Fast Five Quiz: Key Aspects of Multiple Myeloma

Emmanuel C. Besa, MD


September 26, 2019

Simple radiography is indicated for the evaluation of skeletal lesions, and a skeletal survey is performed when myeloma is in the differential diagnosis. Plain radiography remains a key imaging procedure for staging newly diagnosed and relapsed myeloma. Conventional plain radiography can usually depict lytic lesions. Such lesions appear as multiple, rounded, punched-out areas, most often in the skull, vertebral column, ribs, and/or pelvis. Less common but not rare sites of involvement include the long bones.

MRI is useful in detecting thoracic and lumbar spine lesions, paraspinal involvement, and early cord compression. Findings from MRI of the vertebrae are often positive when plain radiographs are not. MRI can depict many spinal abnormalities in patients with asymptomatic gammopathies in whom radiographic studies are normal. For this reason, evaluate symptomatic patients with MRI to obtain a clear view of the spinal column and to assess the integrity of the spinal cord.

Comparative studies have suggested the possible use of PET scanning in the evaluation of multiple myeloma. For example, a comparison study of PET scanning and whole-body MRI in patients with bone marrow biopsy–proven multiple myeloma found that although MRI had higher sensitivity and specificity than PET in the assessment of disease activity, when used in combination and with concordant findings, the two modalities had a specificity and positive predictive value of 100%. However, PET scanning has not yet been integrated into standard practice.

Do not use bone scans to evaluate multiple myeloma. Cytokines secreted by multiple myeloma cells suppress osteoblast activity; therefore, typically no increased uptake is observed. On technetium bone scanning, more than half of lesions can be missed.

Read more about the imaging of multiple myeloma.


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