New recommendations from the International Myeloma Working Group (IMWG) on the use of imaging methods in monoclonal plasma cell disorders were recently published in The Lancet Oncology. (1)
Overall, the guidelines recommend that more sensitive imaging techniques, such as whole-body CT and MRI, be introduced generally into clinical practices for the diagnosis and management of monoclonal plasma cell disorders.
The most notable change from the IMWG is for whole-body imaging techniques to replace conventional skeletal surveys as the standard imaging technique for the diagnosis of myeloma. This change is consistent with NICE guidelines published in 2016 which recommend the use of whole-body MRI for myeloma diagnosis. (2)
However, the majority of myeloma patients still do not receive whole-body imaging at diagnosis, despite these recommendations. Research suggests that scanner capacity, longer reporting times and availability of trained radiologists were barriers to the uptake of these guidelines. (3)
We asked Dr Christina Messiou, Consultant Radiologist, at the Royal Marsden what she thought about the new recommendations and how she is helping to increase the use of whole-body MRI in routine clinical practice.
“It is absolutely fantastic to see that whole-body MRI is now part of the UK and international guidance for imaging in myeloma. This highly sensitive technique will improve early diagnosis and reduce false negatives. At The Royal Marsden, we have been offering the service since 2011 and we are also using it to monitor and assess response in patients who have high-risk disease. A further major advantage is that the scans are non-invasive – no radiation and no injections. However, the current challenge is to ensure that it is performed to correct standards and that all patients have access. The new MY-RADS (Myeloma Response Assessment and Diagnosis System) recently published in the US imaging journal Radiology, was developed by a team at The Royal Marsden in collaboration with colleagues across Europe and at Memorial Sloane Kettering and Roswell Park in the US. This system represents an important step forward in standardising the technique and making it easier for treatment centres to adopt.
“Alongside this, The Royal Marsden is leading a training programme in how to perform and report whole-body MRI scans for radiologists from across the UK. The programme is supported by the NIHR Clinical Research Facility at The Royal Marsden and The Institute of Cancer Research, London, and the CRUK National Cancer Imaging Translator Accelerator.
“In the last two years, 250 radiologists from the UK have attended four full-day case and lecture based interactive courses. These were organised as part of The Royal Marsden Imaging Perspectives course, in partnership with The International Cancer Imaging Society, and with Professor Hall-Craggs and The British Institute of Radiology. The Royal Marsden Imaging Perspectives programme included hands-on training on scanners with Lead MRI Superintendent Radiographer Erica Scurr. The Royal Marsden has also hosted thirty consultant radiologists and 30 radiographers to support their training in whole-body MRI reporting and acquisition.
We also know that a significant barrier to providing the service is a lack of MRI scanner time so we are working on Artificial Intelligence techniques to make scan acquisition faster as well as developing tools to help radiologists report the scans.”
To find out more about training programmes at The Royal Marsden please contact/click here.
References
- Hillengass, J., Usmani, S., Rajkumar, S.V., Durie, B.G., Mateos, M.V., Lonial, S., Joao, C., Anderson, K.C., García-Sanz, R., Serra, E.R. and Du, J., (2019) International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders. Lancet Oncol. 20(6):e302.
- National Institute for Health and Care Excellence (2018) Myeloma: diagnosis and management NG35
- Westerland, O.A., Pratt, G., Kazmi, M., El-Najjar, I., Streetly, M., Yong, K., Morris, M., Mehan, R., Sambrook, M., Hall-Craggs, M. and Silver, D., (2018) National survey of imaging practice for suspected or confirmed plasma cell malignancies. Br. J. Radiol., 91:20180462.
- Messiou, C., Hillengass, J., Delorme, S., Lecouvet, F.E., Moulopoulos, L.A., Collins, D.J., Blackledge, M.D., Abildgaard, N., Østergaard, B., Schlemmer, H.P. and Landgren, O., (2019) Guidelines for acquisition, interpretation, and reporting of whole-body MRI in myeloma: myeloma response assessment and diagnosis system (MY-RADS). Radiology, 291(1):5