Clin Nucl Med. 2025 Jul 8. doi: 10.1097/RLU.0000000000006048. Online ahead of print.
ABSTRACT
PURPOSE: This systematic review and meta-analysis compared the diagnostic performance of MRI, [18F]FDG-PET/CT, and [18F]FDG-PET/MRI in detecting focal bone lesions and bone marrow infiltration in the initial staging of patients with multiple myeloma (MM) who underwent both MRI and [18F]FDG-PET/CT or [18F]FDG-PET/MRI studies.
PATIENTS AND METHODS: A systematic literature search was conducted across PubMed, Embase, and Cochrane databases, including studies comparing the performance of MRI (WB-MRI or spine/pelvis MRI), [18F]FDG-PET/CT, and/or [18F]FDG-PET/MRI in the same patients for MM initial staging. Pooled sensitivities and concordance between imaging modalities were analyzed using R (package META-R). Heterogeneity and bias were assessed with the QUADAS-C tool.
RESULTS: Twenty studies (published between 2007 and 2025) using the international MM diagnostic criteria as a reference standard met the inclusion criteria. Of these, 13 (n=742) compared per-patient sensitivity of [18F]FDG-PET/CT and MRI, and 4 (n=224) compared MRI and [18F]FDG-PET/MRI. Pooled sensitivities were 0.807 (95% CI: 0.74-0.86) for [18F]FDG-PET/CT (with significant heterogeneity) versus 0.914 (95% CI: 0.88-0.94) for MRI (0.906 for spine/pelvis MRI and 0.920 for WB-MRI) (P<0.001 for meta-regression analysis). Using contingency tables, 83% (599/721) of included patients had concordant [18F]FDG-PET/CT and MRI results, while 14% (101/721) patients had negative [18F]FDG-PET/CT and positive MRI with significant differences between the 2 techniques for the paired sample analysis (P<0.001). The pooled sensitivity of the 4 studies including [18F]FDG-PET/MRI was 0.944 (95% CI: 0.88-0.98). Consensus definitions for specificity in MM imaging should be standardized across studies.
CONCLUSIONS: This systematic review and comparative meta-analysis demonstrates superior sensitivity of WB-MRI compared with [18F]FDG-PET/CT for initial staging of MM patients. Future international guidelines might prioritize MRI and [18F]FDG-PET/MRI for staging of MM patients.
REGISTRATION: PROSPERO CRDXXX.
PMID:40644586 | DOI:10.1097/RLU.0000000000006048