Skip to main content

Advertisement

SpringerLink
Log in

Vertebral lesion distribution in multiple myeloma—assessed by reduced-dose whole-body MDCT

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To observe the distribution and potential distribution patterns of osteolytic and sclerotic vertebral involvement in a representative collective of multiple myeloma patients.

Materials and methods

A total of 66 consecutive patients with a diagnosis of multiple myeloma at initial diagnosis or during follow-up were examined by multidetector reduced-dose computed tomography to evaluate the distribution of bone lesions along the spine with focus on size, location, and lesion character. Confirmation of diagnosis was performed by comparison to follow-up computed tomography or magnetic resonance tomography. If >50 % of all detected malignant lesions occurred in one spinal segment, the distribution pattern was called cervical, thoracic, lumbar, or sacral, otherwise a “mixed” pattern was classified.

Results

Of a total number of 933 osseous spine lesions, 632 (67.7 %) were classified as malignant (98.9 % of them osteolytic) and 293 (31.5 %) as benign. The distribution pattern analysis yielded two patients (3.8 %) with a cervical, 26 (50 %) with a thoracic, 4 (7.7 %) with a lumbar, one (1.9 %) with a sacral pattern, and 19 cases (36.6 %) showed a mixed distribution pattern. Segment-wise, the mean lesion size was 6.52 ± 2.76 mm (cervical), 8.97 ± 5.43 mm (thoracic), 11.97 ± 7.11 mm (lumbar), and 17.5 ± 16.465 (sacral), whilst, related to the vertebra size, the lesion/vertebra size ratio is decreasing through the whole spine beginning from the top.

Conclusions

Multiple myeloma bone lesions occur preferably and are larger in the thoracic and lumbar spine. Moreover, a specific distribution pattern is present in about 60 %.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003;78:21–33.

    Article  PubMed  Google Scholar 

  2. Durie BG, Salmon SE. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer. 1975;36(3):842–54.

    Article  CAS  PubMed  Google Scholar 

  3. International Myeloma Working G. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol. 2003;121(5):749–57.

    Article  Google Scholar 

  4. Terpos E, Dimopoulos MA. Myeloma bone disease: pathophysiology and management. Ann Oncol Off J Eur Soc Med Oncol ESMO. 2005;16(8):1223–31.

    Article  CAS  Google Scholar 

  5. Lacy MQ, Gertz MA, Hanson CA, Inwards DJ, Kyle RA. Multiple myeloma associated with diffuse osteosclerotic bone lesions: a clinical entity distinct from osteosclerotic myeloma (POEMS syndrome). Am J Hematol. 1997;56(4):288–93.

    Article  CAS  PubMed  Google Scholar 

  6. Prasad R, Yadav RR, Singh A, Mathur SP, Mangal Y, Singh M. Case report. Non-secretory multiple myeloma presenting with diffuse sclerosis of affected bones interspersed with osteolytic lesions. Br J Radiol. 2009;82(974):e29–31.

    Article  CAS  PubMed  Google Scholar 

  7. Baur A, Stabler A, Bartl R, Lamerz R, Reiser M. Infiltration patterns of plasmacytomas in magnetic resonance tomography. RoFo Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 1996;164(6):457–63.

    Article  CAS  PubMed  Google Scholar 

  8. Song MK, Chung JS, Lee JJ, Min CK, Ahn JS, Lee SM, et al. Magnetic resonance imaging pattern of bone marrow involvement as a new predictive parameter of disease progression in newly diagnosed patients with multiple myeloma eligible for autologous stem cell transplantation. Br J Haematol. 2014;165(6):777–85.

    Article  CAS  PubMed  Google Scholar 

  9. Moulopoulos LA, Dimopoulos MA, Kastritis E, Christoulas D, Gkotzamanidou M, Roussou M, et al. Diffuse pattern of bone marrow involvement on magnetic resonance imaging is associated with high risk cytogenetics and poor outcome in newly diagnosed, symptomatic patients with multiple myeloma: a single center experience on 228 patients. Am J Hematol. 2012;87(9):861–4.

