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Multiple Myeloma
Pushpender Gupta, MBBS
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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
              • 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

                                              1. 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
                                              2. 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
                                              3. 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.
                                              4. 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
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              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
                                                          • 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

                                                                                          1. 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
                                                                                          2. 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
                                                                                          3. 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.
                                                                                          4. 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