Multiple myeloma (MM): Malignant neoplasm of plasma cells in bone marrow
Smoldering (asymptomatic) MM
Elevated M-protein in serum (IgG or IgA ≥ 3 g/dL), or Bence-Jones protein ≥ 500 mg/24 &/or bone marrow clonal plasma cells 10-60%, no end-organ damage, no bone lesions, no amyloidosis
Active (symptomatic) MM
1 or more of: Myeloma-related organ dysfunction (CRAB criteria), bone marrow clonal plasma cells > 60%; > 1 focal lesion (≥ 5 mm) on MR
Most common radiologic finding: Osteolytic bone lesion (present in ~ 80% of patients on initial staging)
Can be due to solitary plasmacytoma
Solitary bone or soft tissue lesion made of monoclonal plasma cells
Monoclonal gammopathy of undetermined significance (MGUS)
Progresses to MM
Elevated M-protein, bone marrow clonal plasma cells < 10%, no end-organ damage
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Microscopic Features
Pathophysiology
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Seval GC et al: PET with fluorodeoxyglucose F 18/computed tomography as a staging tool in multiple myeloma. PET Clin. 14(3):369-81, 2019
Cavo M et al: Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol. 18(4):e206-e217, 2017
A Comparison of Different Staging Systems for Multiple Myeloma: Can the MRI Pattern Play a Prognostic Role? https://www.ajronline.org/doi/10.2214/AJR.16.17219.
Mesguich C et al: State of the art imaging of multiple myeloma: Comparative review of FDG PET/CT imaging in various clinical settings. Eur J Radiol. ePub, 2014
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KEY FACTS
Terminology
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TERMINOLOGY
Definitions
Multiple myeloma (MM): Malignant neoplasm of plasma cells in bone marrow
Smoldering (asymptomatic) MM
Elevated M-protein in serum (IgG or IgA ≥ 3 g/dL), or Bence-Jones protein ≥ 500 mg/24 &/or bone marrow clonal plasma cells 10-60%, no end-organ damage, no bone lesions, no amyloidosis
Active (symptomatic) MM
1 or more of: Myeloma-related organ dysfunction (CRAB criteria), bone marrow clonal plasma cells > 60%; > 1 focal lesion (≥ 5 mm) on MR
Most common radiologic finding: Osteolytic bone lesion (present in ~ 80% of patients on initial staging)
Can be due to solitary plasmacytoma
Solitary bone or soft tissue lesion made of monoclonal plasma cells
Monoclonal gammopathy of undetermined significance (MGUS)
Progresses to MM
Elevated M-protein, bone marrow clonal plasma cells < 10%, no end-organ damage
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Microscopic Features
Pathophysiology
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Seval GC et al: PET with fluorodeoxyglucose F 18/computed tomography as a staging tool in multiple myeloma. PET Clin. 14(3):369-81, 2019
Cavo M et al: Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol. 18(4):e206-e217, 2017
A Comparison of Different Staging Systems for Multiple Myeloma: Can the MRI Pattern Play a Prognostic Role? https://www.ajronline.org/doi/10.2214/AJR.16.17219.
Mesguich C et al: State of the art imaging of multiple myeloma: Comparative review of FDG PET/CT imaging in various clinical settings. Eur J Radiol. ePub, 2014
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