Multiple myeloma.

Multiple myeloma is a typical bone marrow neoplasia of the elderly. On radiographs it is often difficult to detect the typical osteolyses in early stages or in regions where overlying structures hamper image analysis. Osteoporosis may be a sign of tumor infiltration, but it is difficult to distinguish from senile osteoporosis. Thus cross-sectional methods increasingly are replacing the skeletal survey, which has been the standard imaging method for a long time. When comparing whole-body magnetic resonance imaging (MRI) with whole-body multidetector computed tomography, MRI is much more sensitive. This is mainly because in MRI, marrow infiltrates are displayed before osseous destructions occur. New imaging guidelines, such as the Durie and Salmon PLUS staging system, include whole-body MRI or positron emission tomography-computed tomography (PET-CT). PET-CT can be used especially for restaging because fluorodeoxyglucose uptake is usually reduced after successful chemotherapy or stem cell transplant. MRI is a prognostic factor and should be used in primary staging for precise evaluation of the extent of disease.