COMy 2026 | How may whole body MRI enhance patient management strategies in myeloma?

So, myeloma for a long time was hard to track in terms of its location inside the bone marrow. It’s a disease that of course is hidden to most imaging techniques. We had for a long time FDG PET-CT which showed at least those tumors that had a lot of glucose uptake. But we knew already for a long time that a lot of tumors are just growing slowly and they’re not really visible on PET-CT. So, one of the things that our research, but also other groups of research, has shown that whole-body MRI, including diffusion-weighted imaging, which is a new technology that is radiation-free, can look inside the bone marrow and find myeloma activity down to a millimeter size. And because it doesn’t depend on the tumor being very active or proliferative, it also finds disease that is relatively quiet. It has a consistently higher sensitivity. We see not only smaller areas of disease, we also see more areas of disease than we have ever seen on FDG PET-CT in a prospective direct comparison of the two technologies. That changes actually quite a lot in patient management because we have been very lucky to have this technology partly developed at our institution with an excellent radiology colleague, Professor Christina Messiou. We have been using it in standard care for over 10 years now. Our recent paper really encapsulates whether now is the time where we have much more efficacious treatments, where we really need to think about how to use imaging as well as part of precision care and how whole-body MRI can play an important role in this. So why is that the case? It’s the case because we see not only upfront disease in places sometimes where other imaging modalities might miss it. We can, for example, see also extramedullary disease at more resolution. And we do know that that might mean a patient might benefit from more intensive treatments or different treatment approaches. But we can also monitor disease response with whole-body MRI really well, including very early responses that are seen in the diffusion-weighted imaging. That, of course, can help us together with other monitoring tools, such as MRD by bone marrow, by clonoSEQ, or other methodologies, to really assess whether a patient has responded everywhere to a treatment. And that’s not always a given. If we find that there is a residual spot of disease activity, we need to develop new concepts. In standard care, for example, we can apply radiotherapy to a single remaining lesion as an individual treatment approach. But I think there is other opportunities that will open up. The more we use high-resolution diagnostics like this, the more we understand which patient may need more or less treatment and how we can personalize care in context of our treatments getting ever so better.

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