Monoclonal gammopathy of undetermined significance (MGUS)
Multiple myeloma (MM)
Myeloma-defining event (MDE)
Smoldering MM (SMM)
Solitary plasmacytoma of bone (SPB)
International Myeloma Working Group (IMWG)
Synonyms
Symptomatic MM, active MM
Definitions
MM diagnosis based on combination of laboratory and imaging findings
Either of following 2 and ≥ 1 MDE
Clonal bone marrow plasma cells ≥ 10% or
Biopsy-proven plasmacytoma
MDEs (≥ 1 needed)
Presence of end-organ damage (CRAB criteria)
Clonal bone marrow plasma cells ≥ 60%
Serum involved/uninvolved free light chain ratio ≥ 100
> 1 focal lesion on MR ≥ 5 mm
End-organ damage attributable to plasma cell disorder
Hypercalcemia
Renal insufficiency
Anemia
Bone lesions: ≥ 1 osteolytic lesion
If bone marrow has < 10% clonal plasma cells, > 1 bone lesion is required to distinguish from solitary plasmacytoma with minimal marrow involvement
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Reporting Tips
Selected References
Wu F et al: Updates and ongoing challenges in imaging of multiple myeloma: AJR expert panel narrative review. AJR Am J Roentgenol. 217(4):775-85, 2021
Messiou C et al: Guidelines for acquisition, interpretation, and reporting of whole-body MRI in myeloma: myeloma response assessment and diagnosis system (MY-RADS). Radiology. 291(1):5-3, 2019
Amini B et al: State-of-the-art imaging and staging of plasma cell dyscrasias. Radiol Clin North Am. 54(3):581-96, 2016
Giles SL et al: Whole-body diffusion-weighted MR imaging for assessment of treatment response in myeloma. Radiology. 271(3):785-94, 2014
Padhani AR et al: Assessing the relation between bone marrow signal intensity and apparent diffusion coefficient in diffusion-weighted MRI. AJR Am J Roentgenol. 200(1):163-70, 2013
Hanrahan CJ et al: Current concepts in the evaluation of multiple myeloma with MR imaging and FDG PET/CT. Radiographics. 30(1):127-42, 2010
Kyle RA et al: Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Leukemia. 24(6):1121-7, 2010
Lin C et al: Multiple myeloma treatment response assessment with whole-body dynamic contrast-enhanced MR imaging. Radiology. 254(2):521-31, 2010
Dimopoulos M 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. 23(9):1545-56, 2009
Shortt CP et al: Whole-body MRI versus PET in assessment of multiple myeloma disease activity. AJR Am J Roentgenol. 192(4):980-6, 2009
Baur-Melnyk A et al: Whole-body MRI versus whole-body MDCT for staging of multiple myeloma. AJR Am J Roentgenol. 190(4):1097-104, 2008
Kyle RA et al: Multiple myeloma. Blood. 111(6):2962-72, 2008
Greipp PR et al: International staging system for multiple myeloma. J Clin Oncol. 23(15):3412-20, 2005
Angtuaco EJ et al: Multiple myeloma: clinical review and diagnostic imaging. Radiology. 231(1):11-23, 2004
Baur A et al: Magnetic resonance imaging as a supplement for the clinical staging system of Durie and Salmon? Cancer. 95(6):1334-45, 2002
Rahmouni A et al: MR appearance of multiple myeloma of the spine before and after treatment. AJR Am J Roentgenol. 160(5):1053-7, 1993
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Diagnostic Checklist
TERMINOLOGY
Abbreviations
Monoclonal gammopathy of undetermined significance (MGUS)
Multiple myeloma (MM)
Myeloma-defining event (MDE)
Smoldering MM (SMM)
Solitary plasmacytoma of bone (SPB)
International Myeloma Working Group (IMWG)
Synonyms
Symptomatic MM, active MM
Definitions
MM diagnosis based on combination of laboratory and imaging findings
Either of following 2 and ≥ 1 MDE
Clonal bone marrow plasma cells ≥ 10% or
Biopsy-proven plasmacytoma
MDEs (≥ 1 needed)
Presence of end-organ damage (CRAB criteria)
Clonal bone marrow plasma cells ≥ 60%
Serum involved/uninvolved free light chain ratio ≥ 100
> 1 focal lesion on MR ≥ 5 mm
End-organ damage attributable to plasma cell disorder
Hypercalcemia
Renal insufficiency
Anemia
Bone lesions: ≥ 1 osteolytic lesion
If bone marrow has < 10% clonal plasma cells, > 1 bone lesion is required to distinguish from solitary plasmacytoma with minimal marrow involvement
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Reporting Tips
Selected References
Wu F et al: Updates and ongoing challenges in imaging of multiple myeloma: AJR expert panel narrative review. AJR Am J Roentgenol. 217(4):775-85, 2021
Messiou C et al: Guidelines for acquisition, interpretation, and reporting of whole-body MRI in myeloma: myeloma response assessment and diagnosis system (MY-RADS). Radiology. 291(1):5-3, 2019
Amini B et al: State-of-the-art imaging and staging of plasma cell dyscrasias. Radiol Clin North Am. 54(3):581-96, 2016
Giles SL et al: Whole-body diffusion-weighted MR imaging for assessment of treatment response in myeloma. Radiology. 271(3):785-94, 2014
Padhani AR et al: Assessing the relation between bone marrow signal intensity and apparent diffusion coefficient in diffusion-weighted MRI. AJR Am J Roentgenol. 200(1):163-70, 2013
Hanrahan CJ et al: Current concepts in the evaluation of multiple myeloma with MR imaging and FDG PET/CT. Radiographics. 30(1):127-42, 2010
Kyle RA et al: Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Leukemia. 24(6):1121-7, 2010
Lin C et al: Multiple myeloma treatment response assessment with whole-body dynamic contrast-enhanced MR imaging. Radiology. 254(2):521-31, 2010
Dimopoulos M 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. 23(9):1545-56, 2009
Shortt CP et al: Whole-body MRI versus PET in assessment of multiple myeloma disease activity. AJR Am J Roentgenol. 192(4):980-6, 2009
Baur-Melnyk A et al: Whole-body MRI versus whole-body MDCT for staging of multiple myeloma. AJR Am J Roentgenol. 190(4):1097-104, 2008
Kyle RA et al: Multiple myeloma. Blood. 111(6):2962-72, 2008
Greipp PR et al: International staging system for multiple myeloma. J Clin Oncol. 23(15):3412-20, 2005
Angtuaco EJ et al: Multiple myeloma: clinical review and diagnostic imaging. Radiology. 231(1):11-23, 2004
Baur A et al: Magnetic resonance imaging as a supplement for the clinical staging system of Durie and Salmon? Cancer. 95(6):1334-45, 2002
Rahmouni A et al: MR appearance of multiple myeloma of the spine before and after treatment. AJR Am J Roentgenol. 160(5):1053-7, 1993
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