Skeletal survey and imaging in myeloma
Which imaging to order across the plasma cell spectrum (low-risk MGUS, higher-risk MGUS, smouldering myeloma, myeloma, plasmacytoma, relapse), why the skeletal survey has gone, what whole-body low-dose CT, MRI and PET-CT each show, reading the report against IMWG criteria, and Australian Medicare funding gaps.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Cross-sectional imaging has replaced the plain skeletal survey for every plasma cell disorder that needs imaging (IMWG 2019; MSAG 2021).
- WBLDCT finds lytic lesions. MRI finds marrow infiltration before bone is destroyed. PET-CT shows active disease and extramedullary spread and is the response test.
- Imaging decides the diagnosis: one lytic lesion of 5 mm or more on CT or PET-CT is a CRAB criterion, and more than one focal lesion on MRI is a SLiM criterion (IMWG 2014). See Bony lytic lesions.
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Sources
- International Myeloma Working Group consensus recommendations on imaging in monoclonal plasma cell disordersHillengass J et al., Lancet Oncol 2019;20:e302-12, 2019
- MSAG guidelines: imaging of patients with multiple myeloma and associated plasma cell disordersAU/NZMedical Scientific Advisory Group to Myeloma Australia (Creeper K et al.), April 2021
- International Myeloma Working Group recommendations for the diagnosis and management of solitary plasmacytomasKastritis E et al., J Clin Oncol 2026;44:2447-59, 2026
- International Myeloma Working Group updated criteria for the diagnosis of multiple myelomaRajkumar SV et al., Lancet Oncol 2014;15:e538-48, 2014
- IMWG-IMS consensus workshop summaries: updated response criteria (presented at the 2025 IMS Annual Meeting, Toronto)International Myeloma Working Group, reported by Pharmacy Times, September 2025
- Guidelines for Acquisition, Interpretation, and Reporting of Whole-Body MRI in Myeloma: Myeloma Response Assessment and Diagnosis System (MY-RADS)Messiou C et al., Radiology 2019;291:5-13, 2019
- MBS Online search for FDG PET items (no myeloma indication listed)AU/NZAustralian Government Department of Health, Disability and Ageing, November 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy