How accurate is radiography for the diagnosis of multiple myeloma?

Updated: Mar 15, 2019
  • Author: Michael E Mulligan, MD; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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As many as 90% of patients with newly diagnosed multiple myeloma demonstrate skeletal involvement. [22]  The finding of multiple lytic lesions on a skeletal survey invokes 2 primary differential considerations: myeloma and metastases. However, when lesions are found together with bone marrow plasmacytosis and elevated serum gamma-globulins, the diagnosis of myeloma is certain. If tests for these 2 parameters have not been performed (ie, bone marrow plasmacytosis, blood gamma-globulins), the finding of multiple lytic lesions statistically represents widespread metastatic disease in 60-70% of patients, with most of the remainder representing myeloma. Rarely, other conditions that may have multifocal involvement, such as infection, sarcoidosis, and primary lymphoma of bone, can mimic myeloma and metastatic disease. In diffuse osteopenia found on radiography, consider the diagnosis of myeloma and perform additional tests; however, most of these patients only have age-related decreased bone mineral density. Diffuse osteopenia is often a source of false-negative findings because a substantial amount of cancellous bone must be destroyed before an intramedullary lesion becomes visible radiographically.

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