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Radiological imaging in multiple myeloma: review of the state-of-the-art

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Abstract

Purpose

Multiple myeloma is a type of blood cancer arising from the uncontrolled clonal proliferation of malignant plasma cells resulting in impaired hematopoiesis, hyper production of monoclonal protein, bone tissue destruction leading and renal system alterations up to kidney failure. The aim is to review the state-of-the-art of radiological imaging in multiple myeloma.

Methods

Radiological techniques as well as the advancements in imaging technology have been reviewed and summarized. The main radiological findings of different imaging techniques in patients suffering from multiple myeloma are also illustrated.

Results

Different radiological techniques provide structural and functional data. In the last years, conventional skeletal survey has gradually lost its utility and it has been replaced by whole body low-dose computed tomography which allows to identify also small lytic lesions, the medullary and the extramedullary involvement. Nowadays, magnetic resonance is the most sensitive imaging technique for detecting of skeletal as well as medullary involvement in patients with multiple myeloma. Thanks to the multiparametric evaluation (morphological, diffusion weighted and perfusion imaging sequences) and to the quantitative analysis, magnetic resonance imaging is proved to be useful in the early evaluation of response to therapy. Finally, positron emission tomography has greater sensibility compared to computed tomography as it provides quantitative data; however, the lower expression levels of the specific gene involved in the glycolysis pathway are associated with false-negative results with consequent underestimation of the disease.

Conclusion

The only use of the advanced combined multimodal imaging allows a better evaluation, staging and early assessment of treatment response in patients with multiple myeloma.

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Authors and Affiliations

  1. Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133, Rome, Italy

    Francesca Di Giuliano, Valentina Ferrazzoli & Francesco Garaci

  2. Diagnostic Imaging Unit, Integrated Care Processes Department, Policlinico Tor Vergata, 00133, Rome, Italy

    Eliseo Picchi, Antonello Calcagni & Roberto Floris

  3. Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133, Rome, Italy

    Eliseo Picchi, Antonello Calcagni, Valerio Da Ros, Silvia Minosse, Agostino Chiaravalloti & Roberto Floris

  4. Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80100, Naples, Italy

    Massimo Muto

  5. Department of Neuroradiology, A.O.R.N. Cardarelli, 80100, Naples, Italy

    Massimo Muto & Mario Muto

  6. Integrated Care Processes Department, Interventional Radiology Unit, Policlinico Tor Vergata, 00133, Rome, Italy

    Valerio Da Ros

  7. IRCCS Neuromed, Pozzilli, Italy

    Agostino Chiaravalloti

  8. San Raffaele Cassino, Cassino, FR, Italy

    Francesco Garaci

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  1. Francesca Di Giuliano
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  11. Mario Muto
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Key points

• Multiple myeloma (MM) is the main disorder of the bone marrow in adults representing about 1% of all neoplastic disease. MM is the second most common hematologic malignancy after chronic lymphatic leukemia.

• Conventional skeletal survey lacks of sensitivity, with a false-negative rate ranging from 30 to 70%, leading to misdiagnosis or underestimation of the disease stadium.

• Thanks to its greater sensitivity and high-contrast the whole-body low-dose computed tomography (WBLD-CT) allows the evaluation of bone, medullary and extramedullary involvement in MM reducing the effective radiation dose.

• The whole-body magnetic resonance imaging (WB-MRI) is the most sensitive imaging technique for detecting skeletal and extra-skeletal MM invasion. Moreover, the multiparametric information obtained by MRI may be useful for assessment of treatment response by qualitative and quantitative analyses of the perfusion and diffusion data.

• 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography has been proved to report a good sensitivity and specificity for assessment of medullary and extramedullary disease in patients with MM and for assessment of treatment response.

• Interventional radiology can be useful in multiple myeloma specially to treat complications by percutaneous vertebroplasty, balloon kyphoplasty and radiofrequency.

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Di Giuliano, F., Picchi, E., Muto, M. et al. Radiological imaging in multiple myeloma: review of the state-of-the-art. Neuroradiology 62, 905–923 (2020). https://doi.org/10.1007/s00234-020-02417-9

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  • DOI: https://doi.org/10.1007/s00234-020-02417-9

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