Current and future imaging modalities for multiple myeloma and its precursor states.

Traditionally, the skeletal survey has been the standard modality for the detection of osteolytic bone disease in multiple myeloma. In addition to its poor sensitivity for the detection of osteolytic lesions, this modality is not able to identify extramedullary lesions and focal bone marrow involvement, nor measure response to therapy. The application of novel imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and molecular imaging such as fluorine-18 fluorodeoxyglucose positron emission tomography CT ((18)F-FDG PET/CT) and fluorine-18 sodium fluoride positron emission tomography CT ((18)F-NaF PET/CT) has the potential to overcome these limitations as well as provide prognostic information in precursor states and multiple myeloma. Also promising is the use of dynamic contrast enhanced magnetic resonance imaging (DCE MRI) to measure vascular permeability, an important feature of myelomagenesis. This review summarizes the current status and possible future role of novel imaging modalities in multiple myeloma and its precursor states.