Current Concepts in the Evaluation of Multiple Myeloma with MR Imaging and FDG PET/CT
Current Concepts in the Evaluation of Multiple Myeloma with MR Imaging and FDG PET/CT
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DOI：
10.1148/rg.301095066
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发表时间：
2010-01-01
期刊：
影响因子：
5.5
通讯作者：
Crim, Julia R.
中科院分区：
文献类型：
--
作者：
Hanrahan, Christopher J.;Christensen, Carl R.;Crim, Julia R.
多发性骨髓瘤是一组异质性浆细胞肿瘤，主要累及骨髓，但也可能发生在软组织中。虽然这种疾病的表现和病程各不相同，但在所有情况下最终都是致命的。在过去的20年里，我们对多发性骨髓瘤的遗传学和发病机制及其治疗的理解取得了重大进展。磁共振（MR）成像和氟18氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）与计算机断层扫描（CT）的使用提高了检测这种疾病的灵敏度。PET有助于基于FDG摄取来识别活动性多发性骨髓瘤，而MR成像有助于根据骨髓内正常脂肪的浸润来识别多发性骨髓瘤，其以与疾病阶段相关的特征模式发生。这些先进的横断面成像技术的灵敏度增加，导致了经典的Durie和Salmon分期系统的进一步完善。此外，这些成像技术可以更可靠地评估疾病对当前方案治疗的反应，其中可能包括自体干细胞移植以及各种药物治疗。在对化疗药物有反应的病变中，在MR成像中可以看到脂肪替代先前浸润的骨髓，在FDG PET中可以看到FDG摄取减少;然而，在骨髓的MR成像表现正常化之前，可能需要长期和强化的治疗方案。CT所见的溶解性病变即使在成功治疗后也几乎总是持续存在。为了提供准确的评估，放射科医生不仅要熟悉多发性骨髓瘤及其类似物的表现，还要熟悉常见的治疗相关结果。(c)RSNA，2010年。radiographics.rsna.org
Multiple myeloma is a heterogeneous group of plasma cell neoplasms that primarily involve bone marrow but also may occur in the soft tissue. Although the disease varies in its manifestations and its course, it is eventually fatal in all cases. Over the past 2 decades, significant advances have been made in our understanding of the genetics and pathogenesis of multiple myeloma and in its treatment. The use of magnetic resonance (MR) imaging and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) with computed tomography (CT) has improved sensitivity for the detection of this disease. PET aids in the identification of active multiple myeloma on the basis of FDG uptake, and MR imaging helps identify multiple myeloma from its infiltration of normal fat within the bone marrow, which occurs in characteristic patterns that correlate with the disease stage. The increased sensitivity of these advanced cross-sectional imaging techniques has led to further refinement of the classic Durie and Salmon staging system. In addition, these imaging techniques allow a more reliable assessment of the disease response to treatment with current regimens, which may include autologous stem cell transplantation as well as various medications. In lesions that respond to chemotherapeutic agents, the replacement of previously infiltrated marrow by fat is seen at MR imaging and decreased FDG uptake is seen at FDG PET; however, a lengthy and intensive regimen may be necessary before the MR imaging appearance of marrow normalizes. Lytic lesions seen at CT almost always persist even after successful treatment. To provide an accurate assessment, radiologists must be familiar not only with the appearances of multiple myeloma and its mimics but also with common treatment-related findings. (c) RSNA, 2010 . radiographics.rsna.org