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    Imaging, QoL and Patient-Reported Outcome and Supportive Care

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

    Role of the combination of 3 T whole-body MRI and 18F-FDG PET/CT in the management of multiple myeloma and smoldering myeloma: The new era of imaging

    (PA-114) Role of the Combination of 3 T Whole-body MRI and 18F-FDG PET/CT in the Management of Multiple Myeloma and Smoldering Myeloma: The New Era of Imaging

    Thursday, September 18, 2025
    Introduction:
    FDG-PET/TC and MRI are both imaging diagnostic tools adopted in diagnosis and/or response assessment in multiple myeloma (MM) which can be useful in smoldering, newly diagnosed as well in relapsed myeloma.

    Methods: From January 2021 to April 2025, we enrolled into a prospective trial 159 consecutive patients (63 Male; mean age, 67 years ± 10 [SD]) divided into 3 groups; 51 had a newly diagnosed MM according to the IMWG (group 1); 23 were in follow-up after autologous stem cell transplantation with clinical or laboratory data suspicious for relapse or progression (group 2) and 38 were affected by relapsed/refractory MM during treatment (group 3). In addition we enrolled 47 patients newly diagnosed high risk SMM, according to IMWG (19 Male, mean age 59 years+-10 [SD]).

    Results: On a per-patient basis, 144/159 (90%) had concordant PET/CT and WB-MRI scans, while 16/159 (10%) had discordant scans in terms of positivity/negativity. Among concordant studies, 54/159 (34%) were negative with both imaging methods while 103/159 (65%) were positive at both (including FLs and/or BMI). Among discordant studies, 14/16 had a positive WB-MRI scan and a negative PET-CT scan (6 cases with BMI or micronodular involvement alone), whereas 2/16 had a positive PET-CT and a negative WB-MRI. PET/CT detected FLs pattern in 103/159 patients, WB-MRI alone identified FLs pattern in 11 patients. The combination of the two methods led to a change of management in 99/159 (62%), highlighted in the case of suspected post-transplant relapse. Furthermore, WB-MRI led to a change of management for incidental findings in additional 9 patients (8 suspected malignancies and 1 spinal cord compression). Interim analysis in HR- SMM showed discordance between the results of the two imaging modalities in 32/159 (21%). WB-MRI detected BMI pattern without any overt focal lesion in 14 patients (only 1 correlated with PET/CT) and FLs pattern in 9 patients (4 confirmed also in PET/CT), while PET/CT detected an additional FLs pattern in 1 patient, without bone lytic lesion evidence at the CT images.

    Conclusions: Our preliminary data underlines the fundamental role of functional imaging in the evaluation of FLs and BMI in MM with a superior detection rate of WB-MRI related to the ability to identify diffuse and micronodular pattern. A potential complementary role of the two methods in clinical management could be suggested in suspicion of relapsed or progressing MM. Furthermore our prospective trial supports the utmost role of WB-MRI (performed according to MY-RADS) in the assessment of high risk Smoldering Myeloma.