eMedicine Specialties > Radiology > Musculoskeletal

Multiple Myeloma: Multimedia

Author: Steven M Sorenson, MD, Consulting Staff, Department of Radiology, Coast Radiology Imaging and Intervention
Coauthor(s): Amilcare Gentili, MD, Professor of Clinical Radiology, University of California at San Diego; Consulting Staff, Department of Radiology, Thornton Hospital; Chief of Radiology, San Diego VA Health Care System; Sulabha Masih, MD, Associate Professor of Diagnostic Radiology, University of California at Los Angeles; Consulting Staff, Department of Radiology, Section of Musculoskeletal Radiology, West Los Angeles Veterans Affairs Medical Center; Carol L Andrews, MD, Consulting Musculoskeletal Radiologist, Mink Radiologic Imaging; Consulting Staff, Department of Radiology, Antelope Valley Medical Center
Contributor Information and Disclosures

Updated: Aug 14, 2009

Multimedia

(Enlarge Image)

Media file 1: Lateral radiograph of the skull. This image demonstrates numerous lytic lesions, which are typical for the appearance of widespread myeloma.

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Lateral radiograph of the skull. This image demonstrates numerous lytic lesions, which are typical for the appearance of widespread myeloma.

(Enlarge Image)

Media file 2: Lateral radiograph of the lumbar spine. This image shows deformity of the L4 vertebral body that resulted from a plasmacytoma.

[ CLOSE WINDOW ]

Lateral radiograph of the lumbar spine. This image shows deformity of the L4 vertebral body that resulted from a plasmacytoma.

(Enlarge Image)

Media file 3: Radiograph of the right femur. This image demonstrates the typical appearance of a single myeloma lesion as a well-circumscribed lucency in the intertrochanteric region. Smaller lesions are seen at the greater trochanter.

[ CLOSE WINDOW ]

Radiograph of the right femur. This image demonstrates the typical appearance of a single myeloma lesion as a well-circumscribed lucency in the intertrochanteric region. Smaller lesions are seen at the greater trochanter.

(Enlarge Image)

Media file 4: Radiograph of the right humerus. This image demonstrates a destructive lesion of the diaphysis. Pathologic fracture is seen.

[ CLOSE WINDOW ]

Radiograph of the right humerus. This image demonstrates a destructive lesion of the diaphysis. Pathologic fracture is seen.

(Enlarge Image)

Media file 5: Coronal T1-weighted magnetic resonance image through a myeloma lesion of the humerus. This image shows that the lesion has a low signal intensity. The outer cortical margin is eroded but intact; however, the lesion has transgressed the inner cortex.

[ CLOSE WINDOW ]

Coronal T1-weighted magnetic resonance image through a myeloma lesion of the humerus. This image shows that the lesion has a low signal intensity. The outer cortical margin is eroded but intact; however, the lesion has transgressed the inner cortex.

(Enlarge Image)

Media file 6: A T1-weighted magnetic resonance image of the humerus. This image demonstrates a predominantly hypointense to isointense myelomatous lesion in the medullary space of the diaphysis. The lesion extends through the anterior aspect of the cortex.

[ CLOSE WINDOW ]

A T1-weighted magnetic resonance image of the humerus. This image demonstrates a predominantly hypointense to isointense myelomatous lesion in the medullary space of the diaphysis. The lesion extends through the anterior aspect of the cortex.

(Enlarge Image)

Media file 7: A T2-weighted, fat-suppressed magnetic resonance image of a myeloma lesion of the humerus. This image demonstrates the lesion is hyperintense on this sequence, a typical finding.

[ CLOSE WINDOW ]

A T2-weighted, fat-suppressed magnetic resonance image of a myeloma lesion of the humerus. This image demonstrates the lesion is hyperintense on this sequence, a typical finding.

(Enlarge Image)

Media file 8: Anteroposterior radiograph of the left shoulder. This image shows an expansile process in the glenoid.

