Wight J, Stillwell A, Morris E, Grant B, Lai H C, Irving I
Department of Haematology, Austin Health Service, Townsville, Queensland, Australia.
School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
Intern Med J. 2015 Jul;45(7):762-5. doi: 10.1111/imj.12789.
Magnetic resonance imaging (MRI) is the most sensitive method for detecting focal spinal disease (FSD) in multiple myeloma (MM). It is unclear whether whole spine MRI (WS-MRI) should be employed as a screening test at diagnosis of MM.
To determine the utility of screening WS-MRI at diagnosis of MM.
A retrospective analysis of data from January 2008 to January 2013 at the Townsville Hospital was performed. At this centre, WS-MRI is used routinely in all newly diagnosed MM. The findings of WS-MRI in patients with and without an agreed guideline indication for WS-MRI were compared. Clinical predictors of FSD were determined.
Seventy-one patients were included in the analysis. Forty-four (62%) had an agreed indication for MRI; 33 (75%) of these had FSD. Within this group, 17 required urgent intervention and 13 had spinal plasmacytomas. Within a second group without a guideline indication, 4 of 27 (15%) were found to have FSD on MRI - none required urgent intervention and or had plasmacytomas. Three of eight smouldering myeloma patients were reclassified as symptomatic myeloma by documenting lytic lesions not identified on plain film. The strongest predictors of FSD were back pain (P < 0.001) and vertebral compression fracture (P = 0.003).
WS-MRI in patients without a guideline indication did not detect any lesions that threatened the spinal cord. WS-MRI is essential in those with guideline indications. WS-MRI is of benefit to patients with smouldering myeloma where documentation of lesions not seen on plain film will result in treatment rather than observation.
磁共振成像（MRI）是检测多发性骨髓瘤（MM）中局灶性脊柱疾病（FSD）最敏感的方法。目前尚不清楚在MM诊断时是否应采用全脊柱MRI（WS-MRI）作为筛查试验。
确定在MM诊断时进行筛查性WS-MRI的效用。
对汤斯维尔医院2008年1月至2013年1月的数据进行回顾性分析。在该中心，所有新诊断的MM患者均常规使用WS-MRI。比较了有和没有WS-MRI指南指征患者的WS-MRI检查结果。确定了FSD的临床预测因素。
71例患者纳入分析。44例（62%）有MRI检查的既定指征；其中33例（75%）患有FSD。在这组患者中，17例需要紧急干预，13例患有脊柱浆细胞瘤。在第二组无指南指征的患者中，27例中有4例（15%）MRI检查发现有FSD，均无需紧急干预，也没有浆细胞瘤。8例冒烟型骨髓瘤患者中有3例通过记录X线平片未发现的溶骨性病变，被重新分类为有症状骨髓瘤。FSD最强的预测因素是背痛（P<0.001）和椎体压缩骨折（P = 0.003）。
无指南指征患者的WS-MRI未检测到任何威胁脊髓的病变。有指南指征的患者进行WS-MRI检查至关重要。对于冒烟型骨髓瘤患者，WS-MRI有助于记录X线平片未发现的病变，从而进行治疗而非观察。
