title: Superiority of magnetic resonance imaging over conventional radiographs in multiple myeloma.
abstract: BACKGROUND
  Bone lesions in multiple myeloma (MM) are screened with radiological skeletal survey (RSS) due to its widespread availability. Although bone lesions can be missed by RSS, more sensitive radiological surveys are not as yet recommended for routine use due to the low availability of the methodology and economical considerations.
  
  
  METHODS
  We report on a 68-year-old male with IgG kappa stage IIIA MM presenting with skeletal pain, fatigue and osteolytic lesions. Since the patient refrained from more intensive therapy, including autologous stem cell transplantation (auto-SCT), he was treated with vertebral irradiation and included in an institutionally guided study which randomized melphalan, prednisone (MP)-lenalidomide (MPR) to MP alone. Although he initially responded, his bone pain reoccurred after three MP cycles. The repeated RSS showed minor, if any changes. Therefore, an MRI was added which revealed extensive osteolyses and extramedullary disease. Justified by these results it was possible to convince the patient that a more intensive therapy approach, including auto-SCT, local irradiation and thalidomide maintenance, was appropriate.
  
  
  CONCLUSIONS
  This case calls for an earlier integration of MRI and/or PET/CT scanning in MM, even if RSS remains unchanged, especially if initial bone disease is substantial and/or MM-related symptoms recur. The time course of information and linked decision-making point towards the future significance of an intensified integration of imaging methodologies in the classification and disease management of MM.
authors.affiliation: Department of Hematology and Oncology, University Medical Center Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany. monika.engelhardt@uniklinik-freiburg.de
authors.forename: Monika
authors.initials: M
authors.lastname: Engelhardt
authors.forename: Martina
authors.initials: M
authors.lastname: Kleber
authors.forename: Alex
authors.initials: A
authors.lastname: Frydrychowicz
authors.forename: Gregor
authors.initials: G
authors.lastname: Pache
authors.forename: Annette
authors.initials: A
authors.lastname: Schmitt-Gräff
authors.forename: Ralph
authors.initials: R
authors.lastname: Wäsch
authors.forename: Brian G M
authors.initials: BG
authors.lastname: Durie
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D009101:Multiple Myeloma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D011241:Prednisone / Q000008:administration & dosage; D011859:Radiography; D016032:Randomized Controlled Trials as Topic
chemical_list: D008558:Melphalan; D011241:Prednisone