From the Department of Radiology, Boston University School of Medicine, Boston, Mass (R.F., A.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.L.M.M., P.J.P.); Russell H. Morgan Department of Radiology and Radiological Sciences, Department of Oncology, and Department of Otolaryngology and Head and Neck Surgery, Johns Hopkins School of Medicine, 601 N Caroline St, JHOC 3235, Baltimore, MD 21287 (R.M.S.); and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (R.M.S.).
Radiographics. 2015 Mar-Apr;35(2):438-54. doi: 10.1148/rg.352140112.
Multiple myeloma is a common hematologic malignancy among the elderly population. Although there have been many advances in treatment over the past few decades, the overall prognosis for the disease remains poor. Conventional radiography has long been the standard of reference for the imaging of multiple myeloma. However, 10%-20% of patients with multiple myeloma do not have evidence of disease at conventional radiography. There is a growing body of evidence supporting use of magnetic resonance (MR) imaging and 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) in diagnosis and management of multiple myeloma. MR imaging is useful in detection of bone marrow infiltration, a finding often missed at conventional radiography. FDG PET/CT is especially sensitive for the detection of extramedullary disease and can help detect the metabolically active lesions that often precede evidence of osseous destruction at conventional radiography. MR imaging and FDG PET/CT are useful tools that can provide essential information for diagnosis and management of patients with multiple myeloma. Both modalities allow accurate localization of disease after chemotherapy or autologous stem cell transplantation and can provide important prognostic information that can influence further clinical decision making regarding therapy, particularly when tumor serum markers may be a less reliable indicator of disease burden after repeated treatments.
多发性骨髓瘤是老年人中常见的血液恶性肿瘤。尽管在过去几十年中治疗方法有了很多进展，但该疾病的总体预后仍然较差。传统射线照相术长期以来一直是多发性骨髓瘤成像的标准参考。然而，10%-20%的多发性骨髓瘤患者在常规射线照相术下没有疾病证据。越来越多的证据支持在多发性骨髓瘤的诊断和管理中使用磁共振成像（MR）和 2-[氟-18]氟-2-脱氧-D-葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）。MR 成像有助于检测骨髓浸润，这是常规射线照相术经常遗漏的发现。FDG PET/CT 对骨髓外疾病的检测特别敏感，有助于检测代谢活跃的病变，这些病变往往先于常规射线照相术出现骨破坏的证据。MR 成像和 FDG PET/CT 是有用的工具，可以为多发性骨髓瘤患者的诊断和管理提供重要信息。这两种方式都可以在化疗或自体干细胞移植后准确定位疾病，并提供重要的预后信息，这可能会影响进一步的治疗决策，特别是在肿瘤血清标志物在多次治疗后可能是疾病负担的不太可靠指标时。
