How and when should MRI's be used? What do they show?

[Music] how and when should MRI be used and what do they show MRI has a very high sensitivity but it doesn't show the bone very well so the bone is very important in myeloma especially myeloma imaging obviously so that's the limitation of the MRI we use it to differentiate between areas of high versus low cellular T high cellularity meaning most likely myeloma or something else going on there low cellular T is usually in the especially in the bone marrow says there's a higher fat content and fat content is normally when we grow older we just have a higher fat content in our bone marrow so MRI helps to differentiate that especially if there are fractures if this fracture is caused by the myeloma or if this fracture is caused by an osteoporosis for example there MRI is helpful MRI has a good sensitivity for any spinal or CNS involvement so in if in the brain unfortunately something is growing that would be a reasons fortunately it's very rare but that's an area where MRI is very good if there are fractures that kind of go from the spine to the spinal cord there MRI is very helpful because it shows the spinal cord very well and we see how how a bone fracture can impact the spinal cord and if there are any neurological issues like numbness or motor issues that a weakness in the leg or in the limb then MRI is definitely the choice the again depending on what's available at the moment the fdg-pet city gives us the most information in symptomatic disease because a major thing in symptomatic disease is what is left after our treatment for example high-dose to chemotherapy we want to know what is left after that and they are PET CT is that at the moment the best choice so in symptomatic patients PET CT before and after treatment is our recommendation in smoldering patients we want to see the changes early so the highest sensitivity of the MRI is very helpful so in smoldering patients and rather recommend a whole body MRI available or at least the spinal and pelvic MRI so these are the two different areas in our new guidelines and they we have kind of this this algorithm what to do when we recommend low-dose CT because it's fast it's cheap and it's available all over the world so the recommendations were written for the whole world basically in the US I would say because we recommend low-dose CT there without pet but it's more or less because a lot of countries just don't have access to PET CT that often so in the u.s. I would say PET CT is the choice with the good CT as I mentioned earlier in other countries where there's no excess capacity at least it should be a low dose CT it's kind of this compromise that we recommend there so MRI is also a very powerful imaging technique MRI is great about giving the soft tissue contrast essentially we are tracking water molecules in the tissues and tumor vasculature changes as the disease progresses so MRI can give us very powerful information about how the vascularity is changing are the perfusion within the bone marrow for example is changing and mostly MRI is more effective than the traditional radiographic survey in detecting the changes in the bone marrow and the bone before other techniques can pick up [Music]