Which CT findings are characteristic 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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Answer

Answer

Computed tomography (CT) scanning readily depicts osseous involvement in multiple myeloma patients. However, the usefulness of this modality is still being studied, and separate CT scanning alone is not required in most patients. Low-dose whole body CT, with newer multislice scanners, may be able to replace the standard skeletal survey at institutions where it is available. In one study of 42 patients, whole body CT scanning showed an average of nearly 4 times more lesions than conventional radiographic skeletal survey. [25, 26, 27, 13]

One clinical situation in which CT scanning may be of value is in cases in which the patient has bone pain and a negative radiograph. [26] In this scenario, demonstration of a myeloma lesion may alter therapy significantly. CT scanning can also guide percutaneous biopsies, especially of osseous or extraosseous lesions that are suspected of being plasmacytomas.

(See the CT images of multiple myeloma below.)

Axial computed tomography (CT) scan of the glenoid Axial computed tomography (CT) scan of the glenoid. This image shows a well-defined lesion, with the typical CT scan appearance of myeloma. The cortex is intact.
Axial computed tomography scan of the glenoid (sam Axial computed tomography scan of the glenoid (same patient as in the previous image). One year later, the myeloma lesion had grown significantly, extending to the coracoid process and through the cortex of the glenoid.
Axial computed tomography (CT) scan through the le Axial computed tomography (CT) scan through the left shoulder during a CT-guided biopsy (same patient as in the previous image). This image shows a core biopsy needle has been advanced through the coracoid process to obtain a tissue sample.

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