Advanced Imaging in Multiple Myeloma: New Frontiers for MRI.

Plasma cell dyscrasias are estimated to newly affect almost 40,000 people in 2022. They fall on a spectrum of diseases ranging from relatively benign to malignant, the malignant end of the spectrum being multiple myeloma (MM). The International Myeloma Working Group (IMWG) has traditionally outlined the diagnostic criteria and therapeutic management of MM. In the last two decades, novel imaging techniques have been employed for MM to provide more information that can guide not only diagnosis and staging, but also treatment efficacy. These imaging techniques, due to their low invasiveness and high reliability, have gained significant clinical attention and have already changed the clinical practice. The development of functional MRI sequences such as diffusion weighted imaging (DWI) or intravoxel incoherent motion (IVIM) has made the functional assessment of lesions feasible. Moreover, the growing availability of positron emission tomography (PET)-magnetic resonance imaging (MRI) scanners is leading to the potential combination of sensitive anatomical and functional information in a single step. This paper provides an organized framework for evaluating the benefits and challenges of novel and more functional imaging techniques used for the management of patients with plasma cell dyscrasias, notably MM.

18F-FDG PET-CT incidental lung findings in asymptomatic COVID-19 patients: evidences from the Italian core of the first pandemic peak.

OBJECTIVES: To illustrate incidental 18F-FDG PET-CT findings and related CT alterations of suspicious pulmonary interstitial involvement in asymptomatic oncologic patients during the first COVID-19 outbreak in the core of Italian peak. METHODS: We retrospectively evaluated the 18F-FDG PET-CT follow-up examinations performed during the first Italian COVID-19 outbreak (March 3rd-April 15th, 2020) in 10 asymptomatic oncologic patients with a highly suspicious interstitial pulmonary involvement on CT. Six cases were confirmed SARS-CoV-2 by molecular tests. The following parameters were assessed: 1) lung involvement on co-registration CT as extension (laterality, number of lobes), pattern (ground-glass opacities/GGO, consolidations, mixed) and stage (early, progressive, peak, and absorption); 2) the maximum standardized uptake value (SUVmax) of lung lesions on 18F-FDG PET. RESULTS: The involved lobes were 5 in 5 cases (3 confirmed SARS-CoV-2), 2-4 in 4 cases and 1 in 1 case. GGO were found in all patients; 3 cases also showed a combination of GGO and peripheral consolidations (mixed). Five cases were suggestive for an early stage of interstitial pneumonia, 4 for progressive and 1 for peak. All the lung lesions showed increased FDG uptake. In early stages SUVmax ranged from 1.5 to 11, in progressive from 3.3 to 6.8, in peak from 2.4 to 7.7. SUVmax ranged 1.5-11 in patients with only GGO and 2.8-7.7 in those with mixed pattern. CONCLUSIONS: 18F-FDG PET-CT findings in suspected COVID-19 pulmonary involvement of asymptomatic oncologic patients showed an increase in FDG uptake of GGO and consolidations, but with a wide and apparently nonspecific range of SUVmax values.