Skip to main content

Advertisement

Log in

PET/CT and MR imaging in myeloma

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Myeloma is the most common primary bone malignancy. It accounts for 10% of all hematological malignancies and 1% of all cancers. In the United States, there are an estimated 16,000 new cases and over 11,000 deaths yearly due to myeloma. Plasma cell dyscrasias manifest themselves in a variety of forms that range from MGUS (monoclonal gammopathy of undetermined significance) and smoldering myeloma that require no therapy, to the “malignant” form of multiple myeloma. The role of imaging in the management of myeloma includes: an assessment of the extent of intramedullary bone disease, detection of any extramedullary foci, and severity of the disease at presentation; the identification and characterization of complications; subsequent assessment of disease status. This review will focus on the use of PET/CT and MR imaging for myeloma patients at the time of initial diagnosis and for follow-up management, based on current reports in the literature and our practice at the Marlene and Stewart Greenebaum Cancer Center, University of Maryland Medical Center in Baltimore, USA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14

Similar content being viewed by others

References

  1. Chen-Kiang S. Plasma cells and multiple myeloma. Immunol Rev 2003;194:5–7.

    Article  Google Scholar 

  2. Desikan R, Barlogie B, Sawyer J, et al. Results of high-dose therapy for 1,000 patients with multiple myeloma: durable complete remission and superior survival in the absence of chromosome 13 abnormalities. Blood 2000;95:4008–10.

    PubMed  CAS  Google Scholar 

  3. Barlogie B, Desikan R, Eddelmon P, et al. Extended survival in advanced and refractory multiple myeloma after single-agent thalidomide. Blood 2001;98:492–94.

    Article  PubMed  CAS  Google Scholar 

  4. Greipp PR, San Miguel J, Durie BG, Crowley JJ, Barlogie B, Blade J, et al. International staging system for multiple myeloma. J Clin Oncol 2005;23:3412–20, Epub 2005 Apr 4.

    Article  PubMed  Google Scholar 

  5. International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol 2003;121:749–57.

    Article  Google Scholar 

  6. Pearse R, Sordillo E, Yaccoby S, et al. Multiple myeloma disrupts the TRANCE/osteoprotegerin cytokine axis to trigger bone destruction and promote tumor progression. Proc Natl Acad Sci USA 2001;98:11581–86.

    Article  PubMed  CAS  Google Scholar 

  7. Tian E, Zhan F, Walker R, et al. The role of the Wnt-signaling antagonist DKK1 in the development of osteolytic lesions in multiple myeloma. N Engl J Med 2003;349:2483–94.

    Article  PubMed  CAS  Google Scholar 

  8. Durie BG, Kyle RA, Belch A, et al. Myeloma management guidelines: a consensus report from the Scientific Advisors of the International Myeloma Foundation. Hematol J 2003;4:379–98.

    Article  PubMed  Google Scholar 

  9. Durie BGM, Salmon SE. A clinical staging system for multiple myeloma. Cancer 1975;36:842–54.

    Article  PubMed  CAS  Google Scholar 

  10. Lecouvet F, Malghem J, Michaux L, et al. Skeletal survey in advanced myeloma: radiographic versus MRI survey. Br J Haematol 1999;106:35–9.

    Article  PubMed  CAS  Google Scholar 

  11. Ghanem N, Lohrmann C, Engelhardt M, Pache G, Uhl M, Saueressig U, et al. Whole-body MRI in the detection of bone marrow infiltration in patients with plasma cell neoplasms in comparison to the radiological skeletal survey. Eur Radiol 2006;16:1005–1014, Epub 2006 Feb 4.

    Article  PubMed  Google Scholar 

  12. Moulopoulos LA, Dimopoulos MA, Weber DM, et al. Magnetic resonance imaging in the staging of solitary plasmacytoma of bone. J Clin Oncol 1993;11:1311–15.

    PubMed  CAS  Google Scholar 

  13. Edelstyn G, Gillespie P, Grebbell F. The radiological demonstration of osseous metastases. Clin Radiol 1967;18:158–62.

    Article  PubMed  CAS  Google Scholar 

  14. Mahnken AH, Wildberger JE, Gehbauer G, et al. Multidetector CT of the spine in multiple myeloma: comparison with MR imaging and radiography. AJR Am J Roentgenol 2002;178:1429–36.

