Imaging inmultiplemyeloma. Skeletal survey, whole-body CT, whole-body MRI or PET?

Bone lesions are a key feature of multiple myeloma and for many years the conventional skeletal XaEuroray survey following the Paris scheme was the imaging modality of choice. This has now changed to using cross-sectional imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI) due to their higher sensitivity. In 2014 the international working group on myeloma published new guidelines, where the value of MRI was underlined. This article gives an overview of the current options of imaging modalities in the diagnostics and management of multiple myeloma and related plasma cell disorders. More than one focal bone marrow lesion in MRI, even without corresponding bone destruction in CT now defines active myloma disease requiring treatment. In the case of suspected solitary plasmacytoma, adequate imaging should exclude involvement at other locations. Imaging modalities with low radiation exposure, such as MRI and low-dose CT are recommended for treatment monitoring and follow-up in prolonged survival due to new therapeutic options. Functional imaging techniques can add relevant information to the morphological techniques. In the case of predominantly focal involvement PET-CT for example can provide information regarding glucose and bone metabolism and thereby contribute to successful treatment.