Quiz: Imaging and Therapy in Multiple Myeloma

Question 1

Answer

A.MRI

Whole-body magnetic resonance imaging (MRI) is considered the gold standard for the diagnostic imaging of bone marrow infiltration in multiple myeloma. It is particularly useful for imaging patients with smoldering or asymptomatic disease.

Question 2

Answer

D.All of the above

Uncontrolled, multiple myeloma can cause profound morbidity, including immune system suppression, lytic bone loss, and impaired renal function. Infiltration of the bone marrow by myeloma cells causes upregulation of osteoclast processes and downregulation of osteoblast activity, causing bone loss and the production of cytokines that hasten myeloma proliferation, a “vicious cycle” of reciprocal bone destruction and multiple myeloma progression.

Question 3

Answer

C.5 mm

The IMWG defines bone involvement as more than one focal lesion with a diameter exceeding 5 mm on MRI.

Question 4

Answer

D.50%

Multiple myeloma can occur in any bone, necessitating whole-body diagnostic imaging for the detection of bone involvement. Conventional plain-film X-ray skeletal surveys (CSSs) are less sensitive than MRI and up to 50% of focal bone demineralization can occur before CSS detects a lesion.

Question 5

Answer

C.8% per year

The risk of progression from smoldering to symptomatic myeloma is approximately 8% per year.