[ CLOSE WINDOW ]

Anteroposterior radiograph of the left shoulder. This image shows an expansile process in the glenoid.

(Enlarge Image)

Media file 9: Axial computed tomography (CT) scan of the glenoid. This image shows a well-defined lesion, with the typical CT scan appearance of myeloma. The cortex is intact. (See also Images 10-13.)

[ CLOSE WINDOW ]

Axial computed tomography (CT) scan of the glenoid. This image shows a well-defined lesion, with the typical CT scan appearance of myeloma. The cortex is intact. (See also Images 10-13.)

(Enlarge Image)

Media file 10: Axial computed tomography scan of the glenoid (same patient as in Images 9 and 11-13). One year later, the myeloma lesion had grown significantly, extending to the coracoid process and through the cortex of the glenoid.

[ CLOSE WINDOW ]

Axial computed tomography scan of the glenoid (same patient as in Images 9 and 11-13). One year later, the myeloma lesion had grown significantly, extending to the coracoid process and through the cortex of the glenoid.

(Enlarge Image)

Media file 11: A T1-weighted magnetic resonance image of the shoulder (same patient as in Images 9-10 and 12-13). This image shows the full extent of myelomatous involvement within the glenoid and coracoid process.

[ CLOSE WINDOW ]

A T1-weighted magnetic resonance image of the shoulder (same patient as in Images 9-10 and 12-13). This image shows the full extent of myelomatous involvement within the glenoid and coracoid process.

(Enlarge Image)

Media file 12: A T2-weighted, fat-suppressed magnetic resonance image of the shoulder (same patient as in Images 9-11 and 13). This image demonstrates the myeloma lesion is hyperintense.

[ CLOSE WINDOW ]

A T2-weighted, fat-suppressed magnetic resonance image of the shoulder (same patient as in Images 9-11 and 13). This image demonstrates the myeloma lesion is hyperintense.

(Enlarge Image)

Media file 13: Axial computed tomography (CT) scan through the left shoulder during a CT-guided biopsy (same patient as in Images 9-12). This image shows a core biopsy needle has been advanced through the coracoid process to obtain a tissue sample.

[ CLOSE WINDOW ]

Axial computed tomography (CT) scan through the left shoulder during a CT-guided biopsy (same patient as in Images 9-12). This image shows a core biopsy needle has been advanced through the coracoid process to obtain a tissue sample.

