Moderne Bildgebungsverfahren beim Multiplen Myelom

Zusammenfassung

Bildgebende Verfahren sind von entscheidender Bedeutung für die Diagnostik und das initiale Staging des Multiplen Myeloms sowie für die Abgrenzung zu anderen monoklonalen Plasmazellerkrankungen. Für die Diagnostik ossärer und extraossärer Manifestationen des Multiplen Myeloms steht neben der Projektionsradiografie eine Vielzahl moderner Bildgebungsverfahren wie Ganzkörper-low-dose-CT, Ganzkörper-MRT und ¹⁸F-FDG PET/CT zur Verfügung. Die Projektionsradiografie stellt trotz der bekannten Limitationen wie geringer Sensitivität, eingeschränkter Spezifität und fehlender Nachweismöglichkeit extraossärer Läsionen auch aufgrund der hohen Verfügbarkeit und der geringen Kosten noch den Goldstandard in der Diagnostik des Multiplen Myeloms dar. Die Ganzkörper-low-dose-CT mit ihrer höheren Sensitivität zur Detektion ossärer Manifestationen und der Möglichkeit zur Erfassung eines extraossären Befalls ersetzt an vielen Zentren zunehmend die Projektionsradiografie. Die höchste Sensitivität sowohl für die Darstellung eines Knochenmarkbefalls als auch für die Erfassung eines Weichteil- und Organbefalls besitzen die Ganzkörper-MRT und die ¹⁸F-FDG PET/CT, wobei ein diffuser ossärer Befall am sensitivsten mit der MRT visualisiert werden kann und der extraossäre Befall am sensitivsten mit der PET/CT visualisiert werden kann. Eine Ganzkörper-MRT sollte bei allen Patienten mit unauffälligem konventionellem Röntgenskelettstatus und allen Patienten mit scheinbar solitärem Plasmozytom erwogen werden.

Abstract

Imaging studies are essential for both diagnosis and initial staging of multiple myeloma, as well as for differentiation from other monoclonal plasma cell diseases. Apart from conventional radiography, a variety of newer imaging modalities including whole-body low-dose-CT, whole-body MRI and ¹⁸F-FDG PET/CT may be used for detection of osseous and extraosseous myeloma manifestations. Despite of known limitations such as limited sensitivity and specificity and the inability to detect extraosseous lesions, conventional radiography still remains the gold standard for staging newly diagnosed myeloma, partly due to its wide availability and low costs. Whole-body low-dose CT is increasingly used due to its higher sensitivity for the detection of osseous lesions and its ability to diagnose extraosseous lesions, and is replacing conventional radiography at selected centres. The highest sensitivity for both detection of bone marrow disease and extraosseous lesions can be achieved with whole-body MRI or ¹⁸F-FDG PET/CT. Diffuse bone marrow infiltration may be visualized by whole-body MRI with high sensitivity. Whole-body MRI is at least recommended in all patients with normal conventional radiography and in all patients with an apparently solitary plasmacytoma of bone. To obtain the most precise readings, optimized examination protocols and dedicated radiologists and nuclear medicine physicians familiar with the complex and variable morphologies of myeloma lesions are required.

Key words

hematologic diseases - bone marrow infiltration - diagnostic radiology - multiple myeloma

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