[Imaging methods in diagnosis and monitoring of multiple myeloma].
Imaging methods (IM) are important for both the diagnosis and monitoring of the treatment of multiple myeloma (MM). The report discusses radiological IM as well as methods of nuclear medicine. Hole-body screening using simple X-ray pictures is still used in all newly diagnosed cases of the disease, though its validity is significantly higher in chronic forms and primarily in the diagnostics of vertebral compressions. Computer tomography (CT) ideally scans the destructive changes on the compact bone, but it is not very good in showing bone marrow. It is however, invaluable in targeted biopsy or vertebroplasty. Magnetic resonance imaging (MRI) currently has a decisive role mainly in early diagnostics, thanks to its ability to show early changes in the bone marrow. Of critical importance is also indication for MRI in the imaging of structures of the spinal canal and in evidencing epidural propagation of tumour mass. A disadvantage of the method is its inability to show the effects of the treatment immediately following its administration. Contraindications of MRI are also addressed. Among the methods of nuclear medicine, the most important are hole-body 99mTc-MIBI scintigraphy and full-body FDG-PET/CT examinations. 99mTc-MIBI is a sensitive indicator of the biological activity of the disease. It shows the damage to the skeleton caused by the tumour before anatomic changes appear. It reliably differentiates MM remissions from relapses and can be used to determine the optimal position for biopsy puncture. The method is good for monitoring the course of the disease and forecasting the results of the treatment. Its disadvantage is its limited resolution capacity, therefore focal lesions smaller than 10 mm usually escape scintigraphic detection. Similarly to 99mTc-MIBI scintigraphy, FDG-PET/CT examination shows tumorous affection of the skeleton before structural changes appear. It is a highly effective method especially in detecting skeletal damage and extramedullar exhibitions of the disease. The sensitivity and specificity of FDG-PET/CT examination is increased by simultaneous CT examination which is made possible by new generation hybrid instruments. The method, together with 99mTc-MIBI scintigraphy, is very important in the detection of hypo/non-secretional forms of MM. It provides "real time" information on the response of the tumour to treatment and reliably detects the relapse and the remission. An overview is given of recommended examination algorithms for acute and chronic forms and for the monitoring of the treatment of MM, as well as of the importance of all IM for clinical practice.
Myslivecek
M
M
Klinika nukleární medicíny Lékarské fakulty UP a FN Olomouc. myslivm@fnol.cz
Nekula
J
J
Bacovský
J
J
D006801:Humans; D008279:Magnetic Resonance Imaging; D009101:Multiple Myeloma / Q000175:diagnosis*; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging