Multiple myeloma x ray

Multiple myeloma Microchapters
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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]

Overview

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.

X Ray

• Simple radiography is the current gold standard for the initial diagnosis and evaluation of relapses of multiple myeloma.
• 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 plain film 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 fracture). A typical skeletal survey consists of the following films:

1. Lateral skull
2. Frontal chest film
3. Cervico-thoraco-lumbar spine
4. Shoulder
5. Pelvis
6. Femur

• The vast majority of lesions seen on plain radiography are purely lytic, sharply defined/punched out with endosteal scalloping when abutting cortex. The lesions are sclerotic in only 3% of patients.

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

• 
  X ray showing hair on end appearance.
• 
  X ray spine showing collapsed vertebrae.
• 
  X ray spine showing increased space between 2 vertebrae suggestive of possible malignancy.