Magnetic resonance imaging versus radiological skeletal survey of the lumbosacral spine in patients with advanced multiple myeloma: A single-institute experience
Najmaddin S. H. Khoshnaw1, Kawa A Mahmood2, Ahmed K Yassin3, Sana D Jalal4, Hangaw A Qadir5, Ali I Mohammed4, Layth Mula-Hussain6
1 Department of Hematology, Hiwa Hospital, Ministry of Health, Sulaymaniyah; Department of Clinical Hematology, Kurdistan Board for Medical Specialties, Erbil, Kurdistan Region, Iraq
2 Department of Surgery, Diagnostic Imaging Unit, Sulaimani College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan Region, Iraq
3 Department of Clinical Hematology, Kurdistan Board for Medical Specialties; Department of Medicine, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq
4 Department of Clinical Hematology, Kurdistan Board for Medical Specialties, Erbil; Department of Hematopathology, Sulaimani College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan Region, Iraq
5 Department of Radiology, Hiwa Hospital, Ministry of Health, Sulaymaniyah, Kurdistan Region, Iraq
6 Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Edmonton, Canada
Dr. Najmaddin S. H. Khoshnaw
Department of Hematology, Hiwa Hospital, Sulaymaniyah, Kurdistan Region
Source of Support: None, Conflict of Interest: None
BACKGROUND: Multiple myeloma (MM) is a plasma cell malignancy in the bone marrow (BM), where imaging is an essential tool in its management.
OBJECTIVE: The aim of this study was to compare the sensitivity of radiological skeletal survey (RSS) with magnetic resonance imaging (MRI) of the lumbosacral spine (LSS) in advanced MM patients.
PATIENTS AND METHODS: We retrospectively reviewed the RSS and MRI of the LSS for 33 patients with a new diagnosis of symptomatic MM. Chi-squire test was used for comparing the results.
RESULTS: Of 33 patients, 20 (60%) were male and 13 (40%) female, with a mean age of 61 years. Characteristic findings on RSS were osteopenia (86%), compression fractures (60.5%), multiple lytic lesions (39.5%), solitary focal lesion (6.06%), and normal findings (9.3%), The commonest findings on the MRI were combined diffuse and focal lesions (27.27%), multiple focal lesions of macronodular pattern (18.2%) and variegated (micronodular) pattern (15.15%), The other finding on MRI were diffuse homogeneous infiltration with SI> adjacent disc (12.12%) while SI ≤ adjacent disc (6.06%), solitary focal lesions (6.06%), and normal findings (15.15%). A majority (58.1%) of patients presented with an advanced stage and the pathological compression fracture found in 60% of cases. Focal lesions were detected in five patients (15.15%) whose radiographs were negative, and more lesions were detected in 11 patients (33.33%) with positive radiographs. Diffuse infiltration pattern was found in eight cases (24%) on MRI imaging when radiographs showed only osteopenia and in one patient (3%) in whom radiographs were normal.
CONCLUSIONS: MRI had higher sensitivity in the detection of diffuse BM involvement and discovery of focal spinal lesions compared to conventional radiographs with a positive P value.