Comparison of modern and conventional imaging techniques in establishing multiple myeloma‐related bone disease: a systematic review

Summary This systematic review of studies compared magnetic resonance imaging ( MRI ), 18 F ‐fluorodeoxyglucose positron emission tomography ( FDG ‐ PET ), FDG ‐ PET with computerized tomography ( PET ‐ CT ) and CT with whole body X‐Ray ( WBXR ) or (whole body) CT in order to provide evidence‐based diagnostic guidelines in multiple myeloma bone disease. A comprehensive search of 3 bibliographic databases was performed; methodological quality was assessed using Q uality A ssessment of D iagnostic A ccuracy S tudies ( QUADAS ) criteria (score 1–14). Data from 32 directly comparative studies were extracted. The mean QUADAS score was 7·1 (3–11), with quality hampered mainly by a poor description of selection and execution criteria. All index tests had a higher detection rate when compared to WBXR , with up to 80% more lesions detected by the newer imaging techniques; MRI (1·12–1·82) CT (1·04–1·33), PET (1·00–1·58) and PET ‐ CT (1·27–1·45). However, the modern imaging techniques detected fewer lesions in the skull and ribs. In a direct comparison CT and MRI performed equally with respect to detection rate and sensitivity . This systematic review supports the I nternational M yeloma W orking G roup guidelines, which recommend that WBCT can replace WBXR . In our opinion, the equal performance of MRI also indicates that it is a valuable alternative. As lesions of the skull and ribs are underdiagnosed by modern imaging techniques we advise additional X ‐rays of these regions. The consequences of this approach are discussed.