TARGETED MRI can safely guide clinical decision-making in patients with multiple myeloma who develop new bone pain despite stable biochemical markers, according to a new single-centre analysis.
Multiple myeloma is a plasma cell malignancy affecting the bone marrow, often associated with skeletal complications that can present as bone pain. While biochemical monitoring is central to tracking disease activity, relapse can occur without measurable markers, prompting concern when new pain arises.
Targeted MRI Reveals Causes of Myeloma Pain
Pain in patients with stable myeloma frequently triggers requests for whole-body imaging to exclude disease progression. However, the findings here suggest that most pain in this setting is not driven by active malignancy.
In this retrospective analysis of 134 scans from 111 patients over two years, most targeted MRI scans (84%) focused on one body area1. Degenerative changes were the most common finding, identified in 43% of scans, followed by fractures in 39%. Notably, only one fracture was attributed to progressing disease.
High Diagnostic Accuracy Without Whole-Body Imaging
Overall, 72% of scans showed no evidence of active disease. Among the 28% with active findings, only 16% demonstrated new or increasing lesions. Whole-body imaging was only later required in 9% of cases.
Targeted MRI demonstrated strong diagnostic performance, with a sensitivity of 96% and specificity of 90%. These figures indicate that focused imaging can reliably detect clinically relevant disease activity without routinely resorting to more extensive scans.
Clinical Impact and Resource Implications
Targeted MRI prompted active clinical intervention in 28 patients, underscoring its role in guiding management decisions. For healthcare systems, the findings highlight a potential reduction in imaging burden. Targeted scans not only shorten scan duration for patients – particularly relevant for those experiencing pain – but also conserve radiology resources.
The results imply that new pain in myeloma patients is not always related to disease progression. Here, degenerative changes and non-malignant fractures accounted for a substantial proportion of symptoms, emphasising the need for nuanced clinical assessment.
The findings are limited by the retrospective, single-centre design and relatively modest sample size, which may affect the generalisability. While 111 patients were included, larger, multi-centre studies are needed to confirm the reproducibility.
The absence of sex-disaggregated analysis restricts further exploration of potential differences in the distribution of fractures and degenerative changes. Such analyses may be informative in future research, particularly given established differences in bone health profiles.
Despite these limitations, the high sensitivity and specificity observed suggest that targeted MRI may be a reliable approach to assessing new pain in biochemically stable multiple myeloma, potentially reducing reliance on whole-body imaging.
References
Dragan AD et al. Targeted MRIs inform clinical management in biochemically stable multiple myeloma patients presenting with new pain. Clin Radiol. 2026;DOI:10.1016/j.crad.2026.107309.
Corso A, Mangiacavalli S. Non-Secretory Myeloma: Ready for a new Definition? Mediterr J Hematol Infect Dis. 2017;DOI:10.4084/MJHID.2017.053.
Featured image: David A Litman on Adobe stock
