原著
多発性骨髄腫患者の脊椎MRI所見
キーワード:
multiple myeloma,
spinal lesion,
vertebral fracture,
magnetic resonance image,
differential diagnosis
2019 年 33 巻 2 号 p. 170-174
詳細
2019 年 33 巻 2 号 p. 170-174
The purpose of this article is to analyze the characteristics of spinal magnetic resonance images (MRI) in multiple myeloma patients.
Two hundred and eighteen patients were diagnosed with multiple myelomas at the Shonan Kamakura General Hospital from January 2009 to April 2018. Spinal MRIs were evaluated in 66 cases. Initial symptoms, spinal MRI findings, and blood sample test findings at the time of diagnosis were investigated.
There were 37 males and 29 females analyzed. Mean age at the time of diagnosis was 70.1 years (42 to 87 years). Main initial symptoms were low back pain (n＝23), back pain (n＝15), neck pain (n＝1), lower limb weakness (n＝6), lower limb pain/paresthesia (n＝4), cranial nerve palsy (n＝2), respiratory symptoms (n＝6), renal failure (n＝4), anemia (n＝3) and asymptomatic (n＝6). Spinal MRI revealed vertebral fracture (n＝42), intravertebral tumor (n＝35), epidural tumor (n＝9), diffuse spotty signal (n＝13), and diffuse low signal (n＝4). There were only five cases where no abnormality was observed beyond the vertebral body fracture. Dural sac compression was observed in 16 cases, of which 12 cases were co-localized with the tumor and 4 cases were by a fractured bony fragment. The results of the blood sampling were confirmed in 65 patients. Anemia, decreased albumin/globulin ratio, hyperproteinemia, hypercalcemia, and increased alkaline phosphatase were observed in 57, 44, 29, 13, and 12 patients, respectively. Only 9 cases showed normal blood test results.
The most common symptom of multiple myeloma was lower back pain. As such, half of the patients had visited an orthopedic or spinal surgery clinic. Spinal MRI findings were classified as intervertebral focal lesion, epidural mass, diffuse spotty signal, or diffuse low signal. The presence of an abnormal finding was observed in 92% of patients by spinal MRI and in 86% by blood sampling. Spinal MRI and blood sampling examination should be considered in cases of vertebral fracture in order to prevent the misdiagnosis of multiple myeloma as an osteoporotic vertebral fracture.
