Table 2.

Imaging guidelines in myeloma

	NICE 2016 5	BSH 2017 6	IMWG 2014 2015 2,7
Suspected myeloma	First-line WB-MRI second-line WBLDCT third line SS Note: bone scintigraphy is not recommended	First-line WB-MRI second-line MRI spine & pelvis if WB-MRI cannot be performed third line WBLDCT	MRI has high sensitivity for the early detection of marrow infiltration compared with other radiographic methods
Smouldering/ asymptomatic myeloma a	Spine MRI or WB-MRI or WBLDCT or or FDG PET/CT	First-line WB-MRI or FDG PET/CT second-line WBLDCT	WB-MRI or MRI spine or WBLDCT or FDG PET/CT b (if they have more than one focal lesion of a diameter ≥5 mm accompanied by lytic destruction on the CT component, should be considered to have symptomatic disease that requires therapy. Diffuse disease does not qualify).
Solitary plasmacytoma (to exclude other sites of disease)	WB-MRI or FDG PET/CT	WB-MRI or FDG PET/CT	WDLBCT or MRI
Newly diagnosed myeloma	WB-MRI or WBLDCT or FDG PET/CT	First-line WB-MRI second-line MRI spine & pelvis if WB-MRI cannot be performed third line WBLDCT
Treatment response/ relapse	WB-MRI or MRI spine or FDG PET/CT (Note WBLDCT not indicated)	First-line WB-MRI second-line FDG PET/CT c	WB-MRI or FDG PET/CT
Suspected cord compression	MRI spine CT spine for stability/ if considering vertebral kyphoplasty/ surgery	First-line MRI spine second-line CT spine

FDG, fludeoxyglucose; WBLDCT, whole body low dose CT; WB-MRI, whole body MRI.

^a10–60% plasma cells on trephine biopsy or bone marrow aspirate or M protein >30 g l^–1 (BSH).

^bDependent on availability and resources.

^cDW-WB MRI is recommended in response assessment, but in patients with non/oligosecretory or extramedullary disease DW-WB MRI or FDG PET/CT can be performed (BSH). Changes in FDG avidity can provide an earlier evaluation of response to therapy compared to MRI & predict outcome especially in patients eligible for autologous stem cell transplant.