近年来，创新的策略已经对多发性骨髓瘤患者的治疗格局产生了巨大的重新定义。特别是免疫治疗和高剂量治疗的开发和应用已经显示出很高的有效率，并延长了缓解期的持续时间。在过去的十年中，新型形态学或混合成像技术已逐渐取代了传统的骨骼调查。使用18F-FDG的PET/CT是一种强大的成像工具，可用于诊断工作和治疗评估，允许进行髓内和髓外评估。多个大型前瞻性研究已经报道了PET基线参数与无进展生存和总生存的独立负预测价值，例如骨髓外病变或骨周围病变的存在、骨损害灶的数量和SUVmax。在治疗评估过程中，18F-FDG PET/CT被认为是参考成像技术，因为它可以比缺乏特异性的MRI早得多进行。治疗后持续存在明显异常的18F-FDG摄取是一种独立的负预后因子，而18F-FDG PET/CT和骨髓流式细胞术是在维持治疗之前检测最小残留病的互补工具。近期，PET代谢完全缓解的定义已经标准化，并协调了解释标准。先进的PET分析和基于机器学习的放射组学技术的发展，以及PET/MRI的混合成像，为多发性骨髓瘤成像提供了新的视角。最近，C-X-C趋化因子受体4靶向小分子和抗CD38放射标记抗体等创新放射药物已经显示出肿瘤表型成像和潜在治疗的有希望结果。© 2023年核医学与分子成像学会。

Recent innovative strategies have dramatically redefined the therapeutic landscape for treating multiple myeloma patients. In particular, the development and application of immunotherapy and high-dose therapy have demonstrated high response rates and have prolonged remission duration. Over the past decade, new morphologic or hybrid imaging techniques have gradually replaced conventional skeletal surveys. PET/CT using 18F-FDG is a powerful imaging tool for the workup at diagnosis and for therapeutic evaluation allowing medullary and extramedullary assessment. The independent negative prognostic value for progression-free and overall survival derived from baseline PET-derived parameters such as the presence of extramedullary disease or paramedullary disease, as well as the number of focal bone lesions and SUVmax, has been reported in several large prospective studies. During therapeutic evaluation, 18F-FDG PET/CT is considered the reference imaging technique because it can be performed much earlier than MRI, which lacks specificity. Persistence of significant abnormal 18F-FDG uptake after therapy is an independent negative prognostic factor, and 18F-FDG PET/CT and medullary flow cytometry are complementary tools for detecting minimal residual disease before maintenance therapy. The definition of a PET metabolic complete response has recently been standardized and the interpretation criteria harmonized. The development of advanced PET analysis and radiomics using machine learning, as well as hybrid imaging with PET/MRI, offers new perspectives for multiple myeloma imaging. Most recently, innovative radiopharmaceuticals such as C-X-C chemokine receptor type 4-targeted small molecules and anti-CD38 radiolabeled antibodies have shown promising results for tumor phenotype imaging and as potential theranostics.© 2023 by the Society of Nuclear Medicine and Molecular Imaging.