The Association of Radiological Manifestations (by Both X-Ray and MRI) with the Clinical Presentation of Multiple Myeloma

Waseem F. Al Tameemi, Ahmed S. Al Zubaydi, Ibrahim Kh. Al Shammary


Background: Multiple myeloma (MM) is a neoplastic plasma cell disorder that arises within the bone marrow. Bone destruction is an integral part of MM. With radiological tests, about 75% of patients show punched-out lytic lesions, osteoporosis or fractures on conventional radiography. However with more sensitive tests, like computerized tomography (CT) and magnetic resonance imaging (MRI), nearly all patients show evidence of bone destruction. These more sensitive tests can be applied to define bone marrow abnormalities in MM with greater sensitivity than other imaging modalities.

Patients and Methods: Forty-one patients, newly diagnosed with multiple myeloma, were enrolled in this study. In addition to a clinical examination, both X-rays and spine MRI images were studied in relation to the main clinical and laboratory features like anemia, renal impairment or hypercalcemia as well as the bone marrow plasma cell degree of infiltration. The X-ray radiological abnormalities were described as normal, punched-out lytic lesions, osteoporosis or pathological fracture or any combination of these while MRI patterns were seen as normal, focal lesions or diffuse involvement.

Results: It appeared that the more advanced X-ray radiological features would indicate more plasma cell infiltration in the bone marrow specimen (p=0.047) and the higher risk of renal impairment as a complication (p=0.05) while the more diffuse pattern of MRI findings would indicate higher bone destruction and more calcium mobilization to circulation (p=0.05).

Conclusion: It is clear that almost all MM patients had been referred to the hematology clinic in an advanced symptomatic stage as they had the worst manifestations of the illness (anemia and impaired renal function) as well as advanced radiological features that give no significant superiority to the MRI over the conventional X-ray screen, unlike what has been proven by other studies. A special MRI protocol for MM patients may be required to yield better results in assessing the degree of plasma cell infiltration in bone marrow; allowing it to be applied in follow-ups for those patients.

Keywords: Multiple myeloma, plasma cell disease, imaging tests in multiple myeloma, MRI, X-ray, prognosis.

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