Cancer Treatment Today

MRI used not to be a part of a myeloma staging workup. For bone disease, a bone survey was usually recommended. More recently guidelines have taken a more positive view of MRI. CT or magnetic resonance imaging (MRI) is indicated to delineate the nature and extent of soft tissue disease and these two imaging techniques can give complementary information. MRI is the technique of choice for investigation of patients with a neurological presentation suggestive of cord compression. MRI of the whole spine should be performed in patients with an apparently solitary plasmacytoma of bone irrespective of site of the index lesion. CT or MRI should be employed for evaluation of symptomatic areas where plain radiographs are negative. The most recent consensus was published in 2011 in Blood. It recommends: “An MRI of the spine and pelvis is mandatory in all patients with a presumed diagnosis of solitary plasmacytoma. An MRI should also be considered in patients with smoldering (asymptomatic) myeloma because it can detect occult lesions and, if positive, can predict for more rapid progression to symptomatic myeloma. MRI can be considered in patients with symptomatic myeloma as routine evaluation because (1) unsuspected focal lesion and soft tissue plasmacytomas involving the spine and pelvis can be visualized; and (2) patterns of MRI abnormality (ie, diffuse pattern or a high number of focal lesions) may have prognostic significance. However, MRI is mandatory in symptomatic patients for a detailed evaluation of a painful area of the skeleton to look for a soft tissue mass arising from a bone lesion or for the investigation of patients with a suspicion of cord compression, providing an accurate assessment of the level and extent of cord or nerve root compression, size of the tumor mass, and degree to which it may affect the epidural space. An MRI of the spine is valuable in defining the etiology of new, painful collapsed vertebra (ie, because of osteoporosis or myelomatous involvement). Osteoporosis with compression fracture requires thorough evaluation with an MRI. If a focal myelomatous lesion is detected, then the patient has symptomatic.”

NCCN says “consider MRI *Category 2a”. On p. Myel-1, it says that, “MRI is useful in some circumstances.” More recently, several studies suggest that blood tests are sufficient to follow patients after transplant(Zamarin etal) and .

Meletios Dimopoulos Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel 3 Blood May 5, 2011 vol. 117 no. 18 4701-4705

HR, Reiser M.Role of MRI for the diagnosis and prognosis” of multiple myeloma. Baur-Melnyk A, Buhmann S, Dürr Eur J Radiol. 2005 Jul;55(1):56-63.

Smith A, Wisloff F, Samson D, UK Myeloma Forum, Nordic Myeloma Study Group, British Committee for Standards in Haematology. Guidelines on the diagnosis and management of multiple myeloma 2005. Br J Haematol 2006 Feb;132(4):410-51. [292 references]

Baur-Melnyk, Andrea, Buhmann, Sonja, Becker, Christoph, Schoenberg, Stefan Oswald, Lang, Nicola, Bartl, Reiner, Reiser, Maximilian Ferdinand Whole-Body MRI Versus Whole-Body MDCT for Staging of Multiple Myeloma Am. J. Roentgenol. 2008 190: 1097-1104

Dimopoulos MA et al.International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple myeloma, Leukemia (2009), 1-12.

D Zamarin, S Giralt, H Landau, N Lendvai, A Lesokhin, D Chung, G Koehne, D Chimento, S M Devlin, E Riedel, M Bhutani, D Babu and H Hassoun, Patterns of relapse and progression in multiple myeloma patients after auto-SCT: implications for patients’ monitoring after transplantation, Bone Marrow Transplantation , (13 August 2012)

P. Spinnato et al, Contrast enhanced MRI and 18F-FDG PET-CT in the assessment of multiple myeloma: A comparison of results in different phases of the disease European Journal of Radiology Volume 81, Issue 12 , Pages 4013-4018, December 2012