Role of FDG-PET/CT in the management of multiple myeloma and plasma cell dyscrasia

Abstract

Learning Objectives 1. To review the epidemiology, pathology and patho-physiology of multiple myeloma. 2. To understand current staging classification and the roles of FDG-PET/CT in initial staging and therapy evaluation of multiple myeloma. 3. To understand the FDG-PET/CT evaluation of bone marrow background activity, focal bony lesions, extramedullary disease, infections, osteolytic lesions on CT scan and other pertinent findings for multiple myeloma patients with Bone Density, CT, MR, lab and pathological correlation. 4. To understand quantitative FDG-PET/CT parameters in relation of overall survival on patients with multiple myeloma. 5. To review FDG-PET/CT vs. NaF-PET/CT in the detection of myeloma-related bone lesions.

Multiple myeloma is the second most common hematological malignancy after Hodgkin’s lymphoma, and the most common primary bone marrow malignancy. Until recently, conventional radiographic methods, and to some extent MRI have been employed as the mainstay of diagnosis, but whole-body FDG-PET/CT is rapidly emerging as the modality of choice for assessment of overall disease activity (skeletal and extramedullary), for treatment planning (both initially, and for subsequent response assessment), for follow up, and for differentiating among different plasma cell dyscrasia subtypes. In addition, PET provides prognostic information that is not achievable from structural modalities.