Mesguich Charles, Fardanesh Reza, Tanenbaum Lawrence, Chari Ajai, Jagannath Sundar, Kostakoglu Lale
Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Eur J Radiol. 2014 Dec;83(12):2203-2223. doi: 10.1016/j.ejrad.2014.09.012. Epub 2014 Sep 28.
18-Flurodeoxyglucose Positron Emission Tomography with computed tomography (FDG PET/CT) and Magnetic Resonance Imaging (MRI) have higher sensitivity and specificity than whole-body X-ray (WBXR) survey in evaluating disease extent in patients with multiple myeloma (MM). Both modalities are now recommended by the Durie-Salmon Plus classification although the emphasis is more on MRI than PET/CT. The presence of extra-medullary disease (EMD) as evaluated by PET/CT imaging, initial SUVmax and number of focal lesions (FL) are deemed to be strong prognostic parameters at staging. MRI remains the most sensitive technique for the detection of diffuse bone marrow involvement in both the pre and post-therapy setting. Compression fractures are best characterized with MRI signal changes, for determining vertebroplasty candidates. While PET/CT allows for earlier and more specific evaluation of therapeutic efficacy compared to MRI, when signal abnormalities persist years after treatment. PET/CT interpretation, however, can be challenging in the vertebral column and pelvis as well as in cases with post-therapy changes. Hence, a reading approach combining the high sensitivity of MRI and superior specificity of FDG PET/CT would be preferred to increase the diagnostic accuracy. In summary, the established management methods in MM, mainly relying on biological tumor parameters should be complemented with functional imaging data, both at staging and restaging for optimal management of MM.
18-氟脱氧葡萄糖正电子发射断层扫描与计算机断层扫描（FDG PET/CT）及磁共振成像（MRI）在评估多发性骨髓瘤（MM）患者的疾病范围方面，比全身X线（WBXR）检查具有更高的敏感性和特异性。尽管Durie-Salmon Plus分类法更侧重于MRI而非PET/CT，但现在这两种检查方式均被推荐使用。通过PET/CT成像评估的髓外疾病（EMD）的存在、初始SUVmax及局灶性病变（FL）的数量被认为是分期时强有力的预后参数。MRI仍然是检测治疗前和治疗后弥漫性骨髓受累最敏感的技术。对于确定椎体成形术的候选患者，压缩性骨折通过MRI信号变化能得到最佳的特征描述。与MRI相比，PET/CT能够对治疗效果进行更早且更具特异性的评估，尤其是在治疗后数年信号异常仍然持续存在的情况下。然而，PET/CT在脊柱和骨盆以及存在治疗后改变的病例中的解读可能具有挑战性。因此，将MRI的高敏感性与FDG PET/CT的卓越特异性相结合的解读方法，将更有助于提高诊断准确性。总之，MM既定的管理方法主要依赖生物学肿瘤参数，在分期和再分期时均应以功能成像数据作为补充，以实现MM的最佳管理。
