What is the role of radiography in the workup of multiple myeloma (MM)?

Updated: May 11, 2021
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
  • Print

Simple radiography is indicated for the evaluation of skeleton lesions, and a skeletal survey is performed when myeloma is in the differential diagnosis. Plain radiography remains the gold standard imaging procedure for staging newly diagnosed and relapsed myeloma, according to an International Myeloma Working Group consensus statement. [28]

Perform a complete skeletal series at diagnosis of MM, including the skull (a very common site of bone lesions in persons with MM; see the image below), the long bones (to look for impending fractures), and the spine.

Radiograph of the skull demonstrating a typical ly Radiograph of the skull demonstrating a typical lytic lesion in multiple myeloma. All images and text are (c) 2002 by the American Society of Hematology. All rights reserved.

Conventional plain radiography can usually depict lytic lesions. Such lesions appear as multiple, rounded, punched-out areas, most often in the skull, vertebral column, ribs, and/or pelvis. Less common but not rare sites of involvement include the long bones. Plain radiographs can be supplemented by computed tomography (CT) scanning to assess cortical involvement and risk of fracture. Diffuse osteopenia may suggest myelomatous involvement before discrete lytic lesions are apparent.

Findings from this evaluation may be used to identify impending pathologic fractures, allowing physicians the opportunity to repair debilities and prevent further morbidity.

Also see the topic Imaging Multiple Myeloma.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!