Department of Radiology, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, UT 84132, USA.
Radiographics. 2010 Jan;30(1):127-42. doi: 10.1148/rg.301095066.
Multiple myeloma is a heterogeneous group of plasma cell neoplasms that primarily involve bone marrow but also may occur in the soft tissue. Although the disease varies in its manifestations and its course, it is eventually fatal in all cases. Over the past 2 decades, significant advances have been made in our understanding of the genetics and pathogenesis of multiple myeloma and in its treatment. The use of magnetic resonance (MR) imaging and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) with computed tomography (CT) has improved sensitivity for the detection of this disease. PET aids in the identification of active multiple myeloma on the basis of FDG uptake, and MR imaging helps identify multiple myeloma from its infiltration of normal fat within the bone marrow, which occurs in characteristic patterns that correlate with the disease stage. The increased sensitivity of these advanced cross-sectional imaging techniques has led to further refinement of the classic Durie and Salmon staging system. In addition, these imaging techniques allow a more reliable assessment of the disease response to treatment with current regimens, which may include autologous stem cell transplantation as well as various medications. In lesions that respond to chemotherapeutic agents, the replacement of previously infiltrated marrow by fat is seen at MR imaging and decreased FDG uptake is seen at FDG PET; however, a lengthy and intensive regimen may be necessary before the MR imaging appearance of marrow normalizes. Lytic lesions seen at CT almost always persist even after successful treatment. To provide an accurate assessment, radiologists must be familiar not only with the appearances of multiple myeloma and its mimics but also with common treatment-related findings.
多发性骨髓瘤是一组浆细胞肿瘤，主要累及骨髓，但也可能发生于软组织。尽管该病的临床表现和病程存在差异，但最终在所有病例中均是致命的。在过去的 20 年中，人们对多发性骨髓瘤的遗传学和发病机制及其治疗方法的认识取得了重大进展。磁共振成像（MR）和氟 18 氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）与计算机断层扫描（CT）的联合应用提高了对该病的检出灵敏度。PET 有助于根据 FDG 摄取情况识别活动性多发性骨髓瘤，MR 成像有助于从骨髓中正常脂肪的浸润来识别多发性骨髓瘤，这种浸润以与疾病分期相关的特征性模式发生。这些先进的横断面成像技术的灵敏度提高，进一步完善了经典的 Durie 和 Salmon 分期系统。此外，这些成像技术还可更可靠地评估当前治疗方案（包括自体干细胞移植和各种药物）对疾病的反应。在对化疗药物有反应的病变中，MR 成像上可见先前浸润的骨髓被脂肪取代，FDG PET 上可见 FDG 摄取减少；然而，在 MR 成像上骨髓恢复正常之前，可能需要进行漫长而密集的治疗。CT 上见到的溶骨性病变即使在成功治疗后也几乎总是持续存在。为了提供准确的评估，放射科医生不仅必须熟悉多发性骨髓瘤及其类似疾病的表现，还必须熟悉常见的与治疗相关的表现。
