Comparison of the diagnostic performance and impact on management of 18F-FDG PET/CT and whole body MRI in multiple myeloma

Olwen Westerland, Ashik Amlani, Christian Kelly-Morland, Michal Fraczek, Katherine Bailey, Mary Gleeson, Inas El-Najjar, Matthew Streetly, Paul Bassett, Gary Cook, Vicky Goh, The Myeloma Imaging Research Group at Guy’s & St Thomas’ Hospital, London and King’s College London, Joanna Bell, Isabel Dregely, Adrian Green, Renyang Gu, Ulrike Haberland, Sami Jeljeli, Majid Kazmi, Nessa MuhidunSarah Natas, Radhouene Neji, Francesco Padormo, John Spence, J. James Stirling, Manil Subesinghe, Hema Verma, Zaid Viney

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)


Purpose: Comparative data on the impact of imaging on management is lacking for multiple myeloma. This study compared the diagnostic performance and impact on management of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and whole-body magnetic resonance imaging (WBMRI) in treatment-naive myeloma. Methods: Forty-six patients undergoing 18F-FDG PET/CT and WBMRI were reviewed by a nuclear medicine physician and radiologist, respectively, for the presence of myeloma bone disease. Blinded clinical and imaging data were reviewed by two haematologists in consensus and management recorded following clinical data ± 18F-FDG PET/CT or WBMRI. Bone disease was defined using International Myeloma Working Group (IMWG) criteria and a clinical reference standard. Per-patient sensitivity for lesion detection was established. McNemar test compared management based on clinical assessment ± 18F-FDG PET/CT or WBMRI. Results: Sensitivity for bone lesions was 69.6% (32/46) for 18F-FDG PET/CT (54.3% (25/46) for PET component alone) and 91.3% (42/46) for WBMRI. 27/46 (58.7%) of cases were concordant. In 19/46 patients (41.3%) WBMRI detected more focal bone lesions than 18F-FDG PET/CT. Based on clinical data alone, 32/46 (69.6%) patients would have been treated. Addition of 18F-FDG PET/CT to clinical data increased this to 40/46 (87.0%) patients (p = 0.02); and WBMRI to clinical data to 43/46 (93.5%) patients (p = 0.002). The difference in treatment decisions was not statistically significant between 18F-FDG PET/CT and WBMRI (p = 0.08). Conclusion: Compared to 18F-FDG PET/CT, WBMRI had a higher per patient sensitivity for bone disease. However, treatment decisions were not statistically different and either modality would be appropriate in initial staging, depending on local availability and expertise.

Original languageEnglish
Pages (from-to)2558-2565
Number of pages8
JournalEuropean journal of nuclear medicine and molecular imaging
Issue number8
Early online date19 Jan 2021
Publication statusPublished - 1 Jul 2021


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