More on Multiple Myeloma

Overview: Multiple Myeloma

Imaging: Multiple Myeloma

Follow-up: Multiple Myeloma

Multimedia: Multiple Myeloma

References

Goel A, Carlson SK, Classic KL, et al. Radioiodide imaging and radiovirotherapy of multiple myeloma using VSV({Delta}51)-NIS, an attenuated vesicular stomatitis virus encoding the sodium iodide symporter gene. Blood. Oct 1 2007;110(7):2342-50. [Medline].
O'Sullivan P, O'Dwyer H, Flint J, Munk PL, Muller NL. Malignant chest wall neoplasms of bone and cartilage: a pictorial review of CT and MR findings. Br J Radiol. Aug 2007;80(956):678-84. [Medline].
Pérez-Persona E, Vidriales MB, Mateo G, et al. New criteria to identify risk of progression in monoclonal gammopathy of uncertain significance and smoldering multiple myeloma based on multiparameter flow cytometry analysis of bone marrow plasma cells. Blood. Oct 1 2007;110(7):2586-92. [Medline].
Reece DE. Management of multiple myeloma: the changing landscape. Blood Rev. Aug 28 2007;epub ahead of print. [Medline].
Delorme S, Baur-Melnyk A. Imaging in multiple myeloma. Eur J Radiol. Jun 2009;70(3):401-8. [Medline].
Dinter DJ, Neff WK, Klaus J, Böhm C, Hastka J, Weiss C, et al. Comparison of whole-body MR imaging and conventional X-ray examination in patients with multiple myeloma and implications for therapy. Ann Hematol. May 2009;88(5):457-64. [Medline].
Shortt CP, Gleeson TG, Breen KA, McHugh J, O'Connell MJ, O'Gorman PJ, et al. Whole-Body MRI versus PET in assessment of multiple myeloma disease activity. AJR Am J Roentgenol. Apr 2009;192(4):980-6. [Medline].
Dimopoulos M, Terpos E, Comenzo RL, Tosi P, Beksac M, Sezer O, 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. May 7 2009;[Medline].
Agool A, Slart RH, Dierckx RA, Kluin PM, Visser L, Jager PL, et al. Somatostatin receptor scintigraphy might be useful for detecting skeleton abnormalities in patients with multiple myeloma and plasmacytoma. Eur J Nucl Med Mol Imaging. Jul 14 2009;[Medline].
Katzel JA, Hari P, Vesole DH. Multiple myeloma: charging toward a bright future. CA Cancer J Clin. Sep-Oct 2007;57(5):301-18. [Medline]. [Full Text].
Ries LAG, Melbert D, Krapcho M, et al, eds. SEER cancer statistics review, 1975–2004. Bethesda, MD: National Cancer Institute. Available at http://seer.cancer.gov/csr/1975_2004. Accessed September 28, 2007.
Durie BG, Salmon SE. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer. Sep 1975;36(3):842-54. [Medline].
Cancer reference information. What are the risk factors for multiple myeloma? Revised: 08/04/2006. American Cancer Society. Available at http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_multiple_myeloma_30.asp?sitearea=. Accessed September 28, 2007.
Schreiman JS, McLeod RA, Kyle RA, Beabout JW. Multiple myeloma: evaluation by CT. Radiology. Feb 1985;154(2):483-6. [Medline]. [Full Text].
Wiesenthal AA, Nguyen BD. F-18 FDG PET/CT staging of multiple myeloma with diffuse osseous and extramedullary lesions. Clin Nucl Med. Oct 2007;32(10):797-801. [Medline].
Nanni C, Zamagni E, Cavo M, et al. 11C-choline vs. 18F-FDG PET/CT in assessing bone involvement in patients with multiple myeloma. World J Surg Oncol. 2007;5:68. [Medline]. [Full Text].
Ludwig H, Kumpan W, Sinzinger H. Radiography and bone scintigraphy in multiple myeloma: a comparative analysis. Br J Radiol. Mar 1982;55(651):173-81. [Medline].
Erten N, Saka B, Berberoglu K, et al. Technetium-99m 2-methoxy-isobutyl-isonitrile uptake scintigraphy in detection of the bone marrow infiltration in multiple myeloma: correlation with MRI and other prognostic factors. Ann Hematol. Nov 2007;86(11):805-13. [Medline].
Gorji J, Francis KC. Multiple myeloma. Clin Orthop Relat Res. Jan-Feb 1965;38:106-19. [Medline].
Kyle RA. Multiple myeloma: review of 869 cases. Mayo Clin Proc. Jan 1975;50(1):29-40. [Medline].
Van de Berg BC, Lecouvet FE, Michaux L, et al. Stage I multiple myeloma: value of MR imaging of the bone marrow in the determination of prognosis. Radiology. Oct 1996;201(1):243-6. [Medline]. [Full Text].

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Keywords

multiple myeloma, plasma cell myeloma, myeloma, Bence-Jones protein, light chains, heavy chains, monoclonal gammopathy of unknown significance, MGUS, plasmacytoma, hypergammaglobulinemia, POEMS syndrome

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Contributor Information and Disclosures

Author

Steven M Sorenson, MD, Consulting Staff, Department of Radiology, Coast Radiology Imaging and Intervention
Steven M Sorenson, MD is a member of the following medical societies: Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Amilcare Gentili, MD, Professor of Clinical Radiology, University of California at San Diego; Consulting Staff, Department of Radiology, Thornton Hospital; Chief of Radiology, San Diego VA Health Care System
Amilcare Gentili, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Society of Skeletal Radiology
Disclosure: Nothing to disclose.

