidetector computed tomography for follow-up and therapy response monitoring in patients with multiple myeloma.  Cancer. 2007;  109(8) 1617-1626
  • 16 Baur-Melnyk A, Buhmann S, Becker C et al.. Whole-body MRI versus whole-body MDCT for staging of multiple myeloma.  AJR Am J Roentgenol. 2008;  190(4) 1097-1104
  • 17 Moulopoulos L A, Dimopoulos M A, Alexanian R, Leeds N E, Libshitz H I. Multiple myeloma: MR patterns of response to treatment.  Radiology. 1994;  193(2) 441-446
  • 18 Rahmouni A, Divine M, Mathieu D et al.. MR appearance of multiple myeloma of the spine before and after treatment.  AJR Am J Roentgenol. 1993;  160(5) 1053-1057
  • 19 Horger M, Claussen C D, Bross-Bach U et al.. Whole-body low-dose multidetector row-CT in the diagnosis of multiple myeloma: an alternative to conventional radiography.  Eur J Radiol. 2005;  54(2) 289-297
  • 20 Antoch G, Vogt F M, Freudenberg L S et al.. Whole-body dual-modality PET/CT and whole-body MRI for tumor staging in oncology.  JAMA. 2003;  290(24) 3199-3206
  • 21 Baur-Melnyk A, Buhmann S, Dürr H R, Reiser M. Role of MRI for the diagnosis and prognosis of multiple myeloma.  Eur J Radiol. 2005;  55(1) 56-63
  • 22 Hargaden G, O'Connell M, Kavanagh E, Powell T, Ward R, Eustace S. Current concepts in whole-body imaging using turbo short tau inversion recovery MR imaging.  AJR Am J Roentgenol. 2003;  180(1) 247-252
  • 23 Johnston C, Brennan S, Ford S, Eustace S. Whole body MR imaging: applications in oncology.  Eur J Surg Oncol. 2006;  32(3) 239-246
  • 24 Lecouvet F E, Vande Berg B C, Malghem J, Maldague B E. Magnetic resonance and computed tomography imaging in multiple myeloma.  Semin Musculoskelet Radiol. 2001;  5(1) 43-55
  • 25 Weininger M, Lauterbach B, Knop S et al.. Whole-body MRI of multiple myeloma: comparison of different MRI sequences in assessment of different growth patterns.  Eur J Radiol. 2009;  69(2) 339-345
  • 26 Bäuerle T, Hillengass J, Fechtner K et al.. Multiple myeloma and monoclonal gammopathy of undetermined significance: importance of whole-body versus spinal MR imaging.  Radiology. 2009;  252(2) 477-485
  • 27 Baur A, Stäbler A, Bartl R, Lamerz R, Reiser M. Infiltration patterns of plasmacytomas in magnetic resonance tomography [in German].  Rofo. 1996;  164(6) 457-463
  • 28 Shortt C P, Gleeson T G, Breen K A et al.. Whole-body MRI versus PET in assessment of multiple myeloma disease activity.  AJR Am J Roentgenol. 2009;  192(4) 980-986
  • 29 Moulopoulos L A, Dimopoulos M A. Magnetic resonance imaging of the bone marrow in hematologic malignancies.  Blood. 1997;  90(6) 2127-2147
  • 30 Zamagni E, Nanni C, Patriarca F et al.. A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma.  Haematologica. 2007;  92(1) 50-55
  • 31 Schirrmeister H, Bommer M, Buck A K et al.. Initial results in the assessment of multiple myeloma using 18F-FDG PET.  Eur J Nucl Med Mol Imaging. 2002;  29(3) 361-366
  • 32 Mileshkin L, Blum R, Seymour J F, Patrikeos A, Hicks R J, Prince H M. A comparison of fluorine-18 fluoro-deoxyglucose PET and technetium-99m sestamibi in assessing patients with multiple myeloma.  Eur J Haematol. 2004;  72(1) 32-37
  • 33 Bredella M A, Steinbach L, Caputo G, Segall G, Hawkins R. Value of FDG PET in the assessment of patients with multiple myeloma.  AJR Am J Roentgenol. 2005;  184(4) 1199-1204
  • 34 Orchard K, Barrington S, Buscombe J, Hilson A, Prentice H G, Mehta A. Fluorodeoxyglucose positron emission tomography imaging for the detection of occult disease in multiple myeloma.  Br J Haematol. 2002;  117(1) 133-135
  • 35 Gavish I, Bennett M, Israel O, Bar-Shalom R. 2-[18] fluoro-2-deoxy-D-glucose positron emission tomography imaging in non-secretory multiple myeloma.  Br J Haematol. 2003;  123(4) 566
  • 36 Salaun P Y, Gastinne T, Frampas E, Bodet-Milin C, Moreau P, Bodéré-Kraeber F. FDG-positron-emission tomography for staging and therapeutic assessment in patients with plasmacytoma.  Haematologica. 2008;  93(8) 1269-1271
  • 37 Nanni C, Zamagni E, Farsad M et al.. Role of 18F-FDG PET/CT in the assessment of bone involvement in newly diagnosed multiple myeloma: preliminary results.  Eur J Nucl Med Mol Imaging. 2006;  33(5) 525-531
  • 38 Durie B G, Waxman A D, D'Agnolo A, Williams C M. Whole-body (18)F-FDG PET identifies high-risk myeloma.  J Nucl Med. 2002;  43(11) 1457-1463
  • 39 Wiesenthal A A, Nguyen B D. F-18 FDG PET/CT staging of multiple myeloma with diffuse osseous and extramedullary lesions.  Clin Nucl Med. 2007;  32(10) 797-801
  • 40 Jadvar H, Conti P S. Diagnostic utility of FDG PET in multiple myeloma.  Skeletal Radiol. 2002;  31(12) 690-694
  • 41 Villa G, Balleari E, Carletto M et al.. Staging and therapy monitoring of multiple myeloma by 99mTc-sestamibi scintigraphy: a five year single center experience.  J Exp Clin Cancer Res. 2005;  24(3) 355-361
  • 42 Tirovola E B, Biassoni L, Britton K E, Kaleva N, Kouykin V, Malpas J S. The use of 99mTc-MIBI scanning in multiple myeloma.  Br J Cancer. 1996;  74(11) 1815-1820
  • 43 Balleari E, Villa G, Garrè S et al.. Technetium-99m-sestamibi scintigraphy in multiple myeloma and related gammopathies: a useful tool for the identification and follow-up of myeloma bone disease.  Haematologica. 2001;  86(1) 78-84
  • 44 Mirzaei S, Filipits M, Keck A et al.. Comparison of technetium-99m-MIBI imaging with MRI for detection of spine involvement in patients with multiple myeloma.  BMC Nucl Med. 2003;  3(1) 2

Conor P ShorttM.Sc. 

Department of Radiology, Thomas Jefferson University Hospital

132 South 10th St., Rm. 1091, Philadelphia, PA 19107

Email: conor.shortt@jefferson.edu