J Korean Soc Radiol.  2013 Jan;68(1):63-69.

Analysis of Bone Mineral Density in Multiple Myeloma: A Comparison of Bone Mineral Density with Plain Radiography, Magnetic Resonance Imaging, and Clinical Staging

• Kim JN
• Kwon ST
• Song IC

Abstract

PURPOSE
To analyze the bone mineral density (BMD) in multiple myeloma (MM) and to compare BMD with plain radiography, MRI and clinical stage.
MATERIALS AND METHODS
We reviewed 59 patients with MM and an age- and sex-matched control group, with measured BMD. The L-spine and femoral neck (FN) BMD were measured by dual-energy X-ray absorptiometry. Lateral plain radiographs of the L-spine were graded as 3 stages using the modified Saville index. Four bone marrow patterns were classified on sagittal T1- and T2-weighted magnetic resonance images of the L-spine. BMD in the MM and control group were analyzed. BMD in MM was compared with the modified Saville index, bone marrow patterns on MRI, and clinical stages.
RESULTS
In MM, spine BMD was reduced and the difference between spine and FN BMD was larger than the control group (p < 0.001). The modified Saville index was negatively correlated with spine T scores (p < 0.01). The spine BMD in normal marrow pattern on the MRI was the most reduced. There was no statistical correlation between BMD and clinical stage.
CONCLUSION
In MM, spine BMD was significantly reduced and the difference between spine and FN BMD was larger than the control group. The modified Saville index was significantly correlated with spine BMD in MM.

MeSH Terms

Absorptiometry, Photon
Bone Density
Bone Marrow
Femur Neck
Humans
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Multiple Myeloma
Spine

Figure

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  Fig. 1 BMD in MM and control group. A. Spine BMD was significantly reduced in MM patients compared to the control group (p < 0.001). B. The difference between spine and femoral neck BMD in MM was larger than that in the control group (p < 0.001). Note.-BMD = bone mineral density, MM = multiple myeloma

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  Fig. 2 Modified Saville index. A. Lateral plain radiograph of L-spine shows minimal decreased bone density indicating modified Saville index grade 1. B. More obvious vertical striation with concave endplates reveals modified Saville index grade 2. C. Severe diminished bone density and a more collapsed vertebral body indicates modified Saville index grade 3.

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  Fig. 3 Normal marrow pattern on magnetic resonance images. Bone marrow shows hyperintense signal compared with the disc on T1-weighted images.

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  Fig. 4 Multiple focal pattern on magnetic resonance images. Multifocal T1-weighted hypointense lesions are detected in the L-spine.

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  Fig. 5 Salt-and-pepper pattern. The bone marrow shows a very inhomogeneous patchy signal on T1-weighted images.

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  Fig. 6 Diffuse infiltrative pattern. Homogenous hypointense change which is similar or lower than disc signal intensity on T1-weighted images is shown in the spine.

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