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Semin Musculoskelet Radiol 2009; 13(2): 111-119
DOI: 10.1055/s-0029-1220882
© Thieme Medical Publishers

Multiple Myeloma

Andrea Baur-Melnyk1 , Maximilian F. Reiser1
  • 1Department of Clinical Radiology, LMU Ludwig Maximilian University of Munich–Grosshadern Campus, Munich, Germany
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Publication History

Publication Date:
19 May 2009 (online)

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ABSTRACT

Multiple myeloma is a typical bone marrow neoplasia of the elderly. On radiographs it is often difficult to detect the typical osteolyses in early stages or in regions where overlying structures hamper image analysis. Osteoporosis may be a sign of tumor infiltration, but it is difficult to distinguish from senile osteoporosis. Thus cross-sectional methods increasingly are replacing the skeletal survey, which has been the standard imaging method for a long time. When comparing whole-body magnetic resonance imaging (MRI) with whole-body multidetector computed tomography, MRI is much more sensitive. This is mainly because in MRI, marrow infiltrates are displayed before osseous destructions occur. New imaging guidelines, such as the Durie and Salmon PLUS staging system, include whole-body MRI or positron emission tomography-computed tomography (PET-CT). PET-CT can be used especially for restaging because fluorodeoxyglucose uptake is usually reduced after successful chemotherapy or stem cell transplant. MRI is a prognostic factor and should be used in primary staging for precise evaluation of the extent of disease.

