Whole body MRI (wbMRI) is the recommended imaging test for assessment of smouldering myeloma and plasmacytoma (International Myeloma Working Group 2015 Guidelines1). This wil inevitably result in incidental findings. Several studies have reviewed the incidental findings detection rate at wbMRI including large population-based studies2 and studies in other patient cohorts e.g. lymphoma3 with detection rates approaching 80%3.In this institutional review board (IRB) approved study we aimed to assess the detection rate and clinical significance of incidental findings and added value of diffusion-weighted and contrast-enhanced sequences...

wbMRI consisting of T2-HASTE, T1-Dixon, DWI (B=50 and 900 s/mm2)and single phase contrast-enhanced (CE) T1-W sequences from vertex to knees were performed at 1.5T (Siemens HealthCare, Erlangen, Germany) in 100 patients (see Table 1 below for MRI protocol). Post-contrast sequences were obtained in 82/100 patients only, owing to renal impairment in the remaining patients. Imaging was reviewed by a staff radiologist with 7 years of MRI experience. Image contrast Sequence Image plane Reconstructed slice thickness FOV TR TE T1-W DIXON 3D FLASH Axial 5.0 500...

100 patients with suspected/proven plasma cell disorders underwent wbMRI (January 2014 - July 2017). There were 53 female, 47 male patients, median age of 65 years (range 38-90 years). Myeloma = 63, smouldering myeloma = 11, monoclonal gammopathy of unknown significance (MGUS) = 12, plasmacytoma = 6 and other diagnoses = 8. 348 incidental findings were detected on the T2-W sequences in 97/100 (97%) patients, (median = 3 findings per patient, range = 1-9 findings). The five commonest incidental findings were 1, hepatic/renal/splenic cysts (23%)...

Incidental findings are relatively common at wbMRI however the majority are not clinically significant and can be characterized fully with a comprehensive wbMRI protocol. CE T1-W and DWI sequences increase diagnostic confidence in characterization of indeterminate lesions.

1,2Westerland O, 1Sivarasan N, 1Natas S, 1Verma H, 2,3Neji R,4Kazmi M,4El-Najjar I,4Streetly M, 1,2Goh V 1Clinical Imaging and Medical Physics, Guys and St Thomas’ NHS Foundation Trust, London 2Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London 3MR Research Collaborations, Siemens Healthcare Limited, Frimley, UK 4Department of Clinical Haematology, Guy's and St Thomas’ NHS Foundation Trust, London

1. Rajkumar SV, Dimopoulos SA, Palumbo A et al. International Myeloma Working Group updated criteria for the diagnosis of myeloma. Lancet Oncol. 2014; 15:e538-548. 2.Hegenscheid K, Seipel R, Schmidt CO et al. Potentially relevant incidental findings on research whole body MRI in the general adult population: frequencies and management. Eur Radiol. 2013; 23:816-826. 3.Galia M, Albano D, Narese D et al. Whole-body MRI in patients with lymphoma: collateral findings. Radiol Med 2016; 121:793-800.