Ravaud P, Thepot C, Auleley G R, Amor B
Clinique de Rhumatologie, Hôpital Cochin, Paris.
Ann Med Interne (Paris). 1996;147(8):370-5.
Multiple myeloma (MM) is characterized by a proliferation of plasma cells responsible for osteolytic lesions. Imaging studies are performed in MM to establish diagnosis and prognosis, and may also be used to judge the efficacy of treatment and to detect complications. TO ESTABLISH THE DIAGNOSIS: Conventional radiography demonstrates, at the time of diagnosis, characteristic features in 80% of cases. These lytic lesions involve more often the sites of red marrow. More rarely the only abnormal finding is diffuse osteopenia. Tomodensitometry and, above all, magnetic resonance imaging (MRI), which is a reference method for bone marrow disorders, can be useful for diagnosis in some difficult cases. But the lesions observed, hyposignals on spin echo T1 sequences and hyposignals on T2-weighted gradient echo, are not specific and usually do not allow to distinguish MM from osteolytic metastasis or other bone marrow disorders. TO DETERMINE EXTENT OF DISEASE AND TO EVALUATE PROGNOSIS: According to Durie and Salmon, the extension of home lesions at diagnosis is strongly correlated with the myelomatous measured cellular mass and with survival of patients. But this relation is denied by some authors who have noted that the shortest survival was seen in patients with normal X-rays. TO JUDGE THE EFFICACY OF TREATMENT: Improvement of the radiological abnormalities is observed in nearly 30% of patients responding to a conventional chemotherapy and appears to be an adverse pronostic sign. A good correlation between MRI and the biological response to treatment has also been reported. TO RECOGNIZE COMPLICATIONS OF DISEASE: Conventional radiography is also very important in diagnosis of complications like fractures or vertebral compression. Lastly, MRI is the investigation of first choice in the evaluation of patients with suspected spinal cord compression.
多发性骨髓瘤（MM）的特征是负责溶骨性病变的浆细胞增殖。对MM患者进行影像学检查以确立诊断和判断预后，也可用于评估治疗效果及检测并发症。确立诊断：在诊断时，80%的病例通过传统X线摄影可显示出特征性表现。这些溶骨性病变更常累及红骨髓部位。较少见的情况是，唯一的异常发现为弥漫性骨质减少。骨密度测定，尤其是磁共振成像（MRI），作为骨髓疾病的参考检查方法，在某些疑难病例的诊断中可能有用。但所观察到的病变，在自旋回波T1序列上呈低信号，在T2加权梯度回波上也呈低信号，并不具有特异性，通常无法将MM与溶骨性转移瘤或其他骨髓疾病区分开来。确定疾病范围及评估预后：根据Durie和Salmon的标准，诊断时骨髓瘤原发病灶的范围与骨髓瘤细胞计数及患者生存率密切相关。但一些作者对此关系提出质疑，他们指出X线检查正常的患者生存期最短。判断治疗效果：在接受传统化疗的患者中，近30%可观察到放射学异常改善，这似乎是一个不良预后指标。也有报道称MRI与治疗的生物学反应之间存在良好相关性。识别疾病并发症：传统X线摄影在诊断骨折或椎体压缩等并发症方面也非常重要。最后,对于疑似脊髓受压的患者，MRI是首选的检查方法。