KEYWORDS

Multiple myeloma - MRI - MDCT - whole-body imaging

REFERENCES

  • 1 Durie B GM, Kyle R A, Belch A Scientific Advisors of the International Myeloma Foundation et al. Myeloma management guidelines: a consensus report from the Scientific Advisors of the International Myeloma Foundation.  Hematol J. 2003;  4(6) 379-398
    CrossrefPubMedGoogle Scholar
  • 2 Durie B GM, Salmon S E. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival.  Cancer. 1975;  36(3) 842-854
    CrossrefPubMedGoogle Scholar
  • 3 Hall F M, Gore S M. Osteosclerotic myeloma variants.  Skeletal Radiol. 1988;  17(2) 101-105
    CrossrefPubMedGoogle Scholar
  • 4 Mahnken A H, Wildberger J E, Gehbauer G et al.. Multidetector CT of the spine in multiple myeloma: comparison with MR imaging and radiography.  AJR Am J Roentgenol. 2002;  178(6) 1429-1436
    CrossrefPubMedGoogle Scholar
  • 5 Baur-Melnyk A, Buhmann S, Dürr H R, Reiser M. Role of MRI for the diagnosis and prognosis of multiple myeloma.  Eur J Radiol. 2005;  55 56-64
    CrossrefPubMedGoogle Scholar
  • 6 Baur-Melnyk A, Buhmann S, Becker C et al.. Whole-body MRI versus whole-body MDCT for staging of multiple myeloma.  AJR Am J Roentgenol. 2008;  190(4) 1097-1104
    CrossrefPubMedGoogle Scholar
  • 7 Stäbler A, Baur A, Bartl R, Munker R, Lamerz R, Reiser M. Contrast enhancement and quantitative signal analysis in MRI of multiple myeloma: assessment of focal and diffuse growth patterns in marrow correlated with biopsies and survival rates.  AJR Am J Roentgenol. 1996;  167 1029-1036
    PubMedGoogle Scholar
  • 8 Rahmouni A, Divine M, Mathieu D et al.. Detection of multiple myeloma involving the spine: efficacy of fat suppression and contrast-enhanced MRI.  AJR Am J Roentgenol. 1993;  160 1049-1052
    PubMedGoogle Scholar
  • 9 Baur A, Bartl R, Pellengahr C, Baltin V, Reiser M F. Neovascularization of bone marrow in patients with diffuse multiple myeloma: a correlative study of magnetic resonance imaging and histopathologic findings.  Cancer. 2004;  101(11) 2599-2604
    CrossrefPubMedGoogle Scholar
  • 10 Tertti R, Alanen A, Remes K. The value of magnetic resonance imaging in screening myeloma lesions of the lumbar spine.  Br J Haematol. 1995;  91 658-660
    CrossrefPubMedGoogle Scholar
  • 11 Lecouvet F E, Malghem J, Michaux L et al.. Skeletal survey in advanced multiple myeloma: radiographic versus MR imaging survey.  Br J Haematol. 1999;  106(1) 35-39
    CrossrefPubMedGoogle Scholar
  • 12 Van de Berg B C, Lecouvet F E, Michaux L et al.. Stage I multiple myeloma: value of MR imaging of the bone marrow in the determination of prognosis.  Radiology. 1996;  201(1) 243-246
    PubMedGoogle Scholar
  • 13 Dimopoulos M A, Moulopoulos A, Smith T L, Delasalle K B, Alexanian R. Risk of disease progression in asymptomatic multiple myeloma.  Am J Med. 1993;  94(1) 57-61
    CrossrefPubMedGoogle Scholar
  • 14 Baur A, Staebler A, Nagel D, Lamerz R, Bartl R, Hiller E, Wendtner C, Bachner F, Reiser M. Magnetic resonance imaging as a supplement for the clinical staging system of Durie and Salmon.  Cancer. 2002;  95 1334-1345
    CrossrefPubMedGoogle Scholar
  • 15 Schirrmeister H, Bommer M, Buck A K et al.. Initial results in the assessment of multiple myeloma using F18-FDG PET.  Eur J Nucl Med Mol Imaging. 2002;  29 361-366
    CrossrefPubMedGoogle Scholar
  • 16 Durie B GM, Waxman A D, D'Agnolo A, Williams C M. Whole-body (18)F-FDG PET identifies high-risk myeloma.  J Nucl Med. 2002;  43(11) 1457-1463
    PubMedGoogle Scholar
  • 17 Zamagni E, Nanni C, Patriarca F et al.. A prospective comparison of 18F-fluorodeoxyglucose positron emission computer tomography, magnetic resonance imaging and whole body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma.  Haematologica. 2007;  92 50-55
    CrossrefPubMedGoogle Scholar
  • 18 Fonti R, Salvatore B, Quarantelli M et al.. 18F-FDG PET/CT, 99mTc-MIBI, and MRI in evaluation of patients with multiple myeloma.  J Nucl Med. 2008;  49(2) 195-200
    CrossrefPubMedGoogle Scholar
  • 19 Moulopoulos L A, Dimopoulos M A, Smith T L et al.. Prognostic significance of magnetic resonance imaging in patients with asymptomatic multiple myeloma.  J Clin Oncol. 1995;  13(1) 251-256
    PubMedGoogle Scholar
  • 20 Dimopoulos M A, Moulopoulos A, Smith T L, Delasalle K B, Alexanian R. Risk of disease progression in asymptomatic multiple myeloma.  Am J Med. 1993;  94(1) 57-61
    CrossrefPubMedGoogle Scholar
  • 21 Kusumoto S, Jinnai I, Itoh K et al.. Magnetic resonance imaging patterns in patients with multiple myeloma.  Br J Haematol. 1997;  99 649-655
    CrossrefPubMedGoogle Scholar
  • 22 Walker R, Barlogie B, Haessler J et al.. Magnetic resonance imaging in multiple myeloma: diagnostic and clinical implications.  J Clin Oncol. 2007;  25(9) 1121-1128
    CrossrefPubMedGoogle Scholar
  • 23 Hillengass J, Wasser K, Delorme S et al.. Lumbar bone marrow microcirculation measurements from dynamic contrast-enhanced magnetic resonance imaging is a predictor of event-free survival in progressive multiple myeloma.  Clin Cancer Res. 2007;  13(2 Pt 1) 475-481
    CrossrefPubMedGoogle Scholar
  • 24 Singh J, Fairbairn K J, Williams C, Das-Gupta E P, Russell N H, Byrne J L. Expert radiological review of skeletal surveys identifies additional abnormalities in 23% of cases: further evidence for the value of myeloma multi-disciplinary teams in the accurate staging and treatment of myeloma patients.  Br J Haematol. 2007;  137 172-173
    CrossrefPubMedGoogle Scholar
  • 25 Horger M, Kanz L, Denecke B et al.. The benefit of using whole-body, low-dose, nonenhanced, multidetector computed tomography for follow-up and therapy response monitoring in patients with multiple myeloma.  Cancer. 2007;  109(8) 1617-1626
    CrossrefPubMedGoogle Scholar
  • 26 Moulopoulos L A, Dimopoulos M A, Alexanian R, Leeds N E, Libshitz H I. Multiple myeloma: MR patterns of response to treatment.  Radiology. 1994;  193(2) 441-446
    CrossrefPubMedGoogle Scholar
  • 27 Rahmouni A, Divine M, Mathieu D et al.. MR appearance of multiple myeloma of the spine before and after treatment.  AJR Am J Roentgenol. 1993;  16 1053-1057
    PubMedGoogle Scholar
  • 28 Carlson K, Aström G, Nyman R, Ahlström H, Simonsson B. MR imaging of multiple myeloma in tumour mass measurement at diagnosis and during treatment.  Acta Radiol. 1995;  36(1) 9-14
    PubMedGoogle Scholar
  • 29 Bredella M A, Steinbach L, Caputo G, Segall G, Hawkins R. Value of FDG PET in the assessment of patients with multiple myeloma.  AJR Am J Roentgenol. 2005;  184(4) 1199-1204
    CrossrefPubMedGoogle Scholar

Andrea Baur-MelnykM.D. 

Department of Clinical Radiology, LMU Ludwig Maximilian University of Munich–Grosshadern Campus

Marchioninistr. 15, 81377 Munich, Germany

Email: Andrea.Baur@med.uni-muenchen.de

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