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COMy 2025 | Bone disease evaluation in newly diagnosed myeloma with PET-CT vs whole-body diffusion-weighted MRI
Marco Talarico, MD, University of Bologna, Bologna, Italy, comments on the diagnostic performance of whole-body diffusion-weighted MRI versus PET-CT in newly diagnosed multiple myeloma (MM), highlighting the superiority of MRI in detecting focal lesions and paraskeletal disease, as well as its perfect concordance with PET-CT in detecting extramedullary disease. This interview took place at the 11th World Congress on Controversies in Multiple Myeloma (COMy) congress in Paris, France.
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Transcript
In Bologna, we are conducting a prospective study including patients with a new diagnosis of multiple myeloma, with the aim of comparing diagnostic performance of PET-CT and whole-body-diffusion-weighted MRI, both at staging and in response assessment. We have observed that whole-body-diffusion-weighted MRI has a significant superiority versus PET-CT in detection of both focal lesions in all skeletal districts except from the skull and in detection of paraskeletal disease...
In Bologna, we are conducting a prospective study including patients with a new diagnosis of multiple myeloma, with the aim of comparing diagnostic performance of PET-CT and whole-body-diffusion-weighted MRI, both at staging and in response assessment. We have observed that whole-body-diffusion-weighted MRI has a significant superiority versus PET-CT in detection of both focal lesions in all skeletal districts except from the skull and in detection of paraskeletal disease.
I also want to underline that the two techniques have a perfect concordance in detection of extramedullary disease. We know that PET-CT has always been considered the standard and recommended technique for detection of extramedullary disease, but even though we have a small amount of patients with the EMD in our study, the concordance was perfect between the two techniques. We also observed a slight concordance in detection of diffuse disease, and this is something that we are going to study more.
The International Myeloma Working Group recommends full-body low-dose CT as the minimum requirement for diagnosis of multiple myeloma-related bone disease, whereas PET-CT is currently considered a potential alternative. And this is right now recommended for response assessment for the study of imaging minimal residual disease. However, MRI studies right now are recommended in patients without CT or PET-CT assessed osteolytic lesions and in absence of other myeloma-defining events. However, whole-body diffusion-weighted MRI has a significantly greater sensitivity than PET-CT. And so standard first-line imaging technique when and where it is available. But I also want to underline that the two techniques in our study have a great concordance also in response assessment. And this suggests that the whole-body diffusion-weighted MRI could become an alternative technique to PET-CT also in assessing of imaging MRD.
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