Learning Radiology xray montage

Multiple Myeloma

  • Clinical

    • Average age is 60-70

    • Men much more common than women

    • Most have an elevated serum protein with 80-90% in the globulin fraction, especially IgG

    • Bence-Jones protein in 40-60% of patients (light chains)

  • X-ray findings

    • Osteoporosis is most common skeletal abnormality in this disease

    • Lesions are usually multiple and found in vertebrae, ribs, skull, pelvis, and femur

    • Over 50% of solitary lesions are found in vertebrae

    • Mandible involved in 1/3 of patients with diffuse involvement

    • Widespread lucencies in bone

      • Discrete, “punched-out” lesions

      • Uniform in size

    • Distinctive to MM are the lucent, elliptical, subcortical shadows, especially in long bones=endosteal scalloping

      • Due to buttressing since MM is usually a slower process than mets

    • In spine, MM destroys body and spares pedicle

  • DDX: mets and disuse osteoporosis

    • MM is more widespread

    • More discrete holes in MM

    • Large foci of coalescence more often due to mets

    • Severe disuse osteoporosis may simulate bone changes of MM

  • Sclerosis is usually seen only with treatment or fracture

    • Bone scans may typically be negative and many hot  areas on scan may be healing fractures

  • Most believe that almost all patients with a solitary plasmacytoma will develop multiple myeloma

    • Solitary plasmacytoma produces “soap-bubbly” expansile, septated lesion, when characteristic

    Multiple myeloma

    Multiple myeloma. The pelvis contains numerous lytic lesions without reactive sclerosis which have an almost "soap-bubbly" appearance in the ischia. There are also lytic lesions in
    both proximal femora.

    Multiple myeloma.

    Multiple myeloma. The skull contains innumerable small lytic lesions of more-or-less uniform size. This has been likened to an "oil-droplet" appearance. Metastases are generally fewer in number and of different sizes and shapes.

    Other examples of Multiple Myeloma (Mouse over to enlarge)

    Multiple myeloma-humerus Multiple myeloma-ribs

    Multiple myeloma-skullMultiple myeloma-spine