    PubMed  CAS  Google Scholar 

  15. Mulligan M. Imaging techniques used in the diagnosis, staging, and follow-up of patients with myeloma. Acta Radiol 2005;46:716–24.

    Article  PubMed  CAS  Google Scholar 

  16. Alexandrakis MG, Kyriakou DS, Passam FH, Malliaraki N, Christophoridou AV, Karkavitsas N. Correlation between the uptake of Tc-99m-sestaMIBI and prognostic factors in patients with multiple myeloma. Clin Lab Haematol 2002;24:155–59.

    Article  PubMed  CAS  Google Scholar 

  17. Schirrmeister H, et al. Positron emission tomography (PET) for staging of solitary plasmacytoma. Cancer Biother Radiopharm 2003;18:841–45.

    Article  PubMed  Google Scholar 

  18. Baur-Melnyk A, Buhmann S, Durr H, Reiser M. Role of MRI for the diagnosis and prognosis of multiple myeloma. Eur J Radiol 2005;55:56–63.

    Article  PubMed  Google Scholar 

  19. Lecouvet F, Vande Berg B, Maldague B, et al. Vertebral compression fractures in multiple myeloma. Radiology 1997;204:195–99.

    PubMed  CAS  Google Scholar 

  20. Mulligan ME. Myeloma and lymphoma. Semin Musculoskelet Radiol 2000;4:127–35.

    Article  PubMed  CAS  Google Scholar 

  21. Lecouvet FE, Dechambre S, Malghem J, Ferrant A, Vande Berg BC, Maldague B. Bone marrow transplantation in patients with multiple myeloma: prognostic significance of MR imaging. AJR Am J Roentgenol 2001;176:91–6.

    PubMed  CAS  Google Scholar 

  22. Lecouvet F, De Nayer P, Garbar C, et al. Treated plasma cell lesions of bone with MRI signs of response to treatment: unexpected pathological findings. Skeletal Radiol 1998;27:692–95.

    Article  PubMed  CAS  Google Scholar 

  23. Nosas-Garcia S, Moehler T, Wasser K, et al. Dynamic contrast-enhanced MRI for assessing the disease activity of multiple myeloma: a comparative study with histology and clinical markers. J Magn Reson Imaging 2005;22:154–62.

    Article  PubMed  Google Scholar 

  24. Breyer R, Mulligan M, Smith S, Line B, Badros A. Comparison of FDG PET/CT to other imaging modalities in myeloma. Skeletal Radiol 2006; 35:632–40.

    Article  PubMed  Google Scholar 

  25. Bredella M, Steinbach L, Caputo G, Segall G, Hawkins R. Value of FDG PET in the assessment of patients with multiple myeloma. Am J Roentgenol 2005;184:1199–04.

    Google Scholar 

  26. Jadvar H, Conti PS. Diagnostic utility of FDG PET in multiple myeloma. Skeletal Radiol 2002;31:690–94.

    Article  PubMed  Google Scholar 

  27. Durie BG, Waxman AD, D’Agnolo A, Williams CM. Whole-body 18F-FDG PET identifies high-risk myeloma. J Nucl Med 2002;43:1457–63.

    PubMed  Google Scholar 

  28. Grangier C, Garcia J, Howarth N, May M, Rossier P. Role of MRI in the diagnosis of insufficiency fractures of the sacrum and acetabular roof. Skeletal Radiol 1997;9:517–24.

    Article  Google Scholar 

  29. Theodorou SJ, Theodorou DJ, Schweitzer M, Kakitsubata Y, Resnick D. Magnetic resonance imaging of para-acetabular insufficiency fractures in patients with malignancy. Clin Radiol 2006;61:181–90.

    Article  PubMed  CAS  Google Scholar 

  30. LeBihan DJ. Differentiation of benign versus pathologic compression fractures with diffusion-weighted MR imaging: a step closer toward the “holy grail” of tissue characterization. Radiology 1998;207:305–07.

    CAS  Google Scholar 

  31. Baur A, Huber A, Ertl-Wagner, et al. Diagnostic value of increased diffusion weighting of a steady-state free precession sequence for differentiating acute benign osteoporotic fractures from pathologic vertebral compression fractures. AJNR Am J Neuroradiol 2001;22:366–72.

