Whole-Body MRI — myeloma (MY-RADS style)
Skull vertex to at least the knees, and to the feet where symptoms or known disease require it, acquired as overlapping stations.
Typical, not policy
Timings, volumes and delays here are representative values drawn from published guidance. Scanner generation, injector, cardiac output and local preference all move them. Confirm against your department's own protocol before you rely on a number.
When to use it
- Suspected smouldering myeloma, to detect focal lesions that would define symptomatic disease.
- Newly diagnosed myeloma requiring baseline disease burden assessment.
- Response assessment after treatment, using ADC change alongside morphology.
- Solitary plasmacytoma, to exclude additional sites.
- Suspected myeloma where skeletal survey or CT is negative but clinical suspicion remains.
Technique
- Axial diffusion-weighted imaging across all stations with a low b value of about 50 s/mm² and a high b value of about 900 s/mm², with ADC maps.
- Axial T1 Dixon producing fat-only and water-only images, with coronal reconstructions.
- Sagittal T1 and T2 of the whole spine as a dedicated high-resolution component.
- Station overlap, identical b values and matched geometry between baseline and follow-up are what make quantitative comparison possible; multicentre experience shows this is where protocols most often drift.
Where it goes wrong
- Changing b values or station positioning between baseline and follow-up, which invalidates ADC comparison.
- Inadequate fat suppression on the diffusion stations, particularly at the shoulders and the pelvic brim.
- Coverage stopping above the knees when disease or symptoms are more distal.
- Reading only the inverted maximum intensity projections; focal disease is confirmed on the axial source and the Dixon images.
- Red marrow reconversion producing widespread diffusion signal that is over-read as disease — a technique-driven confounder in younger, anaemic and treated patients.
Clinical questions that reach this study
Contrast
None
- The standardised myeloma whole-body protocol is unenhanced. Contrast is not part of the core recipe and is reserved for specific problem-solving.
Acquisition
- Breathing
- Free breathing for the diffusion stations; breath-hold or navigator techniques for the thoracoabdominal Dixon acquisitions.
- Reconstruction
- Composed whole-body coronal reconstructions, inverted-greyscale high b-value maximum intensity projections, and ADC maps with region-of-interest measurements for response assessment.
- Preparation
- This is a long study, typically 45-60 minutes; assess tolerance, claustrophobia and analgesia needs at vetting rather than on the day. Supply the paraprotein or PSA trajectory and prior whole-body imaging so the same stations and b-values are matched for comparison. Intravenous contrast is not routinely part of the diffusion-based protocols and should not be assumed.
Safety checks this protocol carries
Derived from the contrast agent and phases above, not authored here — which is why they cannot drift apart from what the protocol actually does.
- MR safety screening for implants and foreign bodies· radiographer at scan