Screening whole spine magnetic resonance imaging in multiple myeloma

Magnetic resonance imaging (MRI) is the most sensitive method for detecting focal spinal disease (FSD) in multiple myeloma (MM). It is unclear whether whole spine MRI (WS-MRI) should be employed as a screening test at diagnosis of MM.

To determine the utility of screening WS-MRI at diagnosis of MM.

A retrospective analysis of data from January 2008 to January 2013 at the Townsville Hospital was performed. At this centre, WS-MRI is used routinely in all newly diagnosed MM. The findings of WS-MRI in patients with and without an agreed guideline indication for WS-MRI were compared. Clinical predictors of FSD were determined.

Seventy-one patients were included in the analysis. Forty-four (62%) had an agreed indication for MRI; 33 (75%) of these had FSD. Within this group, 17 required urgent intervention and 13 had spinal plasmacytomas. Within a second group without a guideline indication, 4 of 27 (15%) were found to have FSD on MRI - none required urgent intervention and or had plasmacytomas. Three of eight smouldering myeloma patients were reclassified as symptomatic myeloma by documenting lytic lesions not identified on plain film. The strongest predictors of FSD were back pain (P < 0.001) and vertebral compression fracture (P = 0.003).

WS-MRI in patients without a guideline indication did not detect any lesions that threatened the spinal cord. WS-MRI is essential in those with guideline indications. WS-MRI is of benefit to patients with smouldering myeloma where documentation of lesions not seen on plain film will result in treatment rather than observation.