多发性骨髓瘤的临床及影像学分析

目的：探讨多发性骨髓瘤的临床表现特征与影像学的诊断价值．方法：回顾性分析32例经骨髓穿刺或手术病理证实的MM患者的影像学资料，对其临床特征和影像学表现特点进行综合分析．结果：多发性骨髓瘤最常见的临床表现有全身性疼痛、贫血、出血、肾功能损害、发热、肺部感染和全身乏力等．32例患者不同部位X线摄片的阳性率分别为颅骨85％、肋骨56％、脊椎53％、肩胛骨46．1％、骨盆43％、股骨37．5％、胫骨33．3％。15例脊椎CT均显示明显骨质破坏。12例脊椎MRI中有10例示明显信号改变。18例ECT全身骨扫描全部出现多骨的浓聚灶．结论：多发性骨髓瘤起病隐匿。临床表现多样化且缺乏特征性。典型影像学表现为多发穿凿状或虫蚀状骨质破坏及广泛的骨质疏松；X线平片检查尤其是头颅、骨盆、腰椎、肋骨及骨痛部位。应作为多发性骨髓瘤初诊的常规筛查，CT、MRI及ECT检查对早期和不典型多发骨髓瘤病变的显示明显优于X线平片检查．

Clinical and Imaging Analysis of Multiple Myeloma

Objective: To analyze the value of clinical characteristics and imaging findings in the diagnosis of multiple myeloma.Methods: Clinical data and imaging findings of 32 cases with multiple myeloma confirmed by medullary needle biopsy and opertion and pathology were analyzed retrospectively.Results: Most common symptoms of multiple myeloma consist of whole body ache,anemia,bleeding,the kidney dysfunction,fever,infection of lung and fatigue.The sensitivity in detecting the 32 cases with multiple myeloma on radiographs of skull was 85%,ribs was 56%,spine was 53%,shoulder bone was 46.1%,pelvis was 43%,femur was 37.5%,shin was 33.3%.The spine CT scan of 15 cases demonstrated bony destruction and spine MRI also revealed 10 cases of abnormal intensity in 12 cases with multiple myeloma.All cases revealed pathological changes of bone in 18 cases with multiple myeloma.Conclusion: Clinical signs of multiple myeloma may vary in each case.Typical imaging findings are extensive osteoporosis and multipie lytic destructions appearing as numerous punched-out defect without surrounding sclerosis.X-ray plain films should be done routinely,especially the regions of skull,pelvis,spine,ribs and skull.CT and MRI and ECT gain a great advantage over X-ray plain films in the diagnosis of early stage of atypical multiple myeloma.