Skip to content


Cancer Imaging

Open Access

Characterization of multiple myeloma osseous lesions and diffuse infiltration pattern by 18F-FDG-PET/CT, static MRI and diffusion-weighted MR Imaging (DWI-MRI): a comparative multimodality imaging study

  • J Mosebach1Email author,
  • C Sachpekidis2,
  • N Fard1,
  • T Wilhelm1,
  • M Wilhelm3,
  • J Hillengass4,
  • A Dimitrakopoulou-Strauss2,
  • HP Schlemmer1 and
  • S Delorme1
Cancer Imaging201414(Suppl 1):P33

Published: 9 October 2014


To compare the detection rates of different imaging modalities for nodular bone marrow (BM) infiltrates and osteolyses in patients with multiple myeloma (MM).


55 Patients diagnosed according to the International Myeloma Working Group criteria (2003) were referred to consecutive imaging diagnostics including 18F-FDG PET/CT, T1-weighted and short-tau inversion recovery (STIR) whole-body MRI (WB-MRI) as well as diffusion weighted MRI (DWI). Images were reviewed and matched on a lesion-by-lesion basis for the location and number of focal osseous MM lesions by two radiologists and one nuclear medicine physician, grading the conspicuity of each lesion in CT, T1w, T2 STIR, DWI and ADC-Map separately. PET/CT data were compared based on qualitative and semi-quantitative (SUV) evaluation. A scoring system was used, with a certainty score as the reference for each lesion resulting from an evaluation considering all imaging modalities simultaneously. The analysis was carried out without knowledge of the previous treatment or the stage of disease.


In static MRI and DWI different infiltration patterns were observed and PET/CT revealed comparable patterns of tracer uptake: negative, focal, diffuse and mixed. MRI including DWI demonstrates both active as well as inactive MM lesions and displays numerous additional PET-negative lesions.


Possible reasons for lesions being PET positive or negative may be their activity or cellular density of focal BM infiltrates. Additionally, nodules may be masked by surrounding, diffuse BM infiltration. To this date, PET/CT and DWI/MRI are complementary methods, as both modalities interrogate different biophysical tissue properties (cellular density vs glucose metabolism).

Authors’ Affiliations

Department of Radiology, German Cancer Research Center, Heidelberg, Germany
Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
Department of Radiology, University of Freiburg, Freiburg, Germany
Department of Medicine V, Multiple Myeloma Section, University of Heidelberg, Heidelberg, Germany


© Mosebach et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.