De la radiographie standard à l’IRM corps entier : 30 ans de progrès en imagerie du myélome multiple

Multiple myeloma (MM) is an hematologic cancer characterized by the clonal proliferation of plasma cells in the bone marrow. It is the most severe form of plasma cell dyscrasias. The complications of the disease — hypercalcemia, renal failure, anemia and lytic bone lesions — are severe and underlie the initiation of treatment. Imaging of bone lesions is a cardinal feature for the diagnosis, staging, assessment of response to treatment, and prognostic evaluation in MM patients. The radiographic skeletal survey (RSS), covering the axial skeleton, has been used for the detection of bone lesions. New techniques have been evaluated over time. Low dose computed tomography (CT) covering the whole body does better than the RSS for the detection of bone lesions, although its value for the evaluation of therapeutic response is limited. MRI of the bone marrow, covering the axial skeleton or the whole body, is a non-irradiating alternative. Its sensitivity for the detection of bone marrow infiltration, its ability to assess the response to treatment and its prognostic value have been demonstrated. The technique has been refined, is now included in modern staging systems of the disease, and is proposed as first line imaging modality by healthcare and scientific authorities. Along with 18 fluoro-deoxyglucose PET-CT, whole body MRI is the current imaging modality of choice for MM. This paper reviews the development of MRI as an imaging tool in MM over the last three decades