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X-Ray in Multiple Myeloma - Not a "Golden Standard" any More: Case Series

Jiri Minarik, Jan Hrbek, Tomas Pika, Martin Novak, Jaroslav Bacovsky, Miroslav Herman, Lumir Hrabalek, Ladislava Frysakova, Petra Pusciznova and Vlastimil Scudla

The assessment of myeloma bone disease (MBD) in multiple myeloma (MM) is recently based on conventional radiography (CR). Current International Myeloma Working Group (IMWG) guidelines mention other techniques such as whole-body MRI (WB-MRI) or positron emission tomography with computed tomography (PET-CT) but they still acknowledge CR as a “golden standard”. We designed a prospective study on imaging methods and myeloma bone disease (MBD) in patients with MM. The presented paper demonstrates two typical patients who did not qualify for further imaging based on IMWG guidelines. However, further examination using WB-MRI and low-dose CT (LD-CT) revealed severe involvement of the spine even with extramedullary masses of MM, and changed the therapeutic approach. We conclude that patients with monoclonal gammopathies should be examined with novel techniques and not rely on X-ray only as their diagnosis might be underestimated.