Whole body magnetic resonance imaging (MRI) is the most sensitive method for identifying myeloma bone disease, British researchers have reported.
Professor Vicky Goh and colleagues from King’s College London have published their comparison of different techniques in the European Journal of Nuclear Medicine and Molecular Imaging.
Current guidelines for the skeletal assessment of myeloma “are pragmatic, recognising that the imaging modality choice is often influenced by local availability, expertise, and cost”, say the researchers.
But they state: “It is important that the selected baseline imaging test is sufficiently sensitive to detect small volume disease with high specificity and impacts on patient management.”
They compared the use of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) against whole-body MRI on 46 patients with confirmed or suspected myeloma.
Scan results were assessed by a nuclear medicine physician and a radiologist for evidence of myeloma bone disease. Then the scans were reviewed by two haematologists.
Their study showed that whole body MRI was more sensitive when highlighting bone disease than PET/CT.
Professor Goh said: “Our results showed that imaging with whole body MRI changed how patients would have been managed by their doctors in 24% of cases, where review of clinical data alone would have resulted in surveillance only.”
“What this ultimately means for patients is improved outcomes from earlier treatment.”
She believes that the study supports the National Institute for Health and Care Excellence (NICE) guidance, that whole body MRI should be performed as a first-line imaging test for suspected myeloma.
The researchers conclude “either modality would be appropriate in initial staging, depending on local availability and expertise”.
Westerland O, Amlani A, Kelly-Morland C, Fraczek M, Bailey K, Gleeson M, El-Najjar I, Streetly M, Bassett P, Cook GJR, Goh V, on behalf of the Myeloma Imaging Research Group at Guy’s & St Thomas’ Hospital, London and King’s College London. (2021) “Comparison of the diagnostic performance and impact on management of 18F-FDG PET/CT and whole-body MRI in multiple myeloma.” European Journal of Nuclear Medicine and Molecular Imaging, doi: 10.1007/s00259-020-05182-2
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