    Article  PubMed  Google Scholar 

  10. Croucher PI, Apperley JF. Bone disease in multiple myeloma. Br J Haematol. 1998;103(4):902–10.

    Article  CAS  PubMed  Google Scholar 

  11. Prasad D, Schiff D. Malignant spinal-cord compression. Lancet Oncol. 2005;6(1):15–24.

    Article  PubMed  Google Scholar 

  12. Lecouvet FE, Malghem J, Michaux L, Michaux JL, Lehmann F, Maldague BE, et al. Vertebral compression fractures in multiple myeloma. Part II. Assessment of fracture risk with MR imaging of spinal bone marrow. Radiology. 1997;204(1):201–5.

    Article  CAS  PubMed  Google Scholar 

  13. Ramos L, de Las Heras JA, Sanchez S, Gonzalez-Porras JR, Gonzalez R, Mateos MV, et al. Medium-term results of percutaneous vertebroplasty in multiple myeloma. Eur J Haematol. 2006;77(1):7–13.

    Article  PubMed  Google Scholar 

  14. McDonald RJ, Trout AT, Gray LA, Dispenzieri A, Thielen KR, Kallmes DF. Vertebroplasty in multiple myeloma: outcomes in a large patient series. AJNR Am J Neuroradiol. 2008;29(4):642–8.

    Article  CAS  PubMed  Google Scholar 

  15. Anselmetti GC, Manca A, Montemurro F, Hirsch J, Chiara G, Grignani G, et al. Percutaneous vertebroplasty in multiple myeloma: prospective long-term follow-up in 106 consecutive patients. Cardiovasc Intervent Radiol. 2012;35(1):139–45.

    Article  PubMed  Google Scholar 

  16. Cai W, Yan W, Huang Q, Huang W, Yin H, Xiao J. Surgery for plasma cell neoplasia patients with spinal instability or neurological impairment caused by spinal lesions as the first clinical manifestation. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Sect Cervical Spine Res Soc. 2014.

  17. Tamburrelli FC, Proietti L, Scaramuzzo L, De Stefano V, Logroscino CA. Bisphosphonate therapy in multiple myeloma in preventing vertebral collapses: preliminary report. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Sect Cervical Spine Res Soc. 2012;21 Suppl 1:S141–5.

    Article  Google Scholar 

  18. Lecouvet FE, Vande Berg BC, Maldague BE, Michaux L, Laterre E, Michaux JL, et al. Vertebral compression fractures in multiple myeloma. Part I. Distribution and appearance at MR imaging. Radiology. 1997;204(1):195–9.

    Article  CAS  PubMed  Google Scholar 

  19. Princewill K, Kyere S, Awan O, Mulligan M. Multiple myeloma lesion detection with whole body CT versus radiographic skeletal survey. Cancer Investig. 2013;31(3):206–11.

    Article  Google Scholar 

  20. Tancioni F, Lorenzetti M, Navarria P, Nozza A, Castagna L, Gaetani P, et al. Vertebroplasty for pain relief and spinal stabilization in multiple myeloma. Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol. 2010;31(2):151–7.

    Google Scholar 

  21. Hayman JA, Callahan JW, Herschtal A, Everitt S, Binns DS, Hicks RJ, et al. Distribution of proliferating bone marrow in adult cancer patients determined using FLT-PET imaging. Int J Radiat Oncol Biol Phys. 2011;79(3):847–52.

    Article  CAS  PubMed  Google Scholar 

  22. Hur J, Yoon CS, Ryu YH, Yun MJ, Suh JS. Efficacy of multidetector row computed tomography of the spine in patients with multiple myeloma: comparison with magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography. J Comput Assist Tomogr. 2007;31(3):342–7.

    Article  PubMed  Google Scholar 

  23. Bannas P, Kroger N, Adam G, Derlin T. Modern imaging techniques in patients with multiple myeloma. RoFo Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 2013;185(1):26–33.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the Ludwig Hiermaier Foundation for Applied Cancer Research.

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    Georg Bier, Christopher Kloth, Christoph Schabel, Malte Bongers, Konstantin Nikolaou & Marius Horger

Authors
  1. Georg Bier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher Kloth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christoph Schabel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Malte Bongers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Konstantin Nikolaou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marius Horger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Georg Bier.

Ethics declarations

Conflict of interest

The author(s) declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bier, G., Kloth, C., Schabel, C. et al. Vertebral lesion distribution in multiple myeloma—assessed by reduced-dose whole-body MDCT. Skeletal Radiol 45, 127–133 (2016). https://doi.org/10.1007/s00256-015-2268-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-015-2268-4

Keywords

Search

Navigation