Superiority of magnetic resonance imaging over conventional radiographs in multiple myeloma.

Abstract:

BACKGROUND:Bone lesions in multiple myeloma (MM) are screened with radiological skeletal survey (RSS) due to its widespread availability. Although bone lesions can be missed by RSS, more sensitive radiological surveys are not as yet recommended for routine use due to the low availability of the methodology and economical considerations. CASE REPORT:We report on a 68-year-old male with IgG kappa stage IIIA MM presenting with skeletal pain, fatigue and osteolytic lesions. Since the patient refrained from more intensive therapy, including autologous stem cell transplantation (auto-SCT), he was treated with vertebral irradiation and included in an institutionally guided study which randomized melphalan, prednisone (MP)-lenalidomide (MPR) to MP alone. Although he initially responded, his bone pain reoccurred after three MP cycles. The repeated RSS showed minor, if any changes. Therefore, an MRI was added which revealed extensive osteolyses and extramedullary disease. Justified by these results it was possible to convince the patient that a more intensive therapy approach, including auto-SCT, local irradiation and thalidomide maintenance, was appropriate. CONCLUSION:This case calls for an earlier integration of MRI and/or PET/CT scanning in MM, even if RSS remains unchanged, especially if initial bone disease is substantial and/or MM-related symptoms recur. The time course of information and linked decision-making point towards the future significance of an intensified integration of imaging methodologies in the classification and disease management of MM.

journal_name

Anticancer Res

journal_title

Anticancer research

authors

Engelhardt M,Kleber M,Frydrychowicz A,Pache G,Schmitt-Gräff A,Wäsch R,Durie BG

subject

Has Abstract

pub_date

2009-11-01 00:00:00

pages

4745-50

issue

11

eissn

0250-7005

issn

1791-7530

pii

29/11/4745

journal_volume

29

pub_type

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