Papamichail Dimitris, Hog Robert, Goldschmidt Hartmut, Dimitrakopoulou-Strauss Antonia
Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.
Internal Medicine V and National Center for Tumor Diseases (NCT), University Clinic Heidelberg, 69120 Heidelberg, Germany.
Diagnostics (Basel). 2019 Nov 7;9(4):179. doi: 10.3390/diagnostics9040179.
Ηepatic involvement in multiple myeloma is not common; nevertheless, it is associated with poorer outcome. Heterogeneous features have been described in few published reports so far. We present the imaging findings of PET/CT in comparison to those of MRI for two multiple myeloma (MM) patients, one with a liver lesion suspicious for myeloma metastasis on PET and one with multiple liver lesions suspicious for myeloma metastases on MRΙ. The subsequent ultrasound-guided needle biopsies confirmed the extramedullary spread of the disease in both patients. The first case exhibited a match in both functional imaging modalities (PET and MRI) but a mismatch of intense metabolic activity on F-fluorodeoxyglucose (18F-FDG) PET/CT and iso-attenuating liver parenchyma on contrast-enhanced CT. The second case showed a mismatch of signal elevation persistence on diffusion-weighted imaging (DWI) and physiologic 18F-FDG distribution in the liver parenchyma. These cases present different imaging features in MM lesions of the liver using PET/CT and MRI, reflecting the high disease heterogeneity in patients with MM and demonstrating that the use of both PET/CT and MRI may offer complementary information.
肝脏受累于多发性骨髓瘤并不常见；然而，它与较差的预后相关。迄今为止，在少数已发表的报告中描述了其异质性特征。我们展示了两名多发性骨髓瘤（MM）患者的PET/CT影像表现，并与MRI的表现进行比较，其中一名患者的肝脏病变在PET上怀疑为骨髓瘤转移，另一名患者的肝脏有多个病变在MRI上怀疑为骨髓瘤转移。随后的超声引导下穿刺活检证实了两名患者均存在疾病的髓外扩散。第一例在两种功能成像模式（PET和MRI）上表现匹配，但在F-氟脱氧葡萄糖（18F-FDG）PET/CT上有强烈的代谢活性，而在增强CT上肝脏实质呈等密度，两者不匹配。第二例在扩散加权成像（DWI）上信号持续升高与肝脏实质内生理性18F-FDG分布不匹配。这些病例使用PET/CT和MRI显示出肝脏MM病变的不同影像特征，反映了MM患者疾病的高度异质性，并表明同时使用PET/CT和MRI可能提供互补信息。
