Assessment of New Bone Lesions in Treated Multiple Myeloma

Primary Imaging Modalities for Bone Lesion Assessment

The International Myeloma Society recommends WBLD-CT as the standard procedure for detecting lytic bone disease in multiple myeloma patients with high-quality evidence supporting its use 1, 4
WBLD-CT can detect up to 60% more relevant findings compared to conventional skeletal surveys, leading to treatment changes in up to 20% of patients 2
WBLD-CT is quick to perform and provides more accurate evaluation of areas with instability or fracture risk 5

FDG-PET/CT is particularly valuable for evaluating extramedullary disease, assessing treatment response in nonsecretory and oligosecretory myeloma, defining complete or stringent complete response, and detecting disease progression 1, 2, 3, 4, 5
If using PET/CT instead of WBLD-CT, ensure the CT component has imaging quality equivalent to WBLD-CT, not just for attenuation correction 6
MRI can be useful in patients with smoldering multiple myeloma, as 30-50% of such patients will have bone marrow abnormalities 2

The National Comprehensive Cancer Network recommends WBLD-CT as the primary imaging modality for baseline assessment and regular bone disease monitoring 1, 4, 5
Minimum assessment frequency of every 3 months during active treatment 3

Skull and rib lesions are not well detected by WBLD-CT or MRI compared to conventional skeletal surveys; focused X-rays may still be valuable if these areas are of concern 2
MRI and radiographs cannot always differentiate between treated bone marrow lesions and viable neoplastic tumors; PET/CT may help in these cases 7

Combine imaging assessment with regular monitoring of serum and/or urine M-protein values and serum free light chain levels 2, 3
Assess response with each treatment cycle during active therapy to determine treatment effectiveness 3