Abstract：
Advances in morphological and functional imaging have led to superior detection of early bone disease, bone marrow infiltration, paramedullary and extramedullary involvement in multiple myeloma. The two functional imaging modalities that are most widely used and standardized are 18F-fluorodeoxyglucose-Positron emission tomography/computed tomography (FDG PET/CT) and whole-body magnetic resonance imaging with diffusion-weighted imaging (WB DW-MRI). Both prospective and retrospective studies have demonstrated that WB DW-MRI is more sensitive than PET/CT in the detection of baseline tumour burden and to assess response after therapy. In patients with smouldering multiple myeloma, WB DW-MRI is now the preferred imaging modality to rule out two or more unequivocal lesions which would be considered a myeloma-defining event by the updated international myeloma working group (IMWG) criteria. In addition to sensitive detection of baseline tumour burden, both PET/CT and WB DW-MRI have been successfully used for monitoring response to therapy and provide information that is complementary to IMWG response assessment and bone marrow minimal residual disease. In this article, we present 3 vignettes illustrating how we approach the use of modern imaging in the management of patients with multiple myeloma and precursor states, with a specific focus on recent data that have emerged since the publication of the IMWG consensus guideline on imaging. We have utilized data from prospective and retrospective studies to provide a rationale for our approach to imaging in these clinical scenarios and highlighted knowledge gaps requiring future investigation.
摘要：
形态学和功能成像的进展已导致早期骨病的优越检测，骨髓浸润,多发性骨髓瘤的髓旁和髓外受累。最广泛使用和标准化的两种功能成像方式是18F-氟脱氧葡萄糖-正电子发射断层扫描/计算机断层扫描（FDGPET/CT）和具有扩散加权成像的全身磁共振成像（WBDW-MRI）。前瞻性和回顾性研究均表明，WBDW-MRI在检测基线肿瘤负荷和评估治疗后反应方面比PET/CT更敏感。在阴燃的多发性骨髓瘤患者中，WBDW-MRI现在是首选的成像方式，以排除两个或多个明确的病变，这些病变将被更新的国际骨髓瘤工作组（IMWG）标准视为骨髓瘤定义事件。除了敏感检测基线肿瘤负荷外，PET/CT和WBDW-MRI均已成功用于监测治疗反应,并提供补充IMWG反应评估和骨髓微小残留病的信息.在这篇文章中,我们提供了3个插图，说明了我们如何在多发性骨髓瘤和前体状态患者的管理中使用现代成像，特别关注自IMWG影像学共识指南发布以来出现的最新数据。我们利用前瞻性和回顾性研究的数据为我们在这些临床场景中的成像方法提供了理论基础，并强调了需要未来研究的知识差距。
