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World J Orthop. Jul 18, 2014; 5(3): 272-282
Published online Jul 18, 2014. doi: 10.5312/wjo.v5.i3.272
Imaging of multiple myeloma: Current concepts
Thorsten Derlin, Peter Bannas
Thorsten Derlin, Peter Bannas, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, DE-20246 Hamburg, Germany
Author contributions: Both Derlin T and Bannas P designed and wrote the article.
Correspondence to: Dr. Thorsten Derlin, MD, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr 52, DE-20246 Hamburg, Germany.
Telephone: +49-40-741056146 Fax: +49-40-741055181
Received: December 24, 2013
Revised: February 11, 2014
Accepted: April 9, 2014
Published online: July 18, 2014

Medical imaging is of crucial importance for diagnosis and initial staging as well as for differentiation of multiple myeloma (MM) from other monoclonal plasma cell diseases. Conventional radiography represents the reference standard for diagnosis of MM due to its wide availability and low costs despite its known limitations such as low sensitivity, limited specificity and its inability to detect extraosseous lesions. Besides conventional radiography, newer cross-sectional imaging modalities such as whole-body low-dose computed tomography (CT), whole-body magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT are available for the diagnosis of osseous and extraosseous manifestations of MM. Whole-body low-dose CT is used increasingly, replacing conventional radiography at selected centers, due to its higher sensitivity for the detection of osseous lesions and its ability to diagnose extraosseous lesions. The highest sensitivity for both detection of bone marrow disease and extraosseous lesions can be achieved with whole-body MRI and 18F-FDG PET/CT. According to current evidence, MRI is the most sensitive method for initial staging while 18F-FDG PET/CT allows monitoring of treatment of MM. There is an evolving role for assessment of treatment response using newer MR imaging techniques. Future studies are needed to further define the exact role of the different imaging modalities for individual risk stratification and therapy monitoring.

Keywords: Multiple myeloma, Plasmocytoma, X-Ray, Magnetic resonance imaging, Diffusion-weighted imaging, Positron emission tomography-computed tomography, Imaging

Core tip: A comprehensive review about state-of-the-art imaging of multiple myeloma with a focus on whole-body imaging techniques including computed tomography (CT), magnetic resonance imaging and positron emission tomography/CT which are increasingly used for detection and visualization of both osseous and extraosseous myeloma manifestations.