Learning objectives
-To describe all the imaging techniques used currently in Multiple Myeloma (MM) and to point out for each one of them the main imaging findings,
and to compare their strengths,
weaknesses,
and contribution to the management of these patients.
Background
Multiple myeloma (MM),a hematologic malignancy characterized by monoclonal proliferation of mature plasma cells,accounts for 10% of all hematological conditions,
andis the most common primary osseous malignancy in the elderly population,
with a slight male predominance.
It is a severe disease,
and overall the prognosis is poor,
with a 5-year survival rate of about 35%.
MM must be differentiated from other clonal neoplasms that may resemble it,
with which it shares some features: MGUS (Monoclonal Gammopathy of Undetermined Significance),
Smoldering multiple myeloma (SMM) and plasmacytomas.
MGUS...
Findings and procedure details
Imaging techniques for the evaluation of MM can be divided in three grioups:
Morphological,
which detect bone involvement,
functional that detect tumor activity; and a mixed group of the former mentioned techniques (morpho-functional techniques)
MORPHOLOGICAL TECHNIQUES
CONVENTIONAL RADIOLOGY
Skeletal survey is the most used imaging technique..
It includes 14 radiographies,
from the skull to the knees,
with double projections of the tree spine regions and thorax.
The total estimated radiation dose is about 2.5mSv.
Fig. 3
This technique offers some advantages:
Widely available
Low cost...
Conclusion
The role of imaging techniques in the diagnosis,
staging,
prognosis and follow-up of patients with MM and related clonal neoplasms is invaluable.
None of the imaging techniques by itself is perfect for the staging and monitoring of MM; the combination of morphological and functional techniques allows to obtain all the relevant information in the same study,
making DWI weighted MRI and PET/CT the techniques with the most diagnostic and prognostic value.
However,
these techniques are time-consuming,
expensive,
and not widely available,
so the radiologist must...
References
Regan Ferraro et al,
RadioGraphics 2015; 35:438–454
International Myeloma Working Group.
Br J Haematol 2003
Palumbo A et al.
N Engl J Med 2011
Kyrtsonis MC et al,
Semin Hematol 2009
Agarwal A et al,
AJR Am J Roentgenol 2013
Lecouvet FE et al.
Br J Haematol 1999
Hall MN et al AJR Am J Roentgenol 2010
Blodgett TM,
et al.
Semin Nucl Med 2006
Mesguich C,
et al.
European Journal of Radiology 2014
Zamagni E.
et al,
BJH 2012
Zamagni E.
et al,
Blood...