New UK research has shown that whole body magnetic resonance imaging (WBMRI) not only detects more myeloma-defining disease than positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (FDG), but it also allows critical treatment to be initiated earlier.
Currently, less than 50 per cent of myeloma patients survive after five years, with a lack of clarity on the best imaging modality to use.
In this new study, published in the European Journal of Nuclear Medicine and Molecular Imaging, researchers compared the diagnostic performance and impact on management of 18F-FDG PET/CT and WBMRI in 46 patients with treatment-naive myeloma.
The vast majority of the cohort – 89.1 per cent (41/46) – had symptomatic myeloma, 6.5 per cent (3/46) had smouldering myeloma and 4.3 per cent (2/46) had multifocal plasmacytoma, with diagnosis upgraded to myeloma.
All patients underwent baseline bone marrow trephine and biopsy.
Compared with 18F-FDG PET/CT, WBMRI had a higher per patient sensitivity for bone disease. Sensitivity for bone lesions was 69.6 per cent (32/46) for 18F-FDG PET/CT (54.3% [25/46] for PET component alone) and 91.3 per cent (42/46) for WBMRI. A total 27/46 cases (58.7%) 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=.02); and WBMRI to clinical data to 43/46 (93.5%) patients (P=.002).
The difference in treatment decisions, however, was not statistically significant between 18F-FDG PET/CT and WBMRI (P=.08).
Commenting on the implications of the findings, lead researcher Prof Vicky Goh said: “What this ultimately means for patients is improved outcomes from earlier treatment."
“WBMRI resulted in a decision-to-treat in an additional 7 per cent of patients compared with PET/CT.”
Prof Goh said the study supports national NICE guidance that WBMRI should be performed as a first-line imaging test for suspected myeloma.