Journal: European radiology
This article is a practice-focused guidance piece on optimal use of bone marrow MRI in patients with solid tumor metastases and multiple myeloma.
Core message
- MRI should be the first-line imaging modality for suspected skeletal metastases or myeloma, superseding radiography, bone scintigraphy, and CT for these indications.
- MRI is recommended across the disease continuum: initial diagnosis of bone involvement, staging, treatment response assessment, detection of recurrence, and evaluation of osseous complications.
Imaging strategy
- Whole-body MRI is preferred for comprehensive assessment of disease burden.
- Axial skeleton MRI is an acceptable, faster alternative for targeted questions or follow-up, especially when whole-body MRI is not feasible.
- Protocols must be tailored to tumor type and clinical scenario, drawing on existing disease-specific guidelines.
Technical recommendations
- Use standardized protocols that include:
- Anatomical sequences with fat-sensitive contrast, with an emphasis on fast spin echo T2 Dixon techniques.
- Diffusion-weighted imaging as a core component.
- Incorporate quantitative biomarkers—particularly apparent diffusion coefficient (ADC) and fat fraction (FF)—to enhance diagnostic accuracy and to objectively monitor treatment response.
Interpretation and implementation
- Radiologists need familiarity with characteristic patterns of marrow replacement, criteria for response assessment, and common interpretive pitfalls.
- The article emphasizes implementation in every imaging facility, using existing MRI systems and integrating these recommendations into routine oncologic imaging workflows to improve diagnostic precision and patient management.