Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200, Brussels, Belgium.
Haematology Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), 1200, Brussels, Belgium.
Skeletal Radiol. 2022 Jan;51(1):59-80. doi: 10.1007/s00256-021-03841-5. Epub 2021 Aug 7.
Bone imaging has been intimately associated with the diagnosis and staging of multiple myeloma (MM) for more than 5 decades, as the presence of bone lesions indicates advanced disease and dictates treatment initiation. The methods used have been evolving, and the historical radiographic skeletal survey has been replaced by whole body CT, whole body MRI (WB-MRI) and [F]FDG-PET/CT for the detection of bone marrow lesions and less frequent extramedullary plasmacytomas.Beyond diagnosis, imaging methods are expected to provide the clinician with evaluation of the response to treatment. Imaging techniques are consistently challenged as treatments become more and more efficient, inducing profound response, with more subtle residual disease. WB-MRI and FDG-PET/CT are the methods of choice to address these challenges, being able to assess disease progression or response and to detect "minimal" residual disease, providing key prognostic information and guiding necessary change of treatment.This paper provides an up-to-date overview of the WB-MRI and PET/CT techniques, their observations in responsive and progressive disease and their role and limitations in capturing minimal residual disease. It reviews trials assessing these techniques for response evaluation, points out the limited comparisons between both methods and highlights their complementarity with most recent molecular methods (next-generation flow cytometry, next-generation sequencing) to detect minimal residual disease. It underlines the important role of PET/MRI technology as a research tool to compare the effectiveness and complementarity of both methods to address the key clinical questions.
骨骼成像是多发性骨髓瘤（MM）诊断和分期的重要手段，已经有超过 50 年的历史，因为骨病变的存在表明疾病处于晚期，并决定了治疗的开始。所使用的方法一直在不断发展，历史上的放射性骨骼检查已经被全身 CT、全身 MRI（WB-MRI）和 [F]FDG-PET/CT 所取代，用于检测骨髓病变和较少发生的髓外浆细胞瘤。除了诊断外，影像学方法还期望为临床医生提供对治疗反应的评估。随着治疗越来越有效，导致更明显的反应和更微妙的残留疾病，成像技术不断受到挑战。WB-MRI 和 FDG-PET/CT 是应对这些挑战的首选方法，能够评估疾病的进展或反应，并检测“微小”残留疾病，提供关键的预后信息，并指导必要的治疗改变。本文提供了 WB-MRI 和 PET/CT 技术的最新概述，介绍了它们在有反应和进展性疾病中的观察结果，以及它们在检测微小残留疾病方面的作用和局限性。它回顾了评估这些技术用于反应评估的试验，指出了这两种方法之间的有限比较，并强调了它们与最近的分子方法（下一代流式细胞术、下一代测序）的互补性，以检测微小残留疾病。它强调了 PET/MRI 技术作为一种研究工具的重要作用，用于比较这两种方法的有效性和互补性，以解决关键的临床问题。
