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E1394. Imaging in the Diagnosis and Prognosis of Multiple Myeloma
Authors
  1. Majid Mohamed; King's College Hospital NHS Foundation Trust
  2. Dennis Bielecki; King's College Hospital NHS Foundation Trust; King's College, London, UK
Background
Bone lesions are the most common clinical features of multiple myeloma. For this reason, imaging is now a crucial part of the management of patients with multiple myeloma. Skeletal survey, Whole Body Low Dose Computerized Tomography (WBLDCT), Fluorodeoxyglucose (FDG)-PET/CT(positron emission tomography/computerized tomography), MRI (Magnetic resonance imaging), are some of the imaging modalities that have all been explored in the management of such patients. The International Myeloma Working Group have created certain recommendations on imaging in Multiple Myeloma. Furthermore, there is evidence to suggest that the use of certain imaging techniques help in predicting the result and assessing the response to treatment.

Educational Goals / Teaching Points
To explore the different imaging modalities utilised in Multiple Myeloma, To demonstrate the principle imaging findings noted in each imaging modality, and To make comparison regarding imaging reliability, and the assistance in the management of Multiple Myeloma. The target audience includes medical students, radiology residents, radiologists and other physicians interested in this disease process.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Radiological Features - In Myeloma, the most common imaging pattern are lytic bone lesions, and sometimes many sites are affected, and at other times, there are solitary lesions. The axial skeleton is most commonly affected. Many lesions are usually found in the spine, ribs, skull, pelvis and femur in the descending order of frequency. Solitary lesions have a similar distribution. In other cases, lesions have affected the appendicular skeleton as well. In one third of cases, the jaw is affected as well. In 1% of cases, myeloma lesions may be sclerotic in nature. Osteosclerosing (or osteosclerotic) myeloma is an uncommon form of multiple myeloma. It may manifest as multiple sclerotic lesions or areas of diffuse osteosclerosis.

Conclusion
Skeletal Survey is limited and is now obsolete replaced with better sensitive cross-sectional imaging modalities. WBLDCT is better than skeletal survey for spotting focal osteolytic bone disease. However, it is inconsistent in evaluating early disease. Furthermore, it is difficult to differentiate between active and treated disease. Whole Body Diffuse Weighted-MRI and FDG PET/CT are being used more commonly in the diagnosis, prognosis and evaluation of the response to treatment. Whole Body Diffuse Weighted-MRI has the best sensitivity amongst imaging modalities for picking up focal lesions and diffuse infiltration of bone marrow. FDG PET/CT has lower sensitivity in comparison to Whole Body-MRI for diffuse bone marrow infiltration. However, FDG PET/CT plays a crucial role in the prognosis. FDG PET/CT can pick up residual disease after treatment. The use of MRI at this stage has been favourable. It seems that both Whole Body Diffuse Weighted MRI and FDG PET/CT play a crucial part in evaluating the response to treatment. In conclusion, the use of advanced combined multimodal imaging allows a better evaluation.