Multiple Myeloma
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Population Covered By The Guidance
This pathway provides guidance on the imaging of adult patients with suspected multiple myeloma.
Date reviewed: August 2013
Date of next review: December 2023
Published: August 2013
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Images
Image GalleryNote: These images open in a new page |
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|---|---|---|
| 1 |  |
Multiple Myeloma of the Skull Image 1 (Plain Radiograph): Lateral skull radiograph showing typical multiple small punched out lesions of multiple myeloma. |
| 2 |  |
Multiple Myeloma Image 2 (Magnetic Resonance Imaging): Coronal T1 image showing extensive focal areas of marrow replacement (arrows) in patient with known multiple myeloma. |
| 3a |  |
Multiple Myeloma of the Spine Image 3a and 3b (Magnetic Resonance Imaging): Sagittal T1 and STIR images showing extensive myelomatous infiltration of the lower thoracic and lumbar spine. |
| 3b |  |
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| 4 |  |
Multiple Myeloma Image 4 (H&E, x10): Histological section showing sheets of atypical plasma cells with eccentrically placed nuclei, coarse (clock-face) chromatin and paranuclear hoffs. |
Teaching Points
Teaching Points
- A skeletal survey with plain radiographs is the initial imaging modality of choice
- Multidetector CT has the advantage of superior sensitivity for the detection of bone lesions and has a much more rapid acquisition time
- MRI is also highly sensitive but is generally reserved for symptomatic patients with negative skeletal surveys
- Current guidelines suggest that nuclear medicine scans such as Sestamibi and FDG PET should not be routinely used in diagnosis but may be useful to clarify previous imaging findings in selected cases
References
References
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Ludwig H, Kumpan W, Sinzinger H. Radiography and bone scintigraphy in multiple myeloma: a comparative analysis. Br J Radiol. 1982;55(651):173-81. (Level II/III evidence)
- Woolfenden JM, Pitt MJ, Durie BGM, et al. Comparison of bone scintigraphy and radiography in multiple myeloma. Radiology. 1980;134:723-8. (Level III evidence)
- Pace Leonardo, Catalano L, Del Vecchio S, et al. Predictive value of technetium-99m sestamibi in patients with multiple myeloma and potential role in the follow-up. Eur J Nucl Med. 2001;28:304-12. (Level III evidence)
- Svaldi M, Tappa C, Gebert U, et al. Technetium-99m-sestamibi scintigraphy: an alternative approach for diagnosis and follow-up of active myeloma lesions after high-dose chemotherapy and autologous stem cell transplantation. Ann Hematol. 2001;80(7):393-7. (Level II/III evidence)
- Orchard K, Barrington S, Buscombe J, et al. Fluoro-deoxyglucose positron emission tomography imaging for the detection of occult disease in multiple myeloma. Br J Haematol. 2002;117:133-5. (Level IV evidence)
- Lecouvet FE, Vande Berg BC, Malghem J, et al. Magnetic resonance and computed tomography imaging in multiple myeloma. Semin Musculoskeletal Radiol. 2001;5(1):43-55.
- Lecouvet FE, Malghem J, Michaux L, et al. Skeletal survey in advanced multiple myeloma: radiographic versus MR imaging survey. Br J Haematol. 1999;106:35-9. (Level II evidence). View the reference
- Mahnken AH, Wildberger JE, Gehbauer G, et al. Multidetector CT of the spine in multiple myeloma: comparison with MR imaging and radiography. AJR Am J Roentgenol. 2002;178:1429-36 (Level III evidence)
- Dimopoulos M, Terpos E, Comenzo RL, et al. International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple myeloma. Leukemia. 2009. (Guidelines). View the guidelines
- Schreiman JS, McLeod RA, Kyle RA, Beabout JW. Multiple myeloma: evaluation by CT. Radiology. 1985;154:483-6. Level III evidence)
- Mahnken AH, Wildberger JE, Gehbauer G, et al. Multidetector CT of the spine in multiple myeloma: comparison with MR imaging and radiography. AJR Am J Roentgenol. 2002;178:1429-36. (Level III evidence)
- Ghanem N, Lohrmann C, Engelhardt M, et al. Whole-body MRI in the detection of bone marrow infiltration in patients with plasma cell neoplasms in comparison to the radiological skeletal survey. Eur Radiol. 2006;16:1005-14. (Level III evidence)
- Lecouvet FE, Malghem J, Michaux L, et al. Skeletal survey in advanced multiple myeloma: radiographic versus MR imaging survey. Br J Haematol. 1999;106:35-9. (Level II evidence)
- Baur-Melnyk A, Buhmann S, Becker C, et al. Whole-body MRI versus whole-body MDCT for staging of multiple myeloma. AJR Am J Roentgenol. 2008;190:1097-104. (Level III evidence)
- Baur-Melnyk A, Buhmann S, Durr HR, et al. Role of MRI for the diagnosis and prognosis of multiple myeloma. Eur J Radiol. 2005;55:56-63. (Review article). View the reference
- Walker R, Barlogie B, Haessler J, et al. Magnetic resonance imaging in multiple myeloma: diagnostic and clinical implications. J Clin Oncol. 2007;25:1121-8. (Level III evidence)
- Balleari E, Villa G, Garre S, et al. Technetium-99m-sestamibi scintigraphy in multiple myeloma and related gammopathies: a useful tool for the identification and follow-up of myeloma bone disease. Haematologica. 2001;86:78-84. (Level II evidence)
- Bredella MA, Steinbach L, Caputo G, et al. Value of FDG PET in the assessment of patients with multiple myeloma. AJR Am J Roentgenol. 2005;84:1199-204. (Level III evidence)
- Mirzaei S, Filipits M, Keck A, et al. Comparison of Technetium-99m-MIBI imaging with MRI for detection of spine involvement in patients with multiple myeloma. BMC Nucl Med. 2003;3:2. (Level III evidence)
Information for Consumers
Information for Consumers
Information from this website |
Information from the Royal Australian and New Zealand College of Radiologists’ website |
Consent to Procedure or Treatment Radiation Risks of X-rays and Scans Magnetic Resonance Imaging (MRI) Positron Emission Tomography (PET) |
Contrast Medium (Gadolinium versus Iodine) Iodine-Containing Contrast Medium Magnetic Resonance Imaging (MRI) Radiation Risk of Medical Imaging During Pregnancy Radiation Risk of Medical Imaging for Adults and Children |
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