CME 4 Session - EANM'17

(9)
Oncology: PET in Multiple Myeloma

Educational Objectives:
Be able to• describe  the  different  clinical  situations  where  imaging  is  required  in  MultipleMyeloma• choose in a clinical situation the best imaging techniques for diagnosis and responseassessment• describe the results of the different MRI techniques used in MM• describe the results obtained by the main prospective studies focused on the value ofimaging in MM• report a PET in MM according to the current imaging criteria

Summary:
The role of imaging  techniques  for MM lymphoma management will be presented with anemphasis on the more recent study comparing the value of PET and MRI: the three prospectivestudies  (US,  Italian,  French)  conducted  to  assess Minimal  residual  disease  in  pre  and  postAutologous  stem  cell  transplantation  and  before  maintenance  and  the  IMAJEM  studycomparing the respective values of PET and MRI for response assessment. The role of eachtechnique in different clinical situations will be addressed.The  different magnetic  resonance  imaging  (MRI)  techniques  that  have  been  used  for MMstaging will be presented. First of all the standard (MRI), with T1 and T2 images which wasintegrated  in  the  1986 Durie &  Salmon  PLUS  classification and giving good  visualization  ofbone marrow  (BM)  involvement.  Second,  the  whole-body  dynamic  contrast  enhanced-MR(DCE-MR) imaging, thanks to its ability to image the increased angiogenesis in BM induced bythe MM clone proved useful to evaluate the treatment response.The  role of PET in  the different  types of MM will be described at staging and  for  responseevaluation.The criteria so far reported in the literature for PET scan interpretation in MM will be discussedespecially  regarding  BM  infiltration,  low  focal  SUV  max,  small  areas  of  focal  uptake,  focallesions in areas with increased background, recent fractures or vertebral collapse. The resultsof the harmonization proposed by the Italian and French cooperative groups based on theirclinical experience will be presented.

Key Words:
Multiple Myeloma, PET, MRI, Response assessment, Deauville criteria
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