I just turned 50. In July I was diagnosed with 2 spinal compression fractures for no reason. Bone density was in normal range. No sign of lesions or tumors on MRI. In October I was diagnosed with a third spinal fracture. Again, no lesions, and orthopedic doctor said no signs of cancer on either MRI or any of the numerous x-rays. He diagnosed osteoporosis (I am small boned). I saw a thyroid specialist and ruled out hyperparathyroidism. He said density test could have been skewed since I was healing from fractures.
I saw an endocrinologist last week and got blood work back Tuesday. M-spike of 1.4 g/dL (14 g/l). I am anemic, but just barely, and have been for years due to diet and low iron. IgA was elevated, but I don't have the number. The endocrinologist is referring me to a hematologist for more tests.
Wouldn't multiple myeloma have shown on a regular MRI or would it have had to have contrast?
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Re: Is multiple myeloma visible on a regular MRI?
Hi Irosamond,
In general, radiologists look for concentrations of myeloma in the form of focal lesions (lesions made up of concentrations of the disease that are forming inside the bone) and lytic lesions (lesions that are forming on the surface of the bone). Not having focal or lytic lesions as a presenting factor is a very good thing.
As I understand it, an MRI may also pick up on the diffuse infiltration of the myeloma disease (i.e., the portion of the disease that isn't forming lesions but is instead just spread more generally throughout your bone marrow), depending on how advanced the disease is. It also depends on if the MRI scan was set up with the appropriate protocols to pick up on diffuse infiltrations; but having a contrast agent is not a given for detecting diffuse infiltrations of the disease. Again, this is just my understanding and you should verify all this with your doctor.
Given you have no lytic or focal lesions and are only slightly anemic, I would be quite optimistic that an M-spike of 1.4 g/dL only means a diagnosis of something like MGUS. You may also want to go back and look at your lab results and see what your calcium and creatinine levels are doing.
In any case, let us know how things turn out with the hematologist, and good luck!
In general, radiologists look for concentrations of myeloma in the form of focal lesions (lesions made up of concentrations of the disease that are forming inside the bone) and lytic lesions (lesions that are forming on the surface of the bone). Not having focal or lytic lesions as a presenting factor is a very good thing.
As I understand it, an MRI may also pick up on the diffuse infiltration of the myeloma disease (i.e., the portion of the disease that isn't forming lesions but is instead just spread more generally throughout your bone marrow), depending on how advanced the disease is. It also depends on if the MRI scan was set up with the appropriate protocols to pick up on diffuse infiltrations; but having a contrast agent is not a given for detecting diffuse infiltrations of the disease. Again, this is just my understanding and you should verify all this with your doctor.
Given you have no lytic or focal lesions and are only slightly anemic, I would be quite optimistic that an M-spike of 1.4 g/dL only means a diagnosis of something like MGUS. You may also want to go back and look at your lab results and see what your calcium and creatinine levels are doing.
In any case, let us know how things turn out with the hematologist, and good luck!
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Is multiple myeloma visible on a regular MRI?
Thank you, Multibilly. My calcium level was 9.6 a couple of weeks ago. Hemoglobin was 11.3. Creatinine levels were normal on recent test. Hematologist did new blood work, 24-hour urine test and full body x-rays yesterday. I am scheduled for bone marrow biopsy Monday. I may have lesions elsewhere, but none showed in the spinal MRI where the fractures were. I hope it is only MGUS. Wouldn't my fractures put me in CRAB though?
Re: Is multiple myeloma visible on a regular MRI?
Hi Irosamond,
That's good news about your calcium and creatinine levels, and it's also good that your doctor is being thorough and running a 24-hour urine test and a bone marrow biopsy.
Unless your spinal fractures were caused by myeloma-related bone lesions, they would not cause you to technically meet the "B" in the CRAB criteria. But it may be likely that your hematologist will suggest therapy with a bisphosphonate such as Zometa to help strengthen your bones. Also, if your spinal fractures are causing you issues, you may want to look into a procedure such as kyphoplasty. Many folks on this forum have greatly benefited from kyphoplasty and related procedures.
