Myslivecek M, Nekula J, Bacovský J
Klinika nukleární medicíny Lékarské fakulty UP a FN Olomouc.
Vnitr Lek. 2006 Nov;52 Suppl 2:46-54.
Imaging methods (IM) are important for both the diagnosis and monitoring of the treatment of multiple myeloma (MM). The report discusses radiological IM as well as methods of nuclear medicine. Hole-body screening using simple X-ray pictures is still used in all newly diagnosed cases of the disease, though its validity is significantly higher in chronic forms and primarily in the diagnostics of vertebral compressions. Computer tomography (CT) ideally scans the destructive changes on the compact bone, but it is not very good in showing bone marrow. It is however, invaluable in targeted biopsy or vertebroplasty. Magnetic resonance imaging (MRI) currently has a decisive role mainly in early diagnostics, thanks to its ability to show early changes in the bone marrow. Of critical importance is also indication for MRI in the imaging of structures of the spinal canal and in evidencing epidural propagation of tumour mass. A disadvantage of the method is its inability to show the effects of the treatment immediately following its administration. Contraindications of MRI are also addressed. Among the methods of nuclear medicine, the most important are hole-body 99mTc-MIBI scintigraphy and full-body FDG-PET/CT examinations. 99mTc-MIBI is a sensitive indicator of the biological activity of the disease. It shows the damage to the skeleton caused by the tumour before anatomic changes appear. It reliably differentiates MM remissions from relapses and can be used to determine the optimal position for biopsy puncture. The method is good for monitoring the course of the disease and forecasting the results of the treatment. Its disadvantage is its limited resolution capacity, therefore focal lesions smaller than 10 mm usually escape scintigraphic detection. Similarly to 99mTc-MIBI scintigraphy, FDG-PET/CT examination shows tumorous affection of the skeleton before structural changes appear. It is a highly effective method especially in detecting skeletal damage and extramedullar exhibitions of the disease. The sensitivity and specificity of FDG-PET/CT examination is increased by simultaneous CT examination which is made possible by new generation hybrid instruments. The method, together with 99mTc-MIBI scintigraphy, is very important in the detection of hypo/non-secretional forms of MM. It provides "real time" information on the response of the tumour to treatment and reliably detects the relapse and the remission. An overview is given of recommended examination algorithms for acute and chronic forms and for the monitoring of the treatment of MM, as well as of the importance of all IM for clinical practice.
成像方法（IM）对于多发性骨髓瘤（MM）的诊断和治疗监测都很重要。本报告讨论了放射成像方法以及核医学方法。尽管使用简单X线片进行全身筛查在所有新诊断的该病病例中仍在使用，但其有效性在慢性形式中显著更高，主要用于椎体压缩的诊断。计算机断层扫描（CT）理想情况下可扫描密质骨的破坏性改变，但在显示骨髓方面不太好。然而，它在靶向活检或椎体成形术中非常有用。磁共振成像（MRI）目前主要在早期诊断中起决定性作用，这得益于其显示骨髓早期变化的能力。MRI在椎管结构成像以及证明肿瘤块的硬膜外扩散方面的指征也至关重要。该方法的一个缺点是在给药后不能立即显示治疗效果。还讨论了MRI的禁忌证。在核医学方法中，最重要的是全身99mTc-MIBI闪烁显像和全身FDG-PET/CT检查。99mTc-MIBI是疾病生物活性的敏感指标。它在解剖学变化出现之前显示肿瘤对骨骼的损害。它能可靠地区分MM的缓解期和复发期，可用于确定活检穿刺的最佳位置。该方法有利于监测疾病进程并预测治疗结果。其缺点是分辨率有限，因此小于10毫米的局灶性病变通常无法通过闪烁显像检测到。与99mTc-MIBI闪烁显像类似，FDG-PET/CT检查在结构变化出现之前显示骨骼的肿瘤病变。它是一种高效的方法，尤其在检测骨骼损害和疾病的髓外表现方面。新一代混合仪器使同时进行CT检查成为可能，从而提高了FDG-PET/CT检查的敏感性和特异性。该方法与99mTc-MIBI闪烁显像一起，在检测MM的低分泌/无分泌形式方面非常重要。它提供关于肿瘤对治疗反应的确切实时信息，并可靠地检测复发和缓解情况。概述了针对MM急性和慢性形式以及治疗监测的推荐检查算法，以及所有成像方法对临床实践的重要性。
