“ Multiple myeloma is a cancer of the plasma cells found in bone marrow. It accounts for 10% of haematological malignancy with peak age of ...
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Multiple myeloma is a cancer of the plasma cells found in bone marrow. It accounts for 10% of haematological malignancy with peak age of 65 years. Plasma cell proliferation destroys the bone, causing pain and releasing calcium. Infiltration may be focal, diffuse or variegated.
PLAIN FILM
• Well-demarcated, radiolucent lesions of uniform size without a sclerotic border.
• May be symmetrical and associated with osteopenia.
• Endosteal cortical scalloping.
• Bones involved in haematopoiesis are more commonly affected: spine, skull, ribs, pelvis and femoral and humeral shafts.
• The shoulders, elbows, distal clavicles, acromion, glenoid and ulnar olecranon are also often affected.
• Mandibular involvement favours myeloma over metastases.
• Associated with plasmacytomas—these are solitary bone lesions found in the spine (spares posterior elements), pelvis and ribs that may be expansile.
MRI
• Lesions appear similar to marrow oedema, but enhance with gadolinium.
• Lesions restrict on diffusion-weighted imaging.
• Whole-body diffusion-weighted imaging is now used for diagnosis and response to treatment assessment.
NUCLEAR MEDICINE
• Radionuclide examinations are often negative in myeloma due to the lack of osteoblastic activity.
Multiple myeloma. Lateral skull radiograph demonstrating multiple well-defined, ‘punched out’ lucent lesions in keeping with the so-called pepperpot skull.
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