Lastly, when your doctor gets the results of your bone marrow biopsy, have him / her walk you through the results page-by-page so that you understand your bone marrow plasma cell percentage and any worrisome genetic abnormalities that may have been found. Bone marrow biopsies and the related genetic reports are notoriously difficult for a layman to interpret on their own.
That's good news about your calcium and creatinine levels, and it's also good that your doctor is being thorough and running a 24-hour urine test and a bone marrow biopsy.
Unless your spinal fractures were caused by myeloma-related bone lesions, they would not cause you to technically meet the "B" in the CRAB criteria. But it may be likely that your hematologist will suggest therapy with a bisphosphonate such as Zometa to help strengthen your bones. Also, if your spinal fractures are causing you issues, you may want to look into a procedure such as kyphoplasty. Many folks on this forum have greatly benefited from kyphoplasty and related procedures.
Lastly, when your doctor gets the results of your bone marrow biopsy, have him / her walk you through the results page-by-page so that you understand your bone marrow plasma cell percentage and any worrisome genetic abnormalities that may have been found. Bone marrow biopsies and the related genetic reports are notoriously difficult for a layman to interpret on their own.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Is multiple myeloma visible on a regular MRI?
Irosamond,
It should go without saying that I agree with Multibilly. My myeloma center does two different MRI's on different machines. The standard MRI looking for bone involvement, and a diffusion weighted blood supply (DWBS) looking for focal or plasma cell concentration (I "think" they look for homogeneous / good vs. heterogeneous / bad areas. They cross check the DWBS test with a PET/CT test looking and comparing hot spots to heterogeneous areas.
My bone scans are performed on my thigh / femur and forearm. I could see where you could have normal values if any myeloma lesions were elsewhere. Just a guess.
I have had both vertebroplasty and kyphoplasty and they did wonders for controlling most of the pain from prior compression fractures.
The big question is why you had compression fractures. I would "think" those areas would appear less dense on a standard MRI.
Regardless, it appears your healthcare provider is methodically getting to the bottom of things.
It should go without saying that I agree with Multibilly. My myeloma center does two different MRI's on different machines. The standard MRI looking for bone involvement, and a diffusion weighted blood supply (DWBS) looking for focal or plasma cell concentration (I "think" they look for homogeneous / good vs. heterogeneous / bad areas. They cross check the DWBS test with a PET/CT test looking and comparing hot spots to heterogeneous areas.
My bone scans are performed on my thigh / femur and forearm. I could see where you could have normal values if any myeloma lesions were elsewhere. Just a guess.
I have had both vertebroplasty and kyphoplasty and they did wonders for controlling most of the pain from prior compression fractures.
The big question is why you had compression fractures. I would "think" those areas would appear less dense on a standard MRI.
Regardless, it appears your healthcare provider is methodically getting to the bottom of things.
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blueblood - Name: Craig
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 54
Re: Is multiple myeloma visible on a regular MRI?
I was told my skeletal survey x-rays showed no lesions, although I'm wondering how accurate the survey x-rays are. I'm guessing osteoporosis caused my compression fractures. I did not have surgery. I still have pain in my middle back even though MRI indicates they have healed. Hopefully, physical therapy will help.
Re: Is multiple myeloma visible on a regular MRI?
Could my fractures be due to MGUS, or would it more likely be multiple myeloma?
I'm very worried!
I'm very worried!
Re: Is multiple myeloma visible on a regular MRI?
Neither your MRI or xray picked up any lesions. So, again that's good news. But MGUS patients are more susceptible to fractures. You might want to read through the article referenced below to better understand this.
There are very specific criteria for being diagnosed with symptomatic myeloma as opposed to MGUS (i.e., meeting one or more of the CRAB or additional myeloma defining event criteria).
Nothing you've shared so far indicates that you meet any of the aforementioned criteria for a multiple myeloma diagnosis - which again is good news. But given your history, you should be talking to your doctor about how you can minimize the chances for any future fractures going forward (e.g., dietary supplements, bisphosphonate therapy, etc).
