Clinical/methodical issue: Imaging in monoclonal plasma cell disease serves to detect end organ damage, i.e., osteoporosis or bone destruction. Diffuse or circumscribed bone marrow infiltration without damage to mineralized bone is so far not regarded as end organ damage.
Standard radiological methods: Skeletal plain x-ray film survey to detect bone destruction, osteoporosis or fractures.
Methodical innovations: Whole body low-dose computed tomography (CT) and whole body magnetic resonance imaging (MRI) allow a more sensitive assessment of both mineralized bone and bone marrow, with greater patient comfort and in the case of MRI without ionizing radiation.
Performance: According to the literature, cross-sectional imaging is clearly superior to skeletal surveys and MRI is more sensitive than CT. Every locally destructive lesion will be detectable with MRI but for assessing the damage to mineralized bone CT is indispensible. The sensitivities of positron emission tomography (PET)/CT and MRI are comparable.
Achievements: If available whole body MRI and whole body low dose CT should replace conventional skeletal surveys. This has already been implemented in several centers in Germany.
Practical recommendations: For the initial diagnosis of monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma or symptomatic multiple myeloma, a whole-body MRI and a whole body low-dose CT should be performed. For MGUS and asymptomatic myeloma, whole body MRI only should be performed for follow-up until detection of first bone destruction. Patients with symptomatic multiple myeloma and known bone destruction will usually have whole body low-dose CT, supplemented by MRI studies where clinically required.