Baur-Melnyk Andrea, Reiser Maximilian F
Department of Clinical Radiology, LMU Ludwig Maximilian University of Munich-Grosshadern Campus, Munich, Germany.
Semin Musculoskelet Radiol. 2009 Jun;13(2):111-9. doi: 10.1055/s-0029-1220882. Epub 2009 May 19.
Multiple myeloma is a typical bone marrow neoplasia of the elderly. On radiographs it is often difficult to detect the typical osteolyses in early stages or in regions where overlying structures hamper image analysis. Osteoporosis may be a sign of tumor infiltration, but it is difficult to distinguish from senile osteoporosis. Thus cross-sectional methods increasingly are replacing the skeletal survey, which has been the standard imaging method for a long time. When comparing whole-body magnetic resonance imaging (MRI) with whole-body multidetector computed tomography, MRI is much more sensitive. This is mainly because in MRI, marrow infiltrates are displayed before osseous destructions occur. New imaging guidelines, such as the Durie and Salmon PLUS staging system, include whole-body MRI or positron emission tomography-computed tomography (PET-CT). PET-CT can be used especially for restaging because fluorodeoxyglucose uptake is usually reduced after successful chemotherapy or stem cell transplant. MRI is a prognostic factor and should be used in primary staging for precise evaluation of the extent of disease.
多发性骨髓瘤是一种典型的老年骨髓肿瘤。在X线片上，早期或在重叠结构妨碍图像分析的区域，往往很难检测到典型的骨质溶解。骨质疏松可能是肿瘤浸润的征象，但很难与老年性骨质疏松相鉴别。因此，横断面检查方法正越来越多地取代长期以来作为标准成像方法的骨骼X线检查。当将全身磁共振成像（MRI）与全身多排螺旋计算机断层扫描相比较时，MRI的敏感性要高得多。这主要是因为在MRI中，骨髓浸润在骨质破坏发生之前就能显示出来。新的成像指南，如Durie和Salmon PLUS分期系统，包括全身MRI或正电子发射断层扫描-计算机断层扫描（PET-CT）。PET-CT尤其可用于再分期，因为在成功化疗或干细胞移植后，氟脱氧葡萄糖摄取通常会降低。MRI是一个预后因素，应在初次分期时用于精确评估疾病范围。
