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Whole-Body MRI Versus Whole-Body MDCT for Staging of Multiple Myeloma

¹ Institute of Clinical Radiology, University Hospital Grosshadern, Ludwig–Maximilian–University Munich, Marchioninistrasse 15, 81377 Munich, Germany.
² Department of Haemato-Oncology, University Hospital Grosshadern, Ludwig–Maximilian–University Munich, Munich, Germany.

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —66-year-old woman with Bence Jones myeloma and advanced multiple myeloma and multifocal osteolyses. Images show examination protocol of whole-body MDCT: acquisition of 0.75-mm slices from head to proximal lower leg including all skeletal areas of red hematopoietic marrow (120 kV, 100 mAs Care Dose [Siemens Medical Solutions]). Raw data were reconstructed in 3-mm axial slices, 3-mm coronal slices of head including rib cage, coronal slices of pelvis and legs, and 3-mm sagittal slices of spine.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —63-year-old woman with immunoglobulin A myeloma stage III and combined diffuse and multifocal infiltration. Images show examination protocol for whole-body MRI. In all skeletal areas T1-weighted spin-echo sequences were combined with fat-saturated STIR sequences. Axial plane was chosen for skull; coronal plane in combination with axial plane (only STIR) for shoulder girdle, upper arms, and thorax; coronal plane for the pelvis and legs; and sagittal plane for spine, which was examined in two steps (cervical spine including upper thoracic spine and lower thoracic spine including lumbar spine).

View larger version (169K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —66-year-old woman with lambda Bence Jones myeloma. Concordant findings on MRI and MDCT with multifocal myeloma involvement. T1-weighted spin-echo image shows multifocal hypointense foci (A) corresponding to hyperintensity on fat-suppressed STIR image (B). On MDCT image (C) multifocal osseous destructions are detected.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —66-year-old woman with lambda Bence Jones myeloma. Concordant findings on MRI and MDCT with multifocal myeloma involvement. T1-weighted spin-echo image shows multifocal hypointense foci (A) corresponding to hyperintensity on fat-suppressed STIR image (B). On MDCT image (C) multifocal osseous destructions are detected.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —66-year-old woman with lambda Bence Jones myeloma. Concordant findings on MRI and MDCT with multifocal myeloma involvement. T1-weighted spin-echo image shows multifocal hypointense foci (A) corresponding to hyperintensity on fat-suppressed STIR image (B). On MDCT image (C) multifocal osseous destructions are detected.

View larger version (52K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Discordant findings on MRI and MDCT in 68-year-old man with lambda Bence Jones myeloma. T1-weighted spin-echo (A) and STIR (B) images show high-grade diffuse infiltration of bone marrow by myeloma. Signal is diffusely reduced on T1-weighted spin-echo (A) images and increased on fat-saturated STIR (B) images because of increase in cells and reduction of fat. In addition, two circumscribed lesions are detectable in spine. One of them is displayed at ninth thoracic vertebral body (arrow, B).

View larger version (48K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Discordant findings on MRI and MDCT in 68-year-old man with lambda Bence Jones myeloma. T1-weighted spin-echo (A) and STIR (B) images show high-grade diffuse infiltration of bone marrow by myeloma. Signal is diffusely reduced on T1-weighted spin-echo (A) images and increased on fat-saturated STIR (B) images because of increase in cells and reduction of fat. In addition, two circumscribed lesions are detectable in spine. One of them is displayed at ninth thoracic vertebral body (arrow, B).

View larger version (44K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Discordant findings on MRI and MDCT in 68-year-old man with lambda Bence Jones myeloma. On MDCT image (sagittal reconstruction), only circumscribed tumor nodules were displayed as focal destructions. Arrow indicates circumscribed lesion.

View larger version (66K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —61-year-old woman with lambda Bence Jones myeloma. Discordant findings on MRI and MDCT images show multifocal infiltrates in the spine. Note also pathologic fracture in L5. Sagittal MDCT reconstruction of spine in same patient showed large bone destruction in L5 with pathologic fracture and six other smaller osteolyses (not shown in this slice).

View larger version (68K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —61-year-old woman with lambda Bence Jones myeloma. Discordant findings on MRI and MDCT images show multifocal infiltrates in the spine. Note also pathologic fracture in L5. Sagittal MDCT reconstruction of spine in same patient showed large bone destruction in L5 with pathologic fracture and six other smaller osteolyses (not shown in this slice).

View larger version (63K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —61-year-old woman with lambda Bence Jones myeloma. Discordant findings on MRI and MDCT images show multifocal infiltrates in the spine. Note also pathologic fracture in L5. Sagittal MDCT reconstruction of spine in same patient showed large bone destruction in L5 with pathologic fracture and six other smaller osteolyses (not shown in this slice).

View larger version (67K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —61-year-old woman with lambda Bence Jones myeloma. Discordant findings on MRI and MDCT images show multifocal infiltrates in the spine. Note also pathologic fracture in L5. Sagittal MDCT reconstruction of spine in same patient showed large bone destruction in L5 with pathologic fracture and six other smaller osteolyses (not shown in this slice).

View larger version (49K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5E —61-year-old woman with lambda Bence Jones myeloma. Discordant findings on MRI and MDCT images show multifocal infiltrates in the spine. Note also pathologic fracture in L5. Sagittal MDCT reconstruction of spine in same patient showed large bone destruction in L5 with pathologic fracture and six other smaller osteolyses (not shown in this slice).

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