Multiple Myeloma: The Role of Imaging in Staging and Restaging

  • Lia A. MoulopoulosEmail author


Bone disease is one of the CRAB criteria (hypercalcemia, renal impairment, anemia, and bone lesions) which define symptomatic multiple myeloma (myeloma requiring treatment) and has been part of its staging since 1975, when the Durie-Salmon staging system was introduced. Conventional skeletal surveys (radiographs of the spine, pelvis, chest, skull, humeri, and femora) have been traditionally used to detect myeloma bone disease. The presence of three or more osteolyses, defined stage III myeloma, which required treatment. Several studies have, however, shown that Whole-Body Computed-Tomography (WBCT), Magnetic Resonance Imaging (MRI), FDG-Positron Emission Tomography (FDG-PET), and FDG-PET/CT may identify 80% more focal lesions in myeloma patients compared to a conventional skeletal survey (CSS) [1]. As a result, in 2003, the International Myeloma Working Group (IMWG) suggested that findings of both CT and MRI might fulfill the CRAB criteria for multiple myeloma [2]. The same year, MRI and FDG-PET were introduced to the Durie-Salmon PLUS staging system, which did not include any laboratory data apart from creatinine values, but was based on the number of focal bone marrow lesions larger than 5 mm and the extent of diffuse bone marrow involvement on these two imaging modalities. In 2014, the IMWG recommended that FDG-PET/CT, WBCT, WBMRI, or MRI of the axial skeleton, depending on availability, be performed in all patients with asymptomatic (smoldering) multiple myeloma (SMM) [1].


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyUniversity of Athens Medical School, Areteion HospitalAthensGreece

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