Detecting and Staging Multiple Myeloma Using MRI

A recent study published in the American Journal of Roentgenology compared the detection rate of bone lesions and assessed accuracy of staging in whole-body MRI and whole-body multidetector CT, and found that whole-body MRI leads to a significantly higher detection rate and stagings in patients with multiple myeloma.

About 10% percent of all hematologic malignancies are secondary to multiple myeloma, and detection of skeletal involvement is critical for staging, treatment planning and prognosis for patients with multiple myeloma.

Myeloma can present with multiple punched-out lesions, but can also be diffusely infiltrating, mimicking osteoporosis. Prior studies demonstrated radiographs to be false negative in 30–70% of the cases.

The prospective study enrolled 41 newly diagnosed patients. All had whole-body multidetector CT, whole-body MRI, and iliac crest biopsies. Both CT and MRI were performed from the skull to the knees.

MRI Results

• On MRI, 15 patients had no involvement, and 26 patients had 975 regions affected.
• Thirteen patients had focal disease, and 13 patients had combined diffuse and focal involvement.
• Twenty patients had multifocal disease, and one patient had only diffuse disease.
• On the Durie and Salmon PLUS staging system, 21 patients were stage I, two patients were stage II, and 18 were stage III.

CT Results

• On multidetector CT, 19 patients had no involvement.
• In 22 patients, 462 regions were affected.
• Nine patients had multifocal disease.
• According to the Durie and Salmon PLUS staging system, 25 patients were stage I, seven were stage II and nine were stage III.
• Concordance was shown in 15 patients with no involvement and four patients with focal involvement.

Whole-body cross-sectional imaging showed replaced radiographs to be ideal with MRI, but if that is not feasible, multidetector CT should be performed.

The radiation dose for a low-dose CT is only slightly more than for a skeletal survey. This is not significant in a tumor patient with limited survival.

The study concludes that whole-body MRI leads to a significantly higher detection rate and stagings than whole-body multidetector CT in patients with multiple myeloma.

—

Author: Cornelia Wenokor, MD

Reference: Baur-Melnyk A, Buhmann S, et al. Whole-Body MRI Versus Whole-Body MDCT for Staging of Multiple Myeloma. AJR Am J Roentgenol 2008; 190 (April): 1097–1104.

—–

NEW CME Course:
Diagnostic Imaging Review: For Residents, Fellows and Radiologists
UCSF’s Department of Radiology and Biomedical Imaging recently conducted its annual radiology review course. It will soon be available in two video formats to meet your needs— DVD and MP4.
Order Now at the pre-publication price & SAVE $100!
Diagnostic Imaging Review