    PubMed  CAS  Google Scholar 

  32. Castillo M. Diffusion-weighted imaging of the spine: is it reliable? AJNR Am J Neuroradiol 2003;24:1251–53.

    PubMed  Google Scholar 

  33. Laredo JD, Lakhdari K, Bellaiche L, Hamze B, Jankelwicz P, Tubiana JM. Acute vertebral collapse: CT findings in benign and malignant non-traumatic cases. Radiology 1995;194:41–8.

    PubMed  CAS  Google Scholar 

  34. Badros A, Weikel D, Salama A, et al. Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol 2006;24:945–52.

    Article  PubMed  CAS  Google Scholar 

  35. Migliorati CA, Schubert MM, Peterson DE, Seneda LM. Bisphosphonate-associated osteonecrosis of mandibular and maxillary bone: an emerging oral complication of supportive cancer therapy. Cancer 2005;104:83–93.

    Article  PubMed  CAS  Google Scholar 

  36. Lenz JH, Steiner-Krammer B, Schmidt W, Fietkau R, Mueller PC, Gundlach KK. Does avascular necrosis of the jaws in cancer patients only occur following treatment with bisphosphonates? J Craniomaxillofac Surg 2005;33:395–403, Epub 2005 Oct 25.

    PubMed  Google Scholar 

  37. Talamo G, Angtuaco E, Walker R, et al. Avascular necrosis of femoral and/or humeral heads in multiple myeloma. J Clin Oncol 2005;23:5217–23.

    Article  PubMed  CAS  Google Scholar 

  38. Blade J, Rosinol L. Renal, hematologic and infectious complications in multiple myeloma. Best Pract Res Clin Haematol 2005;18:635–52.

    Article  PubMed  CAS  Google Scholar 

  39. Augustson B, Begum G, Dunn JA, et al. Early mortality after diagnosis of multiple myeloma: analysis of patients entered onto the United Kingdom Medical Research Council trials between 1980 and 2002-Medical Research Council Adult Leukaemia Working Party. J Clin Oncol 2005;23:9219–26, Epub 2005 Nov 7.

    Article  PubMed  Google Scholar 

  40. Mahfouz T, Miceli MH, Saghafifar F, et al. 18F-fluorodeoxyglucose positron emission tomography contributes to the diagnosis and management of infections in patients with multiple myeloma: a study of 165 infectious episodes. J Clin Oncol 2005;23:7857–63, Epub 2005 Oct 3.

    Article  PubMed  CAS  Google Scholar 

  41. Hartman RP, Sundaram M, Okuno SH, Sim FH. Effect of granulocyte-stimulating factors on marrow of adult patients with musculoskeletal malignancies: incidence and MRI findings. AJR Am J Roentgenol 2004;183:645–53.

    PubMed  Google Scholar 

  42. Kazama T, Swantson N, Podoloff D, Macapinlac H. Effect of colony-stimulating factor and conventional- or high-dose chemotherapy on FDG uptake in bone marrow. Eur J Nucl Med Mol Imaging 2005;32:1406–11.

    Article  PubMed  CAS  Google Scholar 

  43. Larson S, Erdi Y, Akhurst T, et al. Tumor treatment response based on visual and quantitative changes in global tumor glycolysis using PET-FDG imaging. Clin Pos Imag 1999;2:159–71.

    Article  Google Scholar 

  44. Gorospe L, Raman S, Echeveste J, Avril N, Herrero Y, Herna Ndez S. Whole-body PET/CT: spectrum of physiological variants, artifacts and interpretative pitfalls in cancer patients. Nucl Med Commun 2005;26:671–87.

    Article  PubMed  Google Scholar 

  45. Cook G, Wegner E, Fogelman I. Pitfalls and artifacts in 18FDG PET and PET/CT oncologic imaging. 2004;34:122–33.

  46. Kuo P, Cheng D. Artifactual spinal metastases imaged by PET/CT: a case report. 2005;33:230–31.

  47. Strobel K, Bode B, Lardinois D, Exner U. PET-positive fibrous dysplasia–a potentially misleading incidental finding in a patient with intimal sarcoma of the pulmonary artery. Skeletal Radiol (in press).

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael E. Mulligan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mulligan, M.E., Badros, A.Z. PET/CT and MR imaging in myeloma. Skeletal Radiol 36, 5–16 (2007). https://doi.org/10.1007/s00256-006-0184-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-006-0184-3

Keywords

Navigation