Role of Magnetic Resonance Imaging in the Management of Patients With Multiple Myeloma: A Consensus Statement.
Abstract
PURPOSE: The
aim of International Myeloma Working Group was to develop practical
recommendations for the use of magnetic resonance imaging (MRI) in
multiple myeloma (MM).
METHODS: An
interdisciplinary panel of clinical experts on MM and myeloma bone
disease developed recommendations for the value of MRI based on data
published through March 2014.
RECOMMENDATIONS: MRI
has high sensitivity for the early detection of marrow infiltration by
myeloma cells compared with other radiographic methods. Thus, MRI
detects bone involvement in patients with myeloma much earlier than the
myeloma-related bone destruction, with no radiation exposure. It is the
gold standard for the imaging of axial skeleton, for the evaluation of
painful lesions, and for distinguishing benign versus malignant
osteoporotic vertebral fractures. MRI has the ability to detect spinal
cord or nerve compression and presence of soft tissue masses, and it is
recommended for the workup of solitary bone plasmacytoma. Regarding
smoldering or asymptomatic myeloma, all patients should undergo
whole-body MRI (WB-MRI; or spine and pelvic MRI if WB-MRI is not
available), and if they have > one focal lesion of a diameter > 5
mm, they should be considered to have symptomatic disease that requires
therapy. In cases of equivocal small lesions, a second MRI should be
performed after 3 to 6 months, and if there is progression on MRI, the
patient should be treated as having symptomatic myeloma. MRI at
diagnosis of symptomatic patients and after treatment (mainly after
autologous stem-cell transplantation) provides prognostic information;
however, to date, this does not change treatment selection.
© 2015 by American Society of Clinical Oncology.