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Whole-Body MRI Versus PET in Assessment of Multiple Myeloma Disease Activity

¹ Department of Radiology and Diagnostic Imaging, Mater Misericordiae University Hospital, Dublin, Ireland.
² Department of Radiology, Cappagh National Orthopaedic Hospital, Dublin, Ireland.
³ Present address: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., 1 Silverstein Bldg., Philadelphia, PA 19104.
⁴ Present address: Radiology Department, Vancouver Hospital and Health Sciences Centre, Vancouver, BC, Canada.
⁵ Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland.
⁶ Present address: Department of Haematology, St James's Hospital, Dublin, Ireland.

OBJECTIVE. The purpose of this study was to compare FDG PET; whole-body MRI; and the reference standard, bone marrow aspiration and biopsy, to determine the best imaging technique for assessment of disease activity in multiple myeloma.

SUBJECTS AND METHODS. Twenty-four patients (13 women, 11 men; mean age, 67.1 years; range, 44–83 years) with bone marrow biopsy–proven multiple myeloma were included in the study. All patients underwent PET/CT and whole-body MRI within 10 days of each other. Eight patients underwent more than one follow-up PET/CT and whole-body MRI examination, for a total of 34 pairs of images. Activity was defined as lesions with a maximum standardized uptake value greater than 2.5 at PET and as evidence of marrow packing at whole-body MRI. PET and whole-body MRI results were correlated with findings at bone marrow aspiration biopsy.

RESULTS. PET had a sensitivity of 59%, specificity of 75%, positive predictive value of 81%, and negative predictive value of 50% (p = 0.08). Whole-body MRI had a sensitivity of 68%, specificity of 83%, positive predictive value of 88%, and negative predictive value of 59% (p = 0.01). In 62% of cases, PET and whole-body MRI findings were concordant. When PET and whole-body MRI findings were concordant and positive, no false-positive results were found, yielding a specificity and a positive predictive value of 100% (p = 0.04).

CONCLUSION. Whole-body MRI performed better than PET in the assessment of disease activity, having a higher sensitivity and specificity. The positive predictive value of whole-body MRI in the assessment of active disease was high at 88%. When used in combination and with concordant findings, PET and whole-body MRI were found to have a specificity and positive predictive value of 100%, which may be of value to clinicians assessing the effectiveness of aggressive and expensive treatment regimens.

Keywords: emission-computed • MRI • multiple myeloma • positron emission • tomography • total body

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