多发性骨髓瘤的影像学评估

多发性骨髓瘤具有独特的骨病表现,由于破骨细胞激活和成骨细胞功能抑制导致溶骨性破坏和严重骨质疏松。骨病严重程度对患者生活质量和生存均有负面影响。普通X线检出骨病的灵敏度很低,CT的灵敏度虽明显提高,但难以检出骨外病变。功能性影像方法(主要包括磁共振弥散加权成像和正电子发射断层显像/计算机体层成像)不仅能发现早期溶骨病灶,且在评估全身肿瘤负荷和缓解后微小残留病变方面更有优势。本文将对这些方面的进展进行综述。

Imaging Techniques in the Assessment of Multiple Myeloma

Multiple myeloma has unique manifestations of bone disease, mainly presenting as osteolytic lesions and diffuse osteoporosis as a result of over-activation of osteoclasts and suppression of osteoblasts. The severity of myeloma bone disease is negatively correlated with quality of life and survival. Plain X ray has low sensitivity to contour destructive bone lesions. Whole body low dose CT does not differentiate active foci from tranquil ones. Functional imaging including diffuse weighted imaging-magnetic resonance imaging (DWI-MRI) and positron emission tomography/computed tomography (PET/CT) are more sensitive in evaluation of comprehensive tumor load and detection of early disease. Moreover, minimal residue disease detected by DWI-MRI or PET/CT is a complement of flow cytometry and predicts progressive disease in patients achieving complete response. In this article, we summarized the role of imaging methods in evaluating myeloma bone disease and tumor load.