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Multiple Myeloma
Behrang Amini, MD, PhD
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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

                                      1. 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
                                      2. 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
                                      3. Amini B et al: State-of-the-art imaging and staging of plasma cell dyscrasias. Radiol Clin North Am. 54(3):581-96, 2016
                                      4. Giles SL et al: Whole-body diffusion-weighted MR imaging for assessment of treatment response in myeloma. Radiology. 271(3):785-94, 2014
                                      5. 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
                                      6. 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
                                      7. 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
                                      8. Lin C et al: Multiple myeloma treatment response assessment with whole-body dynamic contrast-enhanced MR imaging. Radiology. 254(2):521-31, 2010
                                      9. 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
                                      10. 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
                                      11. 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
                                      12. Kyle RA et al: Multiple myeloma. Blood. 111(6):2962-72, 2008
                                      13. Greipp PR et al: International staging system for multiple myeloma. J Clin Oncol. 23(15):3412-20, 2005
                                      14. Angtuaco EJ et al: Multiple myeloma: clinical review and diagnostic imaging. Radiology. 231(1):11-23, 2004
                                      15. 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
                                      16. 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

                                                                          1. 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
                                                                          2. 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
                                                                          3. Amini B et al: State-of-the-art imaging and staging of plasma cell dyscrasias. Radiol Clin North Am. 54(3):581-96, 2016
                                                                          4. Giles SL et al: Whole-body diffusion-weighted MR imaging for assessment of treatment response in myeloma. Radiology. 271(3):785-94, 2014
                                                                          5. 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
                                                                          6. 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
                                                                          7. 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
                                                                          8. Lin C et al: Multiple myeloma treatment response assessment with whole-body dynamic contrast-enhanced MR imaging. Radiology. 254(2):521-31, 2010
                                                                          9. 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
                                                                          10. 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
                                                                          11. 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
                                                                          12. Kyle RA et al: Multiple myeloma. Blood. 111(6):2962-72, 2008
                                                                          13. Greipp PR et al: International staging system for multiple myeloma. J Clin Oncol. 23(15):3412-20, 2005
                                                                          14. Angtuaco EJ et al: Multiple myeloma: clinical review and diagnostic imaging. Radiology. 231(1):11-23, 2004
                                                                          15. 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
                                                                          16. 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