H Nèji H Abid A Mâalej S Haddar R Akrout M Ezzeddine S Baklouti Z Mnif J Mnif Imaging department Habib Bourguiba Hospital Rheumatology department ID: 931559
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Slide1
IMAGING OF MEDULLARY COMPLICATIONS OF MYELOMA
H Nèji, H Abid, A Mâalej, S Haddar, R Akrout*, M Ezzeddine*, S Baklouti*, Z Mnif**, J MnifImaging department Habib Bourguiba Hospital, *Rheumatology department Hedi Chaker Hospital, ** Imaging department Hedi Chaker Hospital, Majida Boulila Avenue, 3029 Sfax, Tunisia
NR19
Slide2Introduction:
Myeloma is a plasma cell dyscrasia that preferentially touches the axial skeleton. It can extend into the spinal canal and cause spinal cord compression. The aim of this work is to emphasize how CT and MRI can contribute to the assessment of this extension.
Slide3Materials and methods:
This is a retrospective study in which we were interested in 68 patients in whom the diagnosis of myeloma was certain.Twelve among these 68 patients had extension into the spinal canal.They were 6 women and 6 men with a mean age of 63years.All patients had X-ray examinations. 3 patients underwent a spine computed tomography (CT).9 patients underwent a
spine
MRI.
9 patients
had
thoracic
and
lumbar
spine
aches.
Slide4Results:
5 among the 12 patients had clinical signs of medullary compression. 2 among them had no detectable lesion on the X-ray examination of the spine. CT and MRI showed bone lesions of the spine in all cases. Epidural extension was found in cervical spine in 3 cases, dorsal spine in 8 cases and lumbar spine in 1 case.Epidural extension from posterior arch lesions was found in 5 cases, from the vertebral body in 5 cases.Primitive epidural location was found in 2 cases.
Slide5A
sixty-year-old womanBack pain
Clinical
signs
of
meullary
compression
Immunoelectrophoresis
: normal
MRI : lesion of the posterior arch and medullary compression. Surgical biopsy: IgG class myeloma
Sagittal T1WI
SagittaleT2WI
Contrast
T1WI
Case n°1 :
Slide6A
sixty-four-year-old womanBack pain Medullary MRI and CT: osteolytic lesion of the
fifth
dorsal
vertebra
with
development
of an intra-
canalar
mass. Immunoelectrophoresis: Kappa light chain myelomaSagittal T2 WI
Enhanced-CT of the dorsal spine
Case n°2:
Slide7Sagittal T2WI
A 72-year-old woman Altération de l’état généralBack pain
Clinical
signs
of
medullary
compression
Spine
MRI :
vertebral
compaction with epidural mass squeezing the spinal cord. IEPP : kappa light chain myelomaCase n°3
Slide8Discussion
Multiple myeloma is a malignant disease of plasma cells in the bone marrow. It accounts for about 1% of all cancers and 10 % of hematologic malignancies. The number of plasma cells in the bone marrow is increased and osteoclasts are activated in the region of plasma cell foci.The cell proliferation, then, extends to the epidural space causing spine canal narrowing and spine cord compression.This complication occurs in 5 % of myeloma cases.
Slide9Discussion
In myeloma, MRI is particularly recomended to : Evaluate the extension to the axial skeletonDetect lesions non-detected
on X-ray
examinations
Confirm
the
diagnosis
of
solitary
plasmocytoma
Make the diagnosis of medullary compression
Slide10Discussion
Bony involvement in myeloma is frequently of a lytic nature with frequent extra-osseous spreads
.
Spinal cord compression is usually caused by primary involvement of the vertebral body with tumor extension into the adjacent spinal canal. Imaging modalities show in these cases large,
lytic
bone lesions or collapse of the vertebral body in the corresponding segment.
Slide11Discussion
Extramedullary multiple myeloma is very rare, comprising less than 5% of all plasma cell neoplasms. Few cases have been reported in the literature.In these cases, there is no evidence of vertebral body destruction or collapse. X-ray and CT examinations are usually normal. Only the MRI MRI can confirm the presence of an epidural mass.Epidural lesions without osseous destruction can be explained either by the extension of para-spinal lymph node into the inter- vertebral foramen or by the development from the lymphoid tissue present in the epidural space.
Slide12Discussion
In case of epidural locations without bone lesions, many diagnoses can be discussed such as :
Primitive
mild
or
malignant
tumours
(
lipoma
,
liposarcoma)Metastases Locations of lymphomaLocations of leukemia
Slide13Conclusion
Spinal cord compression is a serious complication of multiple myeloma.It often results from the extension of bone
lesions
of the
vertebral
body.
Epidural location
without
vertebral
destruction or collapse is rare.MRI is the best imaging modality to confirm the medullary compression.