Journal
JOURNAL OF NUCLEAR MEDICINE
Volume 53, Issue 7, Pages 1091-1101Publisher
SOC NUCLEAR MEDICINE INC
DOI: 10.2967/jnumed.111.098830
Keywords
MRI; multiple myeloma; PET/CT; POEMS syndrome; solitary plasmacytoma
Funding
- Accreditation Council for Continuing Medical Education (ACCME)
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Multiple myeloma (MM) is an incurable plasma cell malignancy of the bone marrow. MM has 3 components: diffuse marrow infiltration, focal bone lesions, and soft-tissue (extramedullary) disease. The hallmark biomarker in blood or urine is a monoclonal immunoglobulin, the monoclonal protein. Waldenstrom macro-globulinemia is a similar disease with secretion of IgM. Staging is classically performed with the 1975 Durie-Salmon system, which includes conventional radiographs. Recently updated, the Durie-Salmon Plus staging system includes CT, MRI, and F-18-FDG PET/CT. The hallmark radiographic lesion of symptomatic MM is a well-demarcated, focal osteolytic bone lesion. The number of focal bone lesions correlates inversely with outcome. Extramedullary disease is typically an aggressive, poorly differentiated form of MM that confers inferior outcome, with median survival of less than 1 y if present at diagnosis. Achievement of a complete response on F-18-FDG PET before stem-cell transplantation correlates with a superior outcome.
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