Article reference:
Drake, MT, "Unveiling Skeletal Fragility in Patients Diagnosed With MGUS: No Longer a Condition of Undetermined Significance?", Journal of Bone and Mineral Research, Dec 2014 (abstract; full text of article)
Abstract:
Monoclonal gammopathy of undetermined significance (MGUS) is a common finding in clinical practice, affecting greater than 3% of adults aged 50 years and older. As originally described, the term MGUS reflected the inherent clinical uncertainty of distinguishing patients with a benign stable monoclonal plasma cell disorder from subjects destined to progress to malignancy. There is now clear epidemiologic evidence, however, that patients with MGUS suffer from a significantly increased fracture risk and that the prevalence of MGUS is increased in patients with osteoporosis. Despite this relationship, no clinical care guidelines exist for the routine evaluation or treatment of the skeletal health of patients with MGUS. Recent work has demonstrated that circulating levels of at least two cytokines (CCL3/MIP-1α and DKK1) with well-recognized roles in bone disease in the related monoclonal gammopathy multiple myeloma are also increased in patients with MGUS. Further, recent imaging studies using high-resolution peripheral quantitative CT have documented that patients with MGUS have substantial skeletal microarchitectural deterioration and deficits in biomechanical bone strength that likely underlie the increased skeletal fragility in these patients. Accordingly, this Perspective provides evidence that the “undetermined significance” portion of the MGUS acronym may be best replaced in favor of the term “monoclonal gammopathy of skeletal significance” (MGSS) in order to more accurately reflect the enhanced skeletal risks inherent in this condition.
There are very specific criteria for being diagnosed with symptomatic myeloma as opposed to MGUS (i.e., meeting one or more of the CRAB or additional myeloma defining event criteria).
Nothing you've shared so far indicates that you meet any of the aforementioned criteria for a multiple myeloma diagnosis - which again is good news. But given your history, you should be talking to your doctor about how you can minimize the chances for any future fractures going forward (e.g., dietary supplements, bisphosphonate therapy, etc).
Article reference:
Drake, MT, "Unveiling Skeletal Fragility in Patients Diagnosed With MGUS: No Longer a Condition of Undetermined Significance?", Journal of Bone and Mineral Research, Dec 2014 (abstract; full text of article)
Abstract:
Monoclonal gammopathy of undetermined significance (MGUS) is a common finding in clinical practice, affecting greater than 3% of adults aged 50 years and older. As originally described, the term MGUS reflected the inherent clinical uncertainty of distinguishing patients with a benign stable monoclonal plasma cell disorder from subjects destined to progress to malignancy. There is now clear epidemiologic evidence, however, that patients with MGUS suffer from a significantly increased fracture risk and that the prevalence of MGUS is increased in patients with osteoporosis. Despite this relationship, no clinical care guidelines exist for the routine evaluation or treatment of the skeletal health of patients with MGUS. Recent work has demonstrated that circulating levels of at least two cytokines (CCL3/MIP-1α and DKK1) with well-recognized roles in bone disease in the related monoclonal gammopathy multiple myeloma are also increased in patients with MGUS. Further, recent imaging studies using high-resolution peripheral quantitative CT have documented that patients with MGUS have substantial skeletal microarchitectural deterioration and deficits in biomechanical bone strength that likely underlie the increased skeletal fragility in these patients. Accordingly, this Perspective provides evidence that the “undetermined significance” portion of the MGUS acronym may be best replaced in favor of the term “monoclonal gammopathy of skeletal significance” (MGSS) in order to more accurately reflect the enhanced skeletal risks inherent in this condition.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Is multiple myeloma visible on a regular MRI?
Thank you, Multibilly! Your replies are reassuring and greatly appreciated.
I expect to know more after my appointment tomorrow. I should have the 24-hour urine results. I am very anxious about the results of the bone marrow biopsy, but I won't know them until later in the week. I am still experiencing upper back pain but am hoping since MRI and x-ray were clear that it is just muscular or residual pain from the compression fractures.
I expect to know more after my appointment tomorrow. I should have the 24-hour urine results. I am very anxious about the results of the bone marrow biopsy, but I won't know them until later in the week. I am still experiencing upper back pain but am hoping since MRI and x-ray were clear that it is just muscular or residual pain from the compression fractures.
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