Comparison between computed tomography and magnetic resonance imaging in detecting multiple myeloma lesions in the skull: A systematic review

Objective: Review, qualify and synthesize the evidence that compared computed tomography (CT) images with magnetic resonance imaging (MRI) in detecting multiple myeloma (MM) lesions in the skull, through a systematic review. Methods: Searches were performed in six databases and the grey literature, up to August 2023, without restriction by date or publication language. Observational studies comparing CT images and MRI of the skull of patients previously diagnosed with MM were included. Data were extracted by two reviewers in a standardized and independent manner. The methodological quality assessment was performed using the QUADAS-2 tool and the evidence certainty assessment using the GRADE tool. Results: Of the 911 identified references, 11 were included, and they all used either positron emission computed tomography (PET/CT) and/or low-dose computed tomography (LDCT) to compare to MRI. In 6 of 7 studies, MRI demonstrated a greater capacity to detect MM lesions than PET/CT images. When compared with LDCT images, MRI showed lower detection capacity in 4 studies. Six of the 11 included articles had a low risk of bias. However, as observational data evidence, the assessed certainty of the evidence was considered very low. Conclusions: PET/CT and MRI images presented limitations in detecting MM lesions in the skull compared to LDCT images. The evidence suggested that the greatest detection capability could be achieved by employing whole-body MRI complemented by LDCT images of the skull. Future studies are needed to confirm this result.