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    Imaging, QoL and Patient-Reported Outcome and Supportive Care

    Category: Imaging, QoL and Patient-Reported Outcome and Supportive Care

    Assessment of Extraosseous Multiple Myeloma Using Whole-Body Imaging Techniques: PET/CT, MRI, and MIBI

    (PA-142) Assessment of Extraosseous Multiple Myeloma Using Whole-Body Imaging Techniques: PET/CT, MRI, and MIBI

    Wednesday, September 17, 2025

    Introduction:      The presence of extraosseous manifestations (EM) in multiple myeloma (MM), including both paramedullary and extramedullary involvement, is a significant negative prognostic factor. However, the detection of EM is limited by the variability and sensitivity of imaging techniques. Conventional X-ray imaging has very low sensitivity; therefore, more advanced whole-body imaging modalities are recommended.
    Our aim was to compare the efficacy of three whole-body imaging techniques - PET/CT, whole-body magnetic resonance imaging (MRI), and 99mTc-MIBI scintigraphy - in detecting EM in MM patients.


    Methods:   We analyzed a cohort of 80 MM patients who underwent all three imaging modalities. We evaluated the presence and number of EM lesions and assessed concordance between the methods. Outcomes were compared based on lesion detection (presence vs. absence) and the total number of lesions. Statistical analysis was performed using IBM SPSS Statistics (version 23), employing the Chi-squared test, Wilcoxon test, and Fisher’s exact test with Bonferroni correction. A p-value < 0.05 was considered statistically significant.

    Results:   

    The proportion of detected extraosseous manifestations (EM) varied by imaging modality. MRI detected no EM lesions in 92.5% of patients, one lesion in 6.3%, and three or more in 1.3%. PET/CT was more sensitive: 78.8% had no EM, 13.8% had one, 3.8% had two, and 3.8% had three or more lesions. MIBI scintigraphy had the lowest detection: 97.5% showed no lesions, 1.3% one lesion, and 1.3% three or more.

    Comparing MRI and PET/CT, both detected EM in 8.8% and no lesions in 77.5% of patients, with an overall concordance of 86.3% and discordance in 13.7%. PET/CT revealed significantly more EM than MRI (p = 0.001).

    MRI vs. MIBI showed EM detection in 2.5% and no lesions in 91.3%, with 93.8% concordance and 6.3% discordance. The difference was not statistically significant (p = 0.063), though MRI had slightly better sensitivity.

    PET/CT vs. MIBI: both detected EM in 2.5% and no lesions in 77.5%, with 80.0% concordance and 20.0% discordance. PET/CT showed a significantly higher EM detection rate (p < 0.0001).

    Wilcoxon test showed significant differences in lesion numbers between PET/CT and MRI (p = 0.003), and PET/CT and MIBI (p = 0.0004); the MRI vs. MIBI difference was not significant (p = 0.076).

    Conclusions:   Whole-body imaging plays a crucial role in the diagnosis and prognostication of multiple myeloma. While all three imaging techniques showed high concordance, PET/CT demonstrated significantly higher sensitivity in detecting extraosseous lesions and should be considered the preferred method when available.

    Supported by MH CZ – DRO (FNOl, 00098892) and IGA_LF_2025_005