The role of T2-weighted gradient echo in MRI demonstration of spinal multiple myeloma

Fifty patients with proven multiple myeloma (MM) underwent magnetic resonance (MR) examination of entire spine in sagittal view using T1-weighted image (T1), T2-weighted image (T2), and T2-weighted gradient echo (GE). In 18 patients, the myelomatous foci were hyperintensive in GE and T2 and hypointensive in T1. They corresponded with osteolytic lesions in computed tomography (CT) scan. In another 16 patients with MM, the hyperintensive vertebral foci demonstrated by GE, corresponded with unhomogenic pattern of the vertebral bone marrow in T1 and T2, and insignificant computed tomography (CT) scan. Needle biopsy confirmed histologically the diagnosis MM of involved vertebra in all of them. The vertebral bone marrow had lower signal intensity in GE, which ensured a good contrast between the myelomata and the uninvolved bone marrow. Practically GE enabled the radiologic diagnosis of the spine in 16 patients. It also can prevent a diagnostic pitfall when a fatty focus is suspicious for myeloma in T2 and its demonstration in T1 is poor. Fatty foci were demonstrated in a control group, which included 20 elderly patients who had no history of malignancy. The fatty foci had lower signal intensity in GE and different from the hyperintensive myelomata. Gadolinium diethylene triamine pentaocetic acid (Gd-DTPA) which was administered intravenously in three patients with spinal MM offered no advantage and obscured the lesions.