Evolving role of FDG-PET/CT and FDG-PET/MRI for assessment of multiple myeloma

Learning Objectives 1.Briefly review the staging assessment of patients with Multipe Myeloma (MM). 2.Describe the strengths, limitations, and diagnostic performance of radiography and other conventional imaging procedures including CT, MRI, and bone scintigraphy for assessment of patients with MM. 3.Review the role and diagnostic performance of FDG-PET/CT and FDG-PET/MRI for diagnosis, staging, response assessment, and biopsy guidance of patients with MM. 4.Discuss the potential pitfalls, including false positive and false negative findings, of FDG-PET for assessment of MM that are important to be aware of.

Multiple myeloma (MM) is a rare hematologic disorder characterized by a proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein. MM is the most common cause of primary malignancy in the bone marrow, and the second most frequent blood malignancy after non-Hodgkin lymphoma. In one third of patients, the condition is diagnosed after a pathological fracture has occurred, usually involving the axial skeleton. Despite the introduction of various new treatment modalities, the prognosis for patients with MM remains poor. The standard investigative work-up in patients with suspected MM include a skeletal survey and MRI. However, FDG-PET is rapidly becoming the new reference standard for comprehensive assessment of patients with MM.