Multiple myeloma x ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]; Shyam Patel [3]

## Overview

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X-ray may be helpful in the diagnosis of multiple myeloma. Findings on X-ray suggestive of multiple myeloma include punched out bony lesions, generalized osteopenia, and hair-on-end appearance. In some cases, MRI may be needed if X-ray is insufficient for diagnosis.

## X-ray

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* Simple radiography is the current gold standard for the initial diagnosis and evaluation of lytic lesions of multiple myeloma.[1][2]
* The long bones and the spine must always be evaluated while the evaluation of other bones merit consideration based on the patient's symptoms.
* A series of plain films, or skeletal survey, is essential in not only the diagnosis of multiple myeloma, but also in assessing response, and pre-empting potential complications (e.g. pathological fractures).

### Skeletal survey

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* A typical skeletal survey consists of the following films:

* Lateral skull
* Frontal chest film
* Cervico-thoraco-lumbar spine
* Shoulder
* Pelvis
* Femur
* Humerus
* The vast majority of lesions seen on plain radiography are purely lytic. Lytic lesions are sharply defined and "punched-out" in appearance, with endosteal scalloping when abutting cortex. The lesions are sclerotic in only 3% of patients.

* The X-ray is the most inexpensive diagnostic modality for lytic lesions. In some cases, MRI may be warranted, as MRI has a higher sensitivity than X-ray.
* X-rays should be avoided in pregnant patients with multiple myeloma. MRI can be done instead.

* Shown below are images depicting the involvement of skull and spinal cord respectively in a case of multiple myeloma.

## References

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1. ↑ Multiple myeloma. Radiopaedia (2015)http://radiopaedia.org/articles/multiple-myeloma-1 Accessed on September, 20th 2015
2. ↑ Reisenbuckler C (2014). "Multiple myeloma and diagnostic imaging". Radiol Technol. 85 (4): 391–410, quiz 411–3. PMID 24614435.