Assessment of whole body MRI and sestamibi technetium-99m bone marrow scan in prediction of multiple myeloma disease progression and outcome: a prospective comparative study

99mTc-sestamibi SPECT/CT and 18F-FDG-PET/CT have similar performance but different imaging patterns in newly diagnosed multiple myeloma

PURPOSE

F-fluorodeoxiglucose (F-FDG)-PET/CT has been widely used to evaluate multiple myeloma. Tc-sestamibi (MIBI) scintigraphy has also been proposed for assessing multiple myeloma, but its use with state-of-the-art single-photon emission computed tomography/computed tomography (SPECT/CT) technology has not been fully evaluated.This study aimed to compare these two imaging modalities in multiple myeloma staging.

MATERIALS AND METHODS

Sixty-two patients with recently diagnosed multiple myeloma were submitted to whole-body F-FDG-PET/CT and whole-body MIBI scans plus SPECT/CT of the chest and abdomen/pelvis. Number of focal lesions, contiguous soft tissue involvement (CSTI), extramedullary lesions (EMLs) and diffuse bone marrow (BM) involvement were recorded.

RESULTS

PET/CT was positive in 59 patients (95%) and MIBI SPECT/CT in 58 (93%) (P = 0.69). MIBI detected more diffuse bone marrow involvement than PET/CT (respectively 78 vs. 58% of the patients), while PET/CT demonstrated more focal lesions than MIBI SPECT/CT (81 vs. 54% of the patients) (P = 0.002). PET/CT detected EMLs in four subjects and MIBI in one subject. CSTI was found in 28 (45%) and 23 (37%) patients on PET/CT and MIBI images, respectively (P = 0.36). Three patients with lytic lesions and no FDG uptake were MIBI positive, and two subjects with lytic lesions without MIBI uptake were FDG positive.

CONCLUSION

MIBI SPECT/CT performs similarly to F-FDG-PET/CT in identifying sites of active disease in multiple myeloma staging. MIBI is more efficient than FDG for detecting the diffuse involvement of bone marrow but less efficient for detecting focal lesions. Some patients presented a 'mismatch' pattern of FDG/MIBI uptake.

Role of Magnetic Resonance Imaging in the Management of Patients With Multiple Myeloma: A Consensus Statement

Purpose

The aim of International Myeloma Working Group was to develop practical recommendations for the use of magnetic resonance imaging (MRI) in multiple myeloma (MM).

Methods

An interdisciplinary panel of clinical experts on MM and myeloma bone disease developed recommendations for the value of MRI based on data published through March 2014.

Recommendations

MRI has high sensitivity for the early detection of marrow infiltration by myeloma cells compared with other radiographic methods. Thus, MRI detects bone involvement in patients with myeloma much earlier than the myeloma-related bone destruction, with no radiation exposure. It is the gold standard for the imaging of axial skeleton, for the evaluation of painful lesions, and for distinguishing benign versus malignant osteoporotic vertebral fractures. MRI has the ability to detect spinal cord or nerve compression and presence of soft tissue masses, and it is recommended for the workup of solitary bone plasmacytoma. Regarding smoldering or asymptomatic myeloma, all patients should undergo whole-body MRI (WB-MRI; or spine and pelvic MRI if WB-MRI is not available), and if they have > one focal lesion of a diameter > 5 mm, they should be considered to have symptomatic disease that requires therapy. In cases of equivocal small lesions, a second MRI should be performed after 3 to 6 months, and if there is progression on MRI, the patient should be treated as having symptomatic myeloma. MRI at diagnosis of symptomatic patients and after treatment (mainly after autologous stem-cell transplantation) provides prognostic information; however, to date, this does not change treatment selection.

The utility of newer imaging techniques as predictors of clinical outcomes in multiple myeloma

The 14th International Myeloma Workshop Kyoto, Japan, 3-7 April 2013 The International Myeloma Workshop (IMW) is a biannual meeting that gathers experts in multiple myeloma (MM) from all over the world and scientists interested in clinical and biological aspects of myeloma. The 2013 IMW was held in Kyoto, Japan and presented an interesting program with an appealing section on newer imaging techniques as predictor of outcome in asymptomatic and symptomatic MM. During the meeting, the importance of newer functional imaging techniques as new ways of assessing bone disease and the extent of marrow infiltration by myeloma cells was highlighted. This short meeting report will provide a review of new and/or functional imaging techniques, such as magnetic resonance imaging (MRI), both axial and whole body (WB-MRI), dynamic contrast enhanced (DCE) MRI, diffusion weighted imaging (DWI) and PET integrated with computed tomography.

Imaging of myeloma: beyond lytic lesions

SUMMARY This review will focus on the imaging findings present in patients with typical symptomatic multiple myeloma. The emphasis will be on recent developments related to advanced imaging techniques. There are several different ways to stage or risk-stratify patients with symptomatic multiple myeloma after the diagnosis has been established. The International Myeloma Working Group issued a consensus statement regarding imaging of myeloma patients in 2009. The consensus was that the conventional radiographic survey should still be carried out as the baseline imaging study and that MRI should be added whenever possible. Many other imaging exams are available including: CT, PET/CT, MRI and sestamibi. The strengths and weaknesses of all of the available imaging techniques will be summarized.