Diagnostic performance of F-18-FDG PET/CT and whole-body MRI before and early after treatment of multiple myeloma: a prospective comparative study

To determine the diagnostic accuracy of WB-MRI and F-18-FDG PET/CT in detecting infiltration pattern, disease activity, and response to treatment in patients with multiple myeloma (MM). Fifty-six patients with confirmed MM were included in the present study for pre-treatment evaluation. Among these individuals, 22 patients were available for the post-treatment evaluation of response to therapy. All patients were imaged with both WB-MRI and F-18-FDG PET/CT. All radiographic findings of infiltration pattern, disease activity, and response to therapy were compared. The diagnostic performance of both modalities was estimated using bone marrow aspirate and biopsy as the reference test. For detection of active myelomatous tissue at diagnosis, WB-MRI achieved higher sensitivity (94%) than F-18-FDG PET/CT (75%) (p = 0.0039), whereas both modalities achieved the same specificity (80%). For detection of residual myelomatous tissue after treatment, F-18-FDG PET/CT achieved higher specificity (86%) than WB-MRI (43%) (p = 0.0081), whereas both modalities achieved the same sensitivity (75%). WB-MRI is more sensitive than F-18-FDG PET/CT in the diagnosis of MM before treatment; however, F-18-FDG PET/CT is more specific than WB-MRI in detecting residual involvement in treated patients.