Picture quiz: Imaging in myeloma

Abstract

(a) Myeloma deposit, benign incidental lesion. (b) Determining the extent of disease in this patient is critical. A solitary soft tissue plasmacytoma will be treated with local radiotherapy. Evidence of widespread disease is an indication for systemic therapy. Fluorodeoxyglucose positron emission tomography/ CT would be the preferred examination of choice in this case. It would provide a whole body assessment for other sites of disease and identify whether the left iliac lesion is metabolically active, and therefore more likely to represent myeloma. Serum paraproteins, marrow aspirate and trephine are also necessary for accurate staging. (c) Not necessarily. Although apparent diffusion coefficient can be used to differentiate myeloma disease from normal adult marrow there is overlap in the imaging and diffusion-weighted imaging characteristics of benign and malignant lesions.