Barley Kevin, Chari Ajai
Multiple Myeloma Program, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1185, New York, NY, 10029, USA.
Curr Hematol Malig Rep. 2016 Apr;11(2):111-7. doi: 10.1007/s11899-016-0314-5.
There have been several advances in the diagnosis of multiple myeloma (MM) in recent years. Serum free light chains have improved the ability to diagnose light chain MM; however, there are still difficulties in the serologic diagnosis of MM in some cases, particularly IgA MM. A novel heavy/light chain assay is able to improve the accuracy of diagnosis in these cases. Free light chains may also improve the diagnosis of extramedullary disease in difficult cases such as disease involving the central nervous system, pleura, or ascites. Advances in imaging such as whole body low-dose computed tomography (CT) whole body magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) have improved sensitivity in identifying lytic bone lesions, which would enable earlier treatment, and monitoring of osseous disease particularly in non- or oligosecretory disease. New techniques such as fused PET/MRI may further enhance the diagnosis of both bone lesions and extramedullary disease.
近年来，多发性骨髓瘤（MM）的诊断取得了多项进展。血清游离轻链提高了诊断轻链MM的能力；然而，在某些情况下，MM的血清学诊断仍存在困难，尤其是IgA MM。一种新型重链/轻链检测方法能够提高这些病例的诊断准确性。游离轻链在诸如累及中枢神经系统、胸膜或腹水等疑难病例的髓外疾病诊断中也可能发挥作用。成像技术的进步，如全身低剂量计算机断层扫描（CT）、全身磁共振成像（MRI）和正电子发射断层扫描/计算机断层扫描（PET/CT），提高了识别溶骨性骨病变的敏感性，这有助于更早开始治疗，并对骨病进行监测，尤其是在无分泌或低分泌性疾病中。诸如PET/MRI融合等新技术可能会进一步提高骨病变和髓外疾病的诊断水平。
