Multiple myeloma mm is the second most common 10%15% of all hematological. The overall performance of mri is enhanced by applying dynamic contrastenhanced mri and diffusion weighted imaging sequences, providing. The overall performance of mri is enhanced by applying dynamic contrast enhanced mri and diffusion weighted imaging sequences, providing. The recently updated duriesalmon plus staging system published in 2006 highlights the many advances that have been made in the imaging of multiple myeloma, a common malignancy of plasma cells. Chemotherapy chemo is only used if multiple myeloma develops. Guidelines for acquisition, interpretation, and reporting of whole. Multiple myeloma early detection, diagnosis, and staging. Imaging studies and the development of multiple myeloma. Mri of the thoracic spine demonstrates extensive patchy regions of bone marrow replacement normal fatty marrow is bright on both t1 and t2 abnormal marrow is dark associated with multiple superior endplate crush fractures. Multiple myeloma imaging what you need to know the. The european myeloma network guidelines and european society for. Sep 21, 2016 purpose magnetic resonance imaging mri permits the detection of diffuse and focal bone marrow infiltration in the absence of osteopenia or focal osteolysis on standard metastatic bone surveys mbss. Bone disease is the most frequent diseasedefining clinical feature of multiple myeloma. A plasmacytoma is a plasma cell tumor growing in bone or soft tissue.
Articles written by patients and caregivers about their experiences living with myeloma. The introduction of novel agents, such as immunomodulatory drugs. First described in 1848, mm is characterized by a proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein m protein. Skeletalrelated events occur in 80% of patients with multiple myeloma mm. Symptoms develop as a result of anemia, immunosuppression, renal failure, hypercalcemia, and bone destruction with painful pathologic fractures. Five mri patterns of marrow involvement have been recognised in multiple myeloma. Apr 01, 2005 a comprehensive collection of classic and innovative methodologies used in many laboratories for the investigation of multiple myeloma. Multiple myeloma is a malignant bone marrow neoplasia in which a monoclonal strain of atypical. An mri can show if normal bone marrow has been replaced by myeloma cells or by a. Patients and methods both baseline mbs and mri were available in 611 of 668 myeloma patients who were treated uniformly with a tandem autologous transplantationbased protocol and were. Additional regimens may be added over time, particularly as treatment for multiple myeloma evolves.
Wholebody mr wbmr has emerged as the most sensitive imaging modality to date at detecting diffuse and focal multiple myeloma in the spine, as well as the extraaxial skeleton. Multiple myeloma is challenging to diagnose and stage based on one lab test, so doctors typically perform several tests to confirm a diagnosis. Multiple myeloma early detection, diagnosis, and staging 1. The role of radiology and radiotherapy for multiple myeloma. Bone disease is the most frequent diseasedefining clinical feature of multiple myeloma mm, with 90% of patients developing bone lesions over the course of their disease. This image shows a well defined lesion, with the typical ct scan appearance of myeloma. Since 2014, mri findings are included in the new diagnostic criteria proposed by the international myeloma working group. Guidelines for the use of imaging in the management of patients with. An mri can show if normal bone marrow has been replaced by myeloma cells or by a plasmacytoma, especially in the skull, spine, and pelvis. In time, myeloma cells collect in the bone marrow and in the solid parts of bones. Conventional mri protocols for mm include t1weighted, t2weighted with fat suppression in opposedphase imaging.
The purpose of this study is to compare the utility of whole body mri wbmri with diffusionweighted imaging dwi and simultaneous 18ffdg pet mri. It arises from red marrow due to the monoclonal proliferation of plasma cells and manifests in a wide range of radiographic abnormalities. The pediatric radiologists will usually protocol specific sequences they need in ris. Regarding smoldering or asymptomatic myeloma, all patients should undergo wholebody mri wb mri. May 23, 2018 bone disease is the most frequent diseasedefining clinical feature of multiple myeloma mm, with 90% of patients developing bone lesions over the course of their disease. Purpose magnetic resonance imaging mri permits the detection of diffuse and focal bone marrow infiltration in the absence of osteopenia or focal osteolysis on standard metastatic bone surveys mbss. The core clinical protocol for wholebody mri when used alone is designed for myeloma detection in bone marrow but can also image extramedullary disease and should be completed within 30 minutes of imaging time table 1.
This disease is the second most common hematologic malignancy after lymphoma, and its spectrum of characteristic features are widely known by the acronym crab hyper c. Multiple myeloma mm is the second most common 10%15% of all hematological malignancies and represents 1% of all malignant diseases1,2. At initial diagnosis, both mri and ct are recommended to exclude active myeloma. The pelvis contains numerous lytic lesions without reactive sclerosis which have an almost soapbubbly appearance in the ischia. Frontiers multiple myelomalike spinal mri findings in. The uams myeloma center is the most comprehensive center in the world for research and clinical care related to multiple myeloma and related diseases, such as castleman disease and waldenstrom. This image shows a welldefined lesion, with the typical ct scan appearance of myeloma. Wholebody mri versus wholebody mdct for staging of multiple. If not, follow the adult protocol, but make changes to the slice, gap, and fov as needed. My myeloma center does two different mri s on different machines. Baseline mri recommended for all newly diagnosed patients with multiple myeloma by staff news brief the value of mri examinations ordered for patients multiple myeloma, a malignant neoplastic plasma cell disorder, has been long recognized for the modalitys ability to display focal lesions and soft tissue plasmacytoma involving the spine and. The disease evolves from an asymptomatic premalignant stage, monoclonal gammopathy of undetermined significance mgus, over smouldering multiple myeloma smm, to symptomatic mm with endorgan damage, such as hypercalcemia, renal impairment, anaemia.
Multiple myeloma mm, also known as plasma cell myeloma and simple myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibodies. International myeloma working group consensus criteria for response and minimal residual disease assessment in multiple myeloma. The international myeloma working group imwg has issued practical recommendations on the use of mri in patients with multiple myeloma mm and in patients with asymptomatic disease, such. Wholebody mr imaging protocols, including diffusionweighted mr imaging, are. Patients with active myeloma or light chain amyloidosis are often given a combination of 2 or 3 drugs.
Fdgpetct, mri, and other novel imaging modalities in the management of. Listing a study does not mean it has been evaluated by the u. Multiple myeloma is a cancer that begins in plasma cells, a type of white blood cell. Doctors diagnose multiple myeloma using lab tests, imaging. Mibi is injected into a vein, usually on the front of your arm near the level of your elbow or on the back of your hand, and is taken up by any myeloma cells. Patients were diagnosed with multiple myeloma on the basis of the criteria defined by durie and salmon 6. Multiple myeloma early detection, diagnosis, and staging cancer. Comparison of mri in the evaluation of multiple myeloma. Multiple myeloma mm, also known as plasma cell myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibodies. Patients with smouldering myeloma presenting with more than one unequivocal focal lesion in the bone marrow on mri are considered having symptomatic.
Diagnostic and clinical implications journal of clinical oncology, vol. These readily reproducible techniques range from the standard plasma cell labeling index methodology to a final chapter on making sense of microarrays, and include the full spectrum of cytogenetic and molecular diagnostic methods. Multiple myeloma mm is a bcell malignancy of antibodysecreting plasma cells expanding in the bone marrow. A whole body mibi myeloma scan is a nuclear medicine scan which involves the injection of a radioactive material or radioactive tracer called technetium99msestamibi, or mibi for short. If the plasma cell tumor is not in a bone, it may be removed with surgery. One of the defining criteria for multiple myeloma is the unequivocal. We retrospectively studied patients with multiple myeloma, who were referred for imaging mri, ct, radiographs of the musculoskeletal system to evaluate for myelomatous involvement. Magnetic resonance imaging mri is increasingly being used in the diagnostic workup of patients with multiple myeloma. More comprehensive assessments can be performed within 4550 minutes of imaging time table 1. Mar 06, 2020 spinal cord compression is a common complication of multiple myeloma, occurring in as many as 20% of patients at some point during the course of their illness.
The role of radiological imaging in multiple myeloma is essentially three fold. The first line of diagnostic testing usually includes blood and urine tests, and a bone marrow biopsy. The corresponding bone marrow changes are explained in the table by subdividing mm patients in groups of increasing plasma cell percentages. A comprehensive collection of classic and innovative methodologies used in many laboratories for the investigation of multiple myeloma. Role of 18ffdg petct in the diagnosis and management of multiple myeloma and other plasma cell disorders.
Therefore, this case report will provide a dimension to think about rare spinal fluorosis that may show unusual multiple myelomalike findings in. New recommendations for mri use in multiple myeloma. Multiple myeloma mm is a plasma cell dyscrasia, characterized by a proliferation and accumulation of monoclonal plasma cells. The international myeloma working group imwg has issued practical recommendations on the use of mri in patients with multiple myeloma mm and in patients with. Articles by leading multiple myeloma specialists written exclusively for the beacon. Imaging studies and the development of multiple myeloma the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Evaluation by 3d ct, conventional mr imaging, and inphase and opposedphase mr technique. The first line of diagnostic testing usually includes blood. Then, a yearly mri follow up is suggested as it is the best imaging tool to detect disease progression. The skull contains innumerable small lytic lesions of moreorless uniform size. Patients with smouldering myeloma presenting with more than one unequivocal focal lesion in the bone marrow on mri. Imaging of the right lower extremity was performed on a 3t mr system. These cells are part of your immune system, which helps protect the body from germs and other harmful substances. An mri uses magnetic fields, not xrays, to produce detailed images of the body. Osteoporosis, osteoclastic destructions, pathological fractures of the bone, spinal cord and compression can impair patients. For this reason, imaging plays a major role in the management of disease in patients with mm. Often, a combination containing bortezomib, lenalidomide, and dexamethasone is used. Multiple myeloma mm is a clonal plasma cell proliferative disorder characterized by primary infiltration of bone marrow and excessive production of abnormal immunoglobulin. Value of fdg pet in the assessment of patients with multiple.
Multiple myeloma diagnosis and treatment mayo clinic. The standard mri looking for bone involvement, and a. In this article, we shall focus primarily on the more sensitive and specific wholebody imaging techniques, including wholebody computed tomography, wholebody magnetic resonance imaging, and positron. As it progresses, bone pain, bleeding, frequent infections, and anemia may occur. Wholebody mri versus wholebody mdct for staging of. The drugs chosen depend on the patients health including their kidney function and whether a stem cell transplant is planned. Wholebody imaging in multiple myeloma magnetic resonance. Although conventional radiography has traditionally been the standard of care, its low sensitivity in detecting osteolytic. Mri detects bone marrow infiltration by myeloma cells, whereas wbxr and ct detect osseous destruction. Hillengass suggests the whole body ct and an mri of the spine and pelvis. The standard mri looking for bone involvement, and a diffusion weighted blood supply dwbs looking for focal or plasma cell concentration i think they look for homogeneous good vs. Images show examination protocol of wholebody mdct. Objectives the aim of our study was to compare the accuracy of contrast enhanced mri and fdg petct in the staging, treatment evaluation and followup of multiple myeloma. Practice changing mri recommendations in multiple myeloma.
The purpose of this study is to compare the utility of whole body mri wbmri with diffusionweighted imaging dwi and simultaneous 18ffdg pet mri with time of flight tof pet acquisition to identify and characterize osseous lesions in patients with multiple myeloma. Multiple myeloma mm, a malignancy of mature plasma cells, is the second most. Role of radiography, mri and fdgpetct in diagnosing, staging and therapeutical evaluation of patients with multiple myeloma. Radiologists work closely with ohsu mri techs in the art of creating optimal images from current technology. The diagnosis of multiple myeloma was subsequently confirmed histologically. Article baseline mri recommended for all newly diagnosed. Clinicians need to know the different mri techniques and mri patterns of marrow infiltration, and their value in the diagnosis, followup, and better definition of response in myeloma patients, as well as the mri value in other plasma cell disorders e. Jul 08, 2019 multiple myeloma mm is a clonal plasma cell proliferative disorder characterized by primary infiltration of bone marrow and excessive production of abnormal immunoglobulin. Multiple myeloma is a monoclonal gammopathy and is the most common primary malignant bone neoplasm in adults. Standard and novel imaging methods for multiple myeloma.
After that, imaging tests such as xrays, mris, and ct scans may be performed. May 10, 2016 magnetic resonance imaging mri is increasingly being used in the diagnostic workup of patients with multiple myeloma. Mri of the thoracic spine demonstrates extensive patchy regions of bone marrow replacement normal fatty marrow is bright on both t1 and t2 abnormal marrow is dark associated with multiple superior. Multiple myeloma mm is a debilitating malignancy that is part of a spectrum of diseases ranging from monoclonal gammopathy of unknown significance mgus to plasma cell leukemia. There are also lytic lesions in both proximal femora. In such type of fluorosis patients if mri spine is suggestive of multiple myeloma, the spinal biopsy will rule out multiple myeloma but will not suggest fluorosis and yet it is difficult to diagnose. Some early cancers may have signs and symptoms that can be noticed, but that is not always the case. Baseline mri recommended for all newly diagnosed patients with multiple myeloma by staff news brief the value of mri examinations ordered for patients multiple myeloma, a malignant neoplastic plasma. Wbldct is recommended as first line novel imaging investigation in. Mri has been established as a valuable technique for the diagnosis of bone involvement in mm. Apr 05, 2012 imaging studies and the development of multiple myeloma the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. In the development of multiple myeloma, there is a gradual increase in monoclonal plasma cells in the bone marrow. Patients may present with bone pain or with symptoms that are often nonspecific, such as nausea. Irosamond, it should go without saying that i agree with multibilly.
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