title: Hyperattenuating bone marrow abnormalities in myeloma patients using whole-body non-enhanced low-dose MDCT: correlation with haematological parameters.
abstract: We aimed to establish the role of hyperattenuating medullary abnormalities detected by whole-body non-enhanced low-dose multidetector CT (WBLD-MDCT) in multiple myeloma (MM) patients referred for primary evaluation. 50 consecutive patients with untreated Stage I (n(I) = 11), Stage II (n(II) = 10) and Stage III (n(III) = 29) MM underwent WBLD-MDCT for staging. The number and size of osteolysis, as well as haematologic parameters including paraprotein and beta2-microglobulin levels, were assessed and related to the number, size and density of medullary abnormalities assumed to represent myeloma involvement. Bone marrow abnormalities were found in 2/11 (18%) Stage I, 6/10 (60%) Stage II and 20/29 (69%) Stage III myeloma patients, and did not parallel the incidence of osteolysis. Patients with medullary lesions had higher levels of immunoglobulin A (median, 4730 mg dl(-1) vs 1520 mg dl(-1)), light-chain proteinuria (median, 690 mg dl(-1) vs 214 mg dl(-1)) and IgG paraprotein (median, 3270 mg dl(-1) vs 2610 mg dl(-1)) compared with patients without medullary lesions. In patients with medullary abnormalities, levels of serum beta2-microglobulin were significantly higher than in patients without detectable marrow infiltrates (median, 4.3 mg dl(-1) vs 2.4 mg dl(-1); p = 0.0015). In conclusion, medullary abnormalities visualized by WBLD-MDCT are encountered in all stages of myeloma, including cases without osteolysis. They are associated with significantly elevated serum levels of paraprotein (reflecting tumour mass) and beta2-microglobulin, a prospective prognostic marker for myeloma. The nature and possible prognostic significance of medullary abnormalities detected by WBLD-MDCT therefore warrants further investigation.
authors.affiliation: Department of Diagnostic Radiology, Eberhard-Karls University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany. mshorger@med.uni-tuebingen.de
authors.forename: M
authors.initials: M
authors.lastname: Horger
authors.forename: P
authors.initials: P
authors.lastname: Pereira
authors.forename: C D
authors.initials: CD
authors.lastname: Claussen
authors.forename: L
authors.initials: L
authors.lastname: Kanz
authors.forename: R
authors.initials: R
authors.lastname: Vonthein
authors.forename: B
authors.initials: B
authors.lastname: Denecke
authors.forename: C
authors.initials: C
authors.lastname: Driessen
mesh_terms: D000328:Adult; D000368:Aged; D001855:Bone Marrow Diseases / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000000981:diagnostic imaging / Q000473:pathology*; D011379:Prognosis; D014057:Tomography, X-Ray Computed / Q000379:methods*