These data indicate that both the International Staging System and the Durie-Salmon PLUS system have great potential for characterizing and stratifying MM to determine the survival outcome and therapy response of patients. Observation of a focal pattern on MRI seems to be associated with poorer survival.
Background: We performed a retrospective evaluation of histological and imaging results of patients submitted to computed tomography (CT)-guided biopsy for vertebral fractures (VFs) of unknown etiology to evaluate the pathological causes of fractures and also to observe the diagnostic results of imaging studies available. Methods: We retrospectively reviewed all the CT-guided vertebral biopsies performed in our institution in the last 2 years, selecting patients with VF of unknown etiology. We reviewed clinical records, imaging studies, and histological examination results. We compared diagnostic performance of the 2 most sensitive imaging modalities for detection of malignancy on the collapsed vertebral body: magnetic resonance imaging (MRI) and positron emission tomography-CT (PET-CT). Anatomopathological results have been considered the gold standard to assess the diagnostic performance of imaging studies. Age stratification has been performed to understand the distribution of different anatomopathological diagnoses in age groups. Results: Among 282 CT-guided vertebral biopsies, 36 (12.8%) have been performed to diagnose the etiology of VF of unknown origin. In 26/32 (81.3%), the vertebral biopsy was diagnostic: 8 osteopenia, 6 multiple myelomas, 4 osteomyelitis, 2 eosinophilic granuloma, 3 metastases, 1 mastocytosis, 1 Paget's disease, and 1 dysmielopoiesis. In 6 cases, the anatomopathological diagnosis was normal bone structure, most likely excluding malignancy. There were no statistically significance differences between MRI and PET-CT results (P ¼ 1.0000). Conclusions: Multiple myeloma and osteopenia represent the most frequent causes of this condition in adult patients, while eosinophilic granuloma and osteomyelitis in pediatric patients. Computed tomography-guided biopsy permits one to reach diagnosis in most of cases. Both PET and MRI could be insufficient to discriminate benign from malignant causes of fractures. Computed tomography-guided biopsy is needed when the etiology of fracture remains unclear.
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Bone disease is the hallmark of multiple myeloma. Skeletal lesions are evaluated to establish the diagnosis, to choose the therapies and also to assess the response to treatments. Due to this, imaging procedures play a key-role in the management of multiple myeloma.
For decades, conventional radiography has been the standard imaging modality. Subsequently, advances in the treatment of multiple myeloma have increased the need for accurate evaluation of skeletal disease. The introduction of new high performant imaging tools, such as whole-body low dose computed tomography, different types of magnetic resonance imaging studies, and 18F-fluorodeoxyglucose positron emission tomography, replaced conventional radiography.
In this review we analyze the diagnostic potentials, indications of use, and applications of the imaging tools nowadays available.
Whole body low-dose CT should be considered as the imaging modality of choice for the initial assessment of multiple myeloma lytic bone lesions. MRI is the gold-standard for detection of bone marrow involvement, while PET/CT is the preferred technique in assessment of response to therapy. Both MRI and PET/CT are able to provide prognostic information.
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