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IMAGING OF MEDULLARY COMPLICATIONS OF MYELOMA

IMAGING OF MEDULLARY COMPLICATIONS OF MYELOMA. 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 Hedi Chaker Hospital,

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IMAGING OF MEDULLARY COMPLICATIONS OF MYELOMA

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  1. IMAGING OF MEDULLARY COMPLICATIONS OF MYELOMA H Nèji, H Abid, A Mâalej, S Haddar, R Akrout*, M Ezzeddine*, S Baklouti*, Z Mnif**, J Mnif Imaging department HabibBourguiba Hospital, *Rheumatology department HediChaker Hospital, ** Imaging department HediChaker Hospital, MajidaBoulila Avenue, 3029 Sfax, Tunisia NR19

  2. Introduction: • 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.

  3. Materials 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 spinecomputedtomography (CT). • 9 patients underwent a spine MRI. • 9 patients hadthoracic and lumbarspine aches.

  4. Results: • 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.

  5. Case n°1 : • A sixty-year-oldwoman • Back pain • Clinicalsigns of meullary compression • Immunoelectrophoresis : normal • MRI : lesion of the posteriorarch and medullary compression. • Surgicalbiopsy: IgG class myeloma SagittaleT2WI Sagittal T1WI Contrast T1WI

  6. Case n°2: • A sixty-four-year-oldwoman • Back pain • Medullary MRI and CT: osteolyticlesion of the fifth dorsal vertebrawithdevelopment of an intra-canalar mass. • Immunoelectrophoresis: Kappa light chainmyeloma Enhanced-CT of the dorsal spine Sagittal T2 WI

  7. Case n°3 • A 72-year-oldwoman • Altération de l’état général • Back pain • Clinicalsigns of medullary compression • Spine MRI : vertebral compaction withepidural mass squeezing the spinal cord. • IEPP : kappa light chainmyeloma Sagittal T2WI

  8. Discussion • Multiple myeloma is a malignant disease of plasma cells in the bonemarrow. • 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.

  9. Discussion • In myeloma, MRI isparticularlyrecomended to : • Evaluate the extension to the axial skeleton • Detectlesions non-detected on X-ray examinations • Confirm the diagnosis of solitaryplasmocytoma • Make the diagnosis of medullary compression

  10. Discussion • Bonyinvolvement in myelomaisfrequently of a lytic nature withfrequent extra-osseousspreads. • 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.

  11. Discussion • 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.

  12. Discussion • In case of epidural locations withoutbonelesions, many diagnoses canbediscussedsuch as : • Primitive mild or malignanttumours (lipoma, liposarcoma) • Metastases • Locations of lymphoma • Locations of leukemia

  13. Conclusion • Spinal cord compression is a serious complication of multiple myeloma. • It oftenresultsfrom the extension of bonelesions of the vertebral body. • Epidural location withoutvertebral destruction or collapse is rare. • MRI is the best imagingmodality to confirm the medullary compression.

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