Sulabha Masih, MD, Associate Professor of Diagnostic Radiology, University of California at Los Angeles; Consulting Staff, Department of Radiology, Section of Musculoskeletal Radiology, West Los Angeles Veterans Affairs Medical Center
Sulabha Masih, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Society of Skeletal Radiology
Disclosure: Nothing to disclose.

Carol L Andrews, MD, Consulting Musculoskeletal Radiologist, Mink Radiologic Imaging; Consulting Staff, Department of Radiology, Antelope Valley Medical Center
Carol L Andrews, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Forensic Sciences, American Association for Women Radiologists, American College of Radiology, American Medical Association, American Roentgen Ray Society, California Radiological Society, North American Spine Society, Radiological Society of North America, and Society of Skeletal Radiology
Disclosure: AMIRSYS publishing Royalty Independent contractor

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Wilfred CG Peh, MD, MBBS, FRCP(Glasg), FRCP(Edin), FRCR, Clinical Professor, Faculty of Medicine, National University of Singapore; Senior Consultant Radiologist, Alexandra Hospital, Singapore
Wilfred CG Peh, MD, MBBS, FRCP(Glasg), FRCP(Edin), FRCR is a member of the following medical societies: American Roentgen Ray Society, British Institute of Radiology, International Skeletal Society, Radiological Society of North America, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

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eMedicine Specialties > Radiology > Musculoskeletal

Multiple Myeloma: Multimedia

Multimedia

Lateral radiograph of the skull. This image demonstrates numerous lytic lesions, which are typical for the appearance of widespread myeloma.

Lateral radiograph of the lumbar spine. This image shows deformity of the L4 vertebral body that resulted from a plasmacytoma.

Radiograph of the right femur. This image demonstrates the typical appearance of a single myeloma lesion as a well-circumscribed lucency in the intertrochanteric region. Smaller lesions are seen at the greater trochanter.

Radiograph of the right humerus. This image demonstrates a destructive lesion of the diaphysis. Pathologic fracture is seen.

Coronal T1-weighted magnetic resonance image through a myeloma lesion of the humerus. This image shows that the lesion has a low signal intensity. The outer cortical margin is eroded but intact; however, the lesion has transgressed the inner cortex.

A T1-weighted magnetic resonance image of the humerus. This image demonstrates a predominantly hypointense to isointense myelomatous lesion in the medullary space of the diaphysis. The lesion extends through the anterior aspect of the cortex.

A T2-weighted, fat-suppressed magnetic resonance image of a myeloma lesion of the humerus. This image demonstrates the lesion is hyperintense on this sequence, a typical finding.

Anteroposterior radiograph of the left shoulder. This image shows an expansile process in the glenoid.

Axial computed tomography (CT) scan of the glenoid. This image shows a well-defined lesion, with the typical CT scan appearance of myeloma. The cortex is intact. (See also Images 10-13.)

Axial computed tomography scan of the glenoid (same patient as in Images 9 and 11-13). One year later, the myeloma lesion had grown significantly, extending to the coracoid process and through the cortex of the glenoid.

A T1-weighted magnetic resonance image of the shoulder (same patient as in Images 9-10 and 12-13). This image shows the full extent of myelomatous involvement within the glenoid and coracoid process.

A T2-weighted, fat-suppressed magnetic resonance image of the shoulder (same patient as in Images 9-11 and 13). This image demonstrates the myeloma lesion is hyperintense.

Axial computed tomography (CT) scan through the left shoulder during a CT-guided biopsy (same patient as in Images 9-12). This image shows a core biopsy needle has been advanced through the coracoid process to obtain a tissue sample.

More on Multiple Myeloma

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor