Imaging of multiple myeloma and related plasma cell dyscrasias.
Multiple myeloma (MM) is an incurable plasma cell malignancy of the bone marrow. MM has 3 components: diffuse marrow infiltration, focal bone lesions, and soft-tissue (extramedullary) disease. The hallmark biomarker in blood or urine is a monoclonal immunoglobulin, the monoclonal protein. Waldenstrom macroglobulinemia is a similar disease with secretion of IgM. Staging is classically performed with the 1975 Durie-Salmon system, which includes conventional radiographs. Recently updated, the Durie-Salmon Plus staging system includes CT, MRI, and (18)F-FDG PET/CT. The hallmark radiographic lesion of symptomatic MM is a well-demarcated, focal osteolytic bone lesion. The number of focal bone lesions correlates inversely with outcome. Extramedullary disease is typically an aggressive, poorly differentiated form of MM that confers inferior outcome, with median survival of less than 1 y if present at diagnosis. Achievement of a complete response on (18)F-FDG PET before stem-cell transplantation correlates with a superior outcome.
Medical Imaging Department, Tennessee Valley VA Healthcare System, Nashville, TN, USA. ronald.walker@vanderbilt.edu
Ronald C
RC
Walker
Tracy L
TL
Brown
Laurie B
LB
Jones-Jackson
Lorraine
L
De Blanche
Twyla
T
Bartel
D019046:Bone Marrow Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D009101:Multiple Myeloma / Q000000981:diagnostic imaging* / Q000473:pathology; D016878:POEMS Syndrome / Q000000981:diagnostic imaging / Q000473:pathology; D010265:Paraproteinemias / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi