Multiple myeloma x ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2] Shyam Patel [3]

Overview

X-ray may be helpful in the diagnosis of multiple myeloma. Findings on X-ray suggestive of multiple myeloma include punched out bony lesions, generalized osteopenia, and hair-on-end appearance.[1][2] In some cases, MRI may be needed if X-ray is insufficient for diagnosis.

X-ray

  • Simple radiography is the current gold standard for the initial diagnosis and evaluation of lytic lesions of multiple myeloma.[1]
  • The long bones and the spine must always be evaluated while the evaluation of other bones merit consideration based on the patient's symptoms.[1]
  • A series of plain films, or skeletal survey, is essential in not only the diagnosis of multiple myeloma, but also in assessing response, and pre-empting potential complications (e.g. pathological fractures). A typical skeletal survey consists of the following films:[1]
  • The vast majority of lesions seen on plain radiography are purely lytic. Lytic lesions are sharply defined and "punched-out" in appearance, with endosteal scalloping when abutting cortex. The lesions are sclerotic in only 3% of patients.[1]
  • The X-ray is the most inexpensive diagnostic modality for lytic lesions. In some cases, MRI may be warranted, as MRI has a higher sensitivity than X-ray.
  • X-rays should be avoided in pregnant patients with multiple myeloma. MRI can be done instead.
  • Shown below are images depicting the involvement of skull and spinal cord respectively in a case of multiple myeloma.

References

  1. 1.0 1.1 1.2 1.3 1.4 Multiple myeloma. Radiopaedia (2015)http://radiopaedia.org/articles/multiple-myeloma-1 Accessed on September, 20th 2015
  2. Reisenbuckler C (2014). "Multiple myeloma and diagnostic imaging". Radiol Technol. 85 (4): 391–410, quiz 411–3. PMID 24614435.

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