ASH 2024 | Advancing myeloma imaging: the role of whole-body MRI

So we have actually done collaborative work for many years now on improving imaging methods for myeloma and we have particularly worked interdisciplinary with colleagues from radiology to look at what could be the best and most sensitive method to identify myeloma in the bone marrow. It’s difficult to get through the bones of course to understand where the disease sits. Traditionally, PET-CT was used most, but more recent work has defined a very elaborate way of programming an MRI scanner effectively to run a very specific whole-body MRI program for myeloma. It includes diffusion-weighted sequences. It also includes Dixon sequences to look at the fat fraction of the bone marrow. These are very technical terms, of course, but ultimately what it means is we have a tool at hand now that was compared head-to-head with PET-CT and it is more sensitive. It also has an advantage in that it doesn’t need contrast media. Many whole-body MRI protocols are actually just copied over from orthopedics departments which is not the right way. There is a guideline paper called MI-RADS which gives access to open-access protocols and radiologists can get trained and download these for all different types of scanners for free. And this protocol does not need contrast media, can normally be done in 50 minutes and actually, there are now protocols in the making that can reduce that to 30 minutes. Now what is the advantage of having such a sensitive tool? We actually know that every bone lytic lesion, for example, is preceded by soft tissue first growing in the bone marrow without causing damage. And such a highly sensitive imaging tool, of course, can spot disease activity years before it really causes the damage. And that’s even more sensitive than PET-CT. So I think it changes our approach to screening and keeping smoldering myeloma patients safe. It’s actually helping us to categorize patients correctly at diagnosis. It picks up extramedullary disease really well. And most importantly, it can be used for response assessment in contrast to traditional MRI. The so-called diffusion-weighted sequences show when a disease responds. So actually, we are hopeful that it will be included in upfront and future response criteria by the International Myeloma Working Group, because it is such a versatile tool.

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