Multiple myeloma. Imaging diagnostics

Multiple myeloma first shows alterations in conventional X-ray images at later stages and can be seen as coarse strands of osteoporosis with infiltration of the vertebrae or localized osteolysis. The slice imaging technique does not suffer from overlapping images and smaller osteolytic changes can therefore be recognized earlier using computed tomography (CT). CT is also very well suited for detection of skeletal structures at risk for fractures. In the region of the long bones infiltration of the medullary cavity can be found with or without destruction of the cortical substance. Magnetic resonance imaging (MRI) is the most sensitive method to visualize manifestations of the bone marrow by multiple myeloma. The total vertebral column and the pelvis should always be imaged as these are the main locations of manifestations of multiple myeloma. If possible whole body MRI should be carried out because this is more sensitive than conventional X-rays and CT. MRI also is of value for the prognosis. The guidelines of the International Myeloma Foundation should be used for staging.