Bildgebende Diagnostik des Multiplen Myeloms

Zusammenfassung

Hintergrund Das Multiple Myelom ist eine maligne hämatologische Erkrankung, die sich durch die Proliferation von monoklonalen Plasmazellen vor allem im Knochenmark auszeichnet. Die Bildgebung spielt zur Diagnosestellung und Verlaufsbeurteilung eine wichtige Rolle.

Methode Dieser Übersichtsartikel informiert über das Krankheitsbild des Multiplen Myeloms samt Vorstufen und beschreibt die zur Verfügung stehenden bildgebenden Untersuchungstechniken. Diese werden samt Vor- und Nachteilen sowie möglichen prognostischen und therapeutischen Implikationen vor dem Hintergrund der aktuellen Literatur vorgestellt.

Ergebnisse und Schlussfolgerung Der konventionelle Röntgenstatus ist beim Multiple Myelom mittlerweile vollständig von Schnittbildtechniken ersetzt worden. Die breit verfügbare Ganzkörper-Computertomografie wird routinemäßig verwendet, um Osteolysen nachzuweisen. Die Magnetresonanztomografie hat die höchste Sensitivität zur Detektion von Knochenmarkbefall und wird insbesondere bei den Vorstufen des symptomatischen Multiplen Myeloms empfohlen. Die Positronen-Emissionstomografie vereint morphologische und funktionelle Bildgebung. Sie kommt vor allem bei der Verlaufsbeurteilung und Evaluation von Therapieansprechen zum Einsatz.

Kernaussagen: 

• Der konventionelle Röntgenstatus („Pariser Schema“) ist obsolet.

• Die Detektion von Osteolysen geschieht mittels Ganzkörper-CT.

• Die MRT hat die höchste Sensitivität zur Detektion von Knochenmarkbefall.

• Bei Myelom-Vorstufen kommt die MRT (alternativ: PET/CT) zum Einsatz.

• Die PET/CT wird zur Verlaufsbeurteilung und Therapieevaluation angewandt.

Zitierweise

• Kosmala A, Bley T, Petritsch B. Imaging of Multiple Myeloma. Fortschr Röntgenstr 2019; 191: 805 – 816

Key words

myeloma - MGUS - smouldering multiple myeloma - whole-body magnetic resonance imaging (WBMRI) - whole-body low-dose computed tomography (WBLDCT) - PET-CT

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