Imaging in multiple myeloma

In multiple myeloma, imaging is required to determine the stage of disease and to anticipate impending bone fractures. Whereas the traditionally used Durie and Salmon staging system includes lytic bone lesions in plain films as criteria, modern systems include MRI findings. MRI is most sensitive to both diffuse bone marrow involvement as well as solid plasma cell tumors. Whole-body low-dose CT (WBCT) may replace plain films in the near future, since it is quicker, more sensitive and is better tolerated by patients. Intramedullary lesions are well seen as long as they are located in long bones where they are surrounded by fat. Diffuse bone marrow infiltration as well as intravertebral lesions, however, are difficult to detect with WBCT in the absence of frank destruction of cancellous bone. PET or PET-CT with 18-fluoro-deoxyglucose (FDG) are insensitive to diffuse bone marrow infiltration, but may help to assess treatment response in solitary or multiple solid plasma cell tumors which have a high FDG uptake before treatment.