Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and Surgeons, New York, NY; Faith E. Davies, Institute of Cancer Research, Sutton, United Kingdom; Noopur Raje, Massachusetts General Hospital Cancer Center; Kenneth Anderson, Dana-Farber Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA; Orhan Sezer, Memorial Sisli Hospital, Istanbul, Turkey; Sonja Zweegman, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus University Medical Center, Rotterdam, the Netherlands; Jatin Shah, MD Anderson Cancer Center, Houston, TX; Ashraf Badros, University of Maryland Medical Center, Baltimore, MD; Kazuyuki Shimizu, Tokai Central Hospital, Kakamigahara, Japan; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes, France; Chor-Sang Chim, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region; Jian Hou, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid, Spain; Artur Jurczyszyn, University Hospital, Krakow, Poland; Heinz Ludwig, Wilhelminenspital, Vienna, Austria; Bart Barlogie, University of Arkansas for Medical Sciences, Little Rock, AR; G. David Roodman, Indiana University School of Medicine, Indianapolis, IN; S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; and Brian G.M. Durie, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA.
J Clin Oncol. 2015 Feb 20;33(6):657-64. doi: 10.1200/JCO.2014.57.9961. Epub 2015 Jan 20.
PURPOSE: The aim of International Myeloma Working Group was to develop practical recommendations for the use of magnetic resonance imaging (MRI) in multiple myeloma (MM). METHODS: An interdisciplinary panel of clinical experts on MM and myeloma bone disease developed recommendations for the value of MRI based on data published through March 2014. RECOMMENDATIONS: MRI has high sensitivity for the early detection of marrow infiltration by myeloma cells compared with other radiographic methods. Thus, MRI detects bone involvement in patients with myeloma much earlier than the myeloma-related bone destruction, with no radiation exposure. It is the gold standard for the imaging of axial skeleton, for the evaluation of painful lesions, and for distinguishing benign versus malignant osteoporotic vertebral fractures. MRI has the ability to detect spinal cord or nerve compression and presence of soft tissue masses, and it is recommended for the workup of solitary bone plasmacytoma. Regarding smoldering or asymptomatic myeloma, all patients should undergo whole-body MRI (WB-MRI; or spine and pelvic MRI if WB-MRI is not available), and if they have > one focal lesion of a diameter > 5 mm, they should be considered to have symptomatic disease that requires therapy. In cases of equivocal small lesions, a second MRI should be performed after 3 to 6 months, and if there is progression on MRI, the patient should be treated as having symptomatic myeloma. MRI at diagnosis of symptomatic patients and after treatment (mainly after autologous stem-cell transplantation) provides prognostic information; however, to date, this does not change treatment selection.
目的：国际骨髓瘤工作组的目的是制定在多发性骨髓瘤（MM）中使用磁共振成像（MRI）的实用建议。
方法：一个由 MM 和骨髓瘤骨病临床专家组成的跨学科小组，根据截至 2014 年 3 月发表的数据，为 MRI 的价值制定了建议。
建议：与其他影像学方法相比，MRI 对骨髓瘤细胞骨髓浸润的早期检测具有较高的敏感性。因此，MRI 比骨髓瘤相关的骨破坏更早地检测到骨髓瘤患者的骨骼受累，且无辐射暴露。它是轴骨骼成像的金标准，用于评估疼痛性病变，并区分良性和恶性骨质疏松性椎体骨折。MRI 具有检测脊髓或神经压迫以及软组织肿块的能力，建议用于孤立性骨浆细胞瘤的检查。对于冒烟型或无症状骨髓瘤，所有患者都应进行全身 MRI（WB-MRI；如果无法进行 WB-MRI，则进行脊柱和骨盆 MRI），如果有>1 个直径>5mm 的局灶性病变，则应认为患有需要治疗的症状性疾病。对于有疑问的小病变，应在 3 至 6 个月后进行第二次 MRI，如果 MRI 有进展，应将患者视为患有症状性骨髓瘤。有症状患者在诊断时和治疗后（主要是在自体干细胞移植后）进行 MRI 可提供预后信息；但是，迄今为止，这并未改变治疗选择。
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