The role of imaging techniques in the management of multiple myeloma

Zamagni, Elena; Cavo, Michèle

doi:10.1111/bjh.12007

Cited by 121 publications

(98 citation statements)

References 86 publications

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“…Our paper supports the idea that CR is not sensitive enough in the assessment of MBD, and that the assessment of the spine and extramedullary lesions using CR is rather poor in comparison with modern imaging methods [1][2][3][4][13][14][15][16] . Still, CR can be used for the detection of osteolytic lesions of the skull, pelvis, ribs and long bones where it has acceptable sensitivity.…”

supporting

confidence: 78%

Prospective comparison of conventional radiography, low-dose computed tomography and magnetic resonance imaging in monoclonal gammopathies

Minařík¹,

Krhovská²,

Pika³

et al. 2016

BIOMED PAP

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Aims. We carried out a prospective study in order to identify the best imaging approach for patients with newly diagnosed multiple myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS). Methods. We assessed the extent of myeloma bone disease (MBD) in 112 individuals -84 patients with MM and 28 individuals with MGUS. For the detection of osteolytic involvement we used whole-body magnetic resonance imaging (WB-MRI), low-dose computed tomography (LD-CT) and conventional radiography (CR). Each method assessed the presence of osteolytic involvement, compressive fractures and extramedullary involvement in the following regions: skull, spine and chest, pelvis and humerus and femur. We compared the difference in the number and extent of osteolytic involvement, especially the findings in CR negative patients. Results. Conventional radiography showed no superiority in any of the evaluated regions, and failed in the detection of extramedullary massess and spine involvement. WB-MRI was best at imaging the spine including extramedullary involvement, however, detection of osteolytic lesions of the skull was limited in comparison with both CR and LD-CT. Both WB-MRI and LD-CT were comparable in imaging of lesions of pelvis, humerus, femur and the presence of extramedullary masses. LD-CT showed superiority in detection of skull lesions but lower sensitivity in spine compared to WB-MRI. Conclusions. Our results confirm that relying solely on CR in the diagnostics of MM is insufficient. We suggest that the most suitable method for primary assessment of osteolytic involvement in monoclonal gammopathies should include either whole-body MRI together with CR of the skull or, with an equivalent sensitivity, whole body LD-CT.

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supporting

confidence: 78%

Prospective comparison of conventional radiography, low-dose computed tomography and magnetic resonance imaging in monoclonal gammopathies

Minařík¹,

Krhovská²,

Pika³

et al. 2016

BIOMED PAP

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“…Differently from posttreatment evaluation of response, the serial use of novel imaging techniques during the follow-up phase is not recommended because of the high costs and the radiation exposure (6,7). After the end of first-line treatment, 30% of our patients retained positive PET/CT scans, and in 40% of them (10% of the whole population), the glucose metabolism was still high.…”

Section: Discussionmentioning

confidence: 93%

“…Although novel imaging techniques have a clear role in both the staging and restaging of multiple myeloma at the time of relapse and in the evaluation of treatment response (6)(7)(8), their serial use during follow-up of the disease is currently not recommended because of the high cost and radiation exposure. However, to the best of our knowledge, no formal cost/benefit analysis has yet been performed.…”

Section: Introductionmentioning

confidence: 99%

PET/CT Improves the Definition of Complete Response and Allows to Detect Otherwise Unidentifiable Skeletal Progression in Multiple Myeloma

Zamagni¹,

Nanni

Mancuso³

et al. 2015

Clinical Cancer Research

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147

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Purpose: To evaluate the role of 18F-FDG PET/CT in 282 symptomatic multiple myeloma patients treated up-front between 2002 and 2012.Experimental Design: All patients were studied by PET/CT at baseline, during posttreatment follow-up, and at the time of relapse. Their median duration of follow-up was 67 months.Results: Forty-two percent of the patients at diagnosis had >3 focal lesions, and in 50% SUV max was >4.2; extramedullary disease was present in 5%. On multivariate analysis, ISS stage 3, SUV max >4.2, and failure to achieve best complete response (CR) were the leading factors independently associated with shorter progression-free survival (PFS) and overall survival (OS). These 3 variables were used to construct a prognostic scoring system based on the number of risk factors. After treatment, PET/ CT negativity (PET-neg) was observed in 70% of patients, whereas conventionally defined CR was achieved in 53%. Attainment of PET-neg favorably influenced PFS and OS. PET-neg was an independent predictor of prolonged PFS and OS for patients with conventionally defined CR. Sixty-three percent of patients experienced relapse or progression; in 12%, skeletal progression was exclusively detected by systematic PET/CT performed during follow-up. A multivariate analysis revealed that persistence of SUV max >4.2 following first-line treatment was independently associated with exclusive PET/CT progression.Conclusions: PET/CT combined with ISS stage and achievement or not of CR on first-line therapy sorted patients into different prognostic groups. PET/CT led to a more careful evaluation of CR. Finally, in patients with persistent high glucose metabolism after first-line treatment, PET/CT can be recommended during follow-up, to screen for otherwise unidentifiable progression.

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“…30 Active myeloma is positive on PET scan. 31,32 PET/ CT and MRI scans are more sensitive than plain radiographs and are indicated when symptomatic areas show no abnormality on routine radiographs.…”

Section: Additional Diagnostic Testsmentioning

confidence: 99%