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British Journal of Radiology (2008) 81, 386-396
© 2008 British Institute of Radiology
doi: 10.1259/bjr/21850180
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Full paper

Hyperattenuating bone marrow abnormalities in myeloma patients using whole-body non-enhanced low-dose MDCT: correlation with haematological parameters

M HORGER, MD 1 P PEREIRA, MD 1 C D CLAUSSEN, MD 1 L KANZ, MD 2 R VONTHEIN, PHD 3 B DENECKE, MD 2 and C DRIESSEN, MD 2

1 Department of Diagnostic Radiology, Eberhard-Karls University, Hoppe-Seyler-Str.3, 72076 Tübingen, 2 Department of Internal Medicine-Oncology, Eberhard-Karls University, Ottfried-Müller-Str. 5, 72070 Tübingen, 3 Department of Medical Biometry, Eberhard-Karls University, Westbahnhofstr 55, 72070 Tübingen, Germany

Correspondence: Marius Horger, MD, Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany. E-mail: mshorger{at}med.uni-tuebingen.de

We aimed to establish the role of hyperattenuating medullary abnormalities detected by whole-body non-enhanced low-dose multidetector CT (WBLD-MDCT) in multiple myeloma (MM) patients referred for primary evaluation. 50 consecutive patients with untreated Stage I (nI = 11), Stage II (nII = 10) and Stage III (nIII = 29) MM underwent WBLD-MDCT for staging. The number and size of osteolysis, as well as haematologic parameters including paraprotein and β2-microglobulin levels, were assessed and related to the number, size and density of medullary abnormalities assumed to represent myeloma involvement. Bone marrow abnormalities were found in 2/11 (18%) Stage I, 6/10 (60%) Stage II and 20/29 (69%) Stage III myeloma patients, and did not parallel the incidence of osteolysis. Patients with medullary lesions had higher levels of immunoglobulin A (median, 4730 mg dl–1 vs 1520 mg dl–1), light-chain proteinuria (median, 690 mg dl–1 vs 214 mg dl–1) and IgG paraprotein (median, 3270 mg dl–1 vs 2610 mg dl–1) compared with patients without medullary lesions. In patients with medullary abnormalities, levels of serum β2-microglobulin were significantly higher than in patients without detectable marrow infiltrates (median, 4.3 mg dl–1 vs 2.4 mg dl–1; p = 0.0015). In conclusion, medullary abnormalities visualized by WBLD-MDCT are encountered in all stages of myeloma, including cases without osteolysis. They are associated with significantly elevated serum levels of paraprotein (reflecting tumour mass) and β2-microglobulin, a prospective prognostic marker for myeloma. The nature and possible prognostic significance of medullary abnormalities detected by WBLD-MDCT therefore warrants further investigation.






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