Imaging in Plasma-Cell Neoplasms: Italian Experts’ Recommendations

Objectives: Using suboptimal imaging modalities on the detection of bone and extra-bone myeloma lesions affects disease status recognition and early treatment decisions. Moreover, a systematic search of the evidence was not provided alongside the recommendations. The objective of this study was to assess the current real world imaging practices in Italy, influencing factors, and barriers to adopting international imaging guidelines for MGUS and MM (reported as plasma cell disorders, PCD) and to develop evidence-based, country-specific recommendations for imaging assessment of PCD patients. Methods: A national project was launched in 2024, involving experts from 32 hematology centers and 5 radiology services. A survey was conducted and a Delphi panel comprising 23 experts was used to reach a consensus on the developed recommendations. A total of 25 recommendations were finally formulated. Results: The survey revealed that suboptimal imaging modalities were significantly contributing to the under-recognition of bone and extra-bone lesions in myeloma, leading to suboptimal disease status assessment and treatment decisions. Conclusions: The study emphasizes the importance of adopting effective imaging modalities to improve disease detection and guide treatment decisions in PCD patients. A country-specific, evidence-based set of imaging recommendations has been developed to address existing challenges in the adoption of international imaging guidelines.