Whole-body diffusion-weighted MRI: a new gold standard for assessing disease burden in patients with multiple myeloma?

Low expression of hexokinase-2 is associated with false-negative FDG–positron emission tomography in multiple myeloma

“…In conclusion, we demonstrate a relevant number of patients with FDG-PET falsenegative MM and a strong association between Hexokinase-2 expression and this negativity; a finding which may also be relevant for clinical imaging of other hematological cancers. Recently published results of a pilot study, that examined 17 patients with paired imaging data, suggest that patients with extensive disease on DWIBS may be reported as being disease-free on FDG-PET ("PET-false-negative") 3 . Since FDG-PET is increasingly being used as a diagnostic tool in MM 1,4-7 , a further characterization of this phenomenon is essential.…”

Guidelines for Acquisition, Interpretation, and Reporting of Whole-Body MRI in Myeloma: Myeloma Response Assessment and Diagnosis System (MY-RADS)

“…Whole-body MRI including DW MRI has become established as the most sensitive technique for bone marrow imaging (23)(24)(25) with additional benefits of speed, coverage, and quantification in comparison with traditional MRI, obviating intravenous injections and radiation exposure. Wide anatomic coverage is essential because 50% of lesions would be missed by imaging the spine alone (33).…”

“…Avoidance of ionizing radiation is likely to become increasingly relevant as surveillance imaging of high-risk patients with monoclonal gammopathy of undetermined significance and of those with smoldering disease gains momentum. Whole-body MRI is a generally well-tolerated technique (24) that offers the additional benefits of assessing skeletal complications, such as spinal canal and/or nerve root compression, and is the most accurate method for differentiating benign from malignant vertebral compression fractures (34).…”

Imaging in myeloma with focus on advanced imaging techniques

“…20 Emerging data suggest further improvement in sensitivity with the addition of DWI. 21,22 Quantitative apparentdiffusion coefficient (ADC) measurement may act as an additional tool for the diagnosis of diffuse infiltration on MRI. 23 In addition, DWI permits differentiation between active and treated disease in cases of disease relapse (Figure 3).…”

“…Surveys have shown that although the scan times are relatively long, most patients find scans acceptable with the additional advantage of no contrast or radiation dose. 21 However, there are some disadvantages including cost, limited MRI capacity, time and expertise required to perform and report, and interpretation challenges associated with lack of cortical bone detail. Clinicians should be aware that not all patients may tolerate MRI, particularly those in pain or with claustrophobia, but with the help of dedicated MRI radiographers and effective analgesic planning, light sedation or tailored sequences, most patients can be scanned successfully.…”