D'Anastasi M, Grandl S, Reiser M F, Baur-Melnyk A
Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
Radiologe. 2014 Jun;54(6):556-63. doi: 10.1007/s00117-013-2628-9.
CLINICAL/METHODICAL ISSUE: Robust and reliable imaging methods are required to estimate the skeletal tumor load in multiple myeloma, as well as for the diagnosis of extraskeletal manifestations. Imaging also plays an essential role in the assessment of fracture risk and of vertebral fractures.
The conventional skeletal survey has been the gold standard in the imaging of multiple myeloma for many years.
Other modalities which have been investigated and are in use are whole-body computed tomography (WBCT), 18F-fluorodeoxyglucose positron emission tomography computed tomography (FDG PET-CT) and whole-body magnetic resonance imaging (WBMRI). These techniques are able to depict both mineralized bone and the bone marrow with a high sensitivity for myeloma lesions.
Several studies have shown that cross-sectional imaging is superior to the skeletal survey in the detection of myeloma lesions and WBMRI has been shown to be significantly more sensitive than WBCT for the detection of focal myeloma lesions as well as for diffuse infiltration. The FDG PET-CT technique has a sensitivity comparable to WBMRI.
Due to the higher sensitivity in the detection of myeloma lesions WBCT and WBMRI should replace the skeletal survey.
A WBCT should be performed if there is suspicion of multiple myeloma. If no focal lesions are found WBMRI or at least MRI of the spine and pelvis should be additionally performed if available. If WBMRI has been initially performed and focal lesions are present, an additional WBCT may be performed to assess the extent of bone destruction and fracture risk. In cases of monoclonal gammopathy of undetermined significance (MGUS), solitary and smoldering myeloma, a WBMRI, if available, should be performed in addition to WBCT.
临床/方法学问题：需要强大且可靠的成像方法来评估多发性骨髓瘤的骨骼肿瘤负荷，以及用于诊断骨骼外表现。成像在骨折风险和椎体骨折的评估中也起着至关重要的作用。
传统的骨骼检查多年来一直是多发性骨髓瘤成像的金标准。
已被研究并正在使用的其他检查方式包括全身计算机断层扫描（WBCT）、18F-氟脱氧葡萄糖正电子发射断层扫描计算机断层扫描（FDG PET-CT）和全身磁共振成像（WBMRI）。这些技术能够以高灵敏度描绘矿化骨和骨髓中的骨髓瘤病变。
多项研究表明，断层成像在检测骨髓瘤病变方面优于骨骼检查，并且已证明WBMRI在检测局灶性骨髓瘤病变以及弥漫性浸润方面比WBCT敏感得多。FDG PET-CT技术的灵敏度与WBMRI相当。
由于在检测骨髓瘤病变方面具有更高的灵敏度，WBCT和WBMRI应取代骨骼检查。
如果怀疑有多发性骨髓瘤，应进行WBCT。如果未发现局灶性病变，如有条件，应额外进行WBMRI或至少对脊柱和骨盆进行MRI检查。如果最初进行了WBMRI且存在局灶性病变，可额外进行WBCT以评估骨破坏程度和骨折风险。在意义未明的单克隆丙种球蛋白病（MGUS）、孤立性和冒烟型骨髓瘤的情况下，除WBCT外，如有条件应进行WBMRI检查。
