Value of Spectral CT Techniques for the Assessment of Bone Marrow Infiltration in Multiple Myeloma: A Systematic Literature Review

Abstract

Background

Multiple myeloma (MM) is the second most common hemato-oncological malignancy, characterized by the clonal proliferation of malignant plasma cells and bone marrow infiltration. The degree of bone marrow infiltration, which is crucial for diagnosis and treatment initiation, is determined through biopsy. While MRI and CT are considered standard imaging methods for detecting focal lesions and osteolytic changes, CT has limitations, particularly in detecting diffuse infiltration patterns without osteolysis. Spectral CT techniques offer a promising alternative for assessing bone marrow infiltration through material decomposition.

Method

A systematic literature search was conducted in the PubMed database for relevant keywords in articles published between 01/2010 and 12/2024. Original studies evaluating spectral CT techniques for the assessment of MM bone marrow infiltration were included. Articles with a different focus, such as fracture detection, were excluded. A qualitative synthesis of the study results was performed.

Results and Conclusion

Spectral CT techniques improve the differentiation between healthy and infiltrated bone marrow. Particularly, the commonly applied virtual calcium suppression showed good sensitivity and specificity compared to histology, serology, or MRI. Spectral CT also shows potential for distinguishing different bone marrow infiltration patterns, assessing disease activity, and evaluating treatment response. Limitations included reduced sensitivity for detecting moderate infiltration within red bone marrow and small cohort sizes. Multicenter analyses are required to compare different device manufacturers, evaluate the utility of spectral CT biomarkers, the potential of currently less intensively studied material density maps and radiomics features, as well as, of photon-counting CT.

Key Points

• Spectral CT techniques can detect bone marrow infiltration in MM and allow for differentiation of infiltration patterns in CT imaging.

• Spectral CT parameters appear to have potential as biomarkers for tumor activity and treatment response.

Citation Format

• Melzer YF, Erley J, Ristow I et al. Value of Spectral CT Techniques for the Assessment of Bone Marrow Infiltration in Multiple Myeloma: A Systematic Review. Rofo 2026; 198: 36–54

Keywords

myeloma - bones - marrow - spine

Publication History

Received: 12 February 2025

Accepted after revision: 22 May 2025

Article published online:
23 July 2025

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