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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
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
- Smoldering (asymptomatic) MM
- Monoclonal gammopathy of undetermined significance (MGUS)
- Progresses to MM
- Elevated M-protein, bone marrow clonal plasma cells < 10%, no end-organ damage
- Multiple myeloma (MM): Malignant neoplasm of plasma cells in bone marrow
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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References
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Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
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
- Smoldering (asymptomatic) MM
- Monoclonal gammopathy of undetermined significance (MGUS)
- Progresses to MM
- Elevated M-protein, bone marrow clonal plasma cells < 10%, no end-organ damage
- Multiple myeloma (MM): Malignant neoplasm of plasma cells in bone marrow
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
