This article presents the recommendations of the International Myeloma Working Group regarding the use of magnetic resonance imaging (MRI) in the management of multiple myeloma (MM). ​ The aim of these recommendations is to provide practical guidance for the use of MRI in the diagnosis, staging, and monitoring of MM. ​

Important Points:

1. MRI has high sensitivity for the early detection of marrow infiltration by myeloma cells compared with other radiographic methods. ​
2. MRI is the gold standard for imaging the axial skeleton, evaluating painful lesions, and distinguishing benign versus malignant osteoporotic vertebral fractures. ​
3. MRI can detect spinal cord or nerve compression and the presence of soft tissue masses. ​
4. MRI is recommended for the workup of solitary bone plasmacytoma. ​
5. For smoldering or asymptomatic myeloma, all patients should undergo whole-body MRI (WB-MRI) or spine and pelvic MRI if WB-MRI is not available. ​
6. The presence of even asymptomatic bone disease on conventional radiography is a criterion of symptomatic MM that requires treatment. ​
7. Several MRI techniques, including T1 weighted, T2 weighted with fat suppression, short time inversion recovery, and gadolinium T1 weighted with fat suppression, can be used for the assessment of bone marrow involvement in MM. ​
8. Diffusion-weighted imaging (DWI) is a functional MRI technique that can detect regions with bone marrow infiltration for both diagnosis and monitoring of treatment response. ​
9. Dynamic contrast-enhanced MRI (DCE-MRI) assesses the distribution of a contrast agent inside and outside the blood vessels and provides data for blood volume and vessel permeability for the assessment of microcirculation. ​
10. PET in combination with MRI is a novel methodology that detects active focal lesions and shows the location of the lesions and provides information on myeloma cell infiltration of the bone marrow. ​
11. Five MRI patterns of marrow involvement in myeloma have been recognized: normal appearance of bone marrow, focal involvement, homogeneous diffuse infiltration, combined diffuse and focal infiltration, and variegated or salt-and-pepper pattern with inhomogeneous bone marrow with interposition of fat islands. ​
12. The Durie-Salmon PLUS system uses the number of focal lesions for the staging of a patient with myeloma rather than the diffuse or salt-and-pepper pattern. ​

In conclusion, MRI plays a crucial role in the diagnosis, staging, and monitoring of MM. ​ It provides valuable information on bone marrow involvement, detection of focal lesions, and assessment of treatment response. ​ The recommendations provided by the International Myeloma Working Group aim to standardize the use of MRI in the management of MM and improve patient outcomes. ​

Authors: 

Meletios A. Dimopoulos, Jens Hillengass, Saad Usmani, Elena Zamagni, Suzanne Lentzsch, Faith E. Davies, Noopur Raje, Orhan Sezer, Sonja Zweegman, Jatin Shah, Ashraf Badros, Kazuyuki Shimizu, Philippe Moreau, Chor-Sang Chim, Juan José Lahuerta, Jian Hou, Artur Jurczyszyn, Hartmut Goldschmidt, Pieter Sonneveld, Antonio Palumbo, Heinz Ludwig, Michele Cavo, Bart Barlogie, Kenneth Anderson, G. David Roodman, S. Vincent Rajkumar, Brian G.M. ​​ Durie, and Evangelos Terpos. ​​

Citation:

J Clin Oncol 33:657-664.
https://doi.org/10.1200/JCO.2014.57.996 (https://doi.org/10.1200/JCO.2014.57.9961)