Clinical Radiology 70 (2015) 890e897
Contents lists available at ScienceDirect
Clinical Radiology journal homepage: www.clinicalradiologyonline.net
Pictorial Review
Intracranial involvement by multiple myeloma A. Lasocki a, b, *, S. Gangatharan c, F. Gaillard d, e, S.J. Harrison f, g a
Department of Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia c Department of Haematology, Fremantle Hospital, Fremantle, Western Australia, Australia d Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia e Department of Radiology, The University of Melbourne, Parkville, Victoria, Australia f Department of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia g Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia b
article in formation Article history: Received 31 October 2014 Received in revised form 18 February 2015 Accepted 24 March 2015
Intracranial involvement is a rare complication of multiple myeloma. It results either from direct extra-osseous spread from adjacent skeletal plasmacytomas or extra-medullary disease via haematogenous dissemination. The imaging appearances are non-specific, and dural, leptomeningeal, and parenchymal involvement can all occur. The purpose of this review is to illustrate the various neuroimaging appearances of this rare entity, focusing on MRI. Ó 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
Introduction Multiple myeloma (MM) is a neoplastic proliferation of plasma cells. The annual age-adjusted incidence is approximately 5.6 per 100,000, with a median age at diagnosis of approximately 70 years.1 In the majority of patients, it has been shown to evolve from monoclonal gammopathy of unknown significance (MGUS).2 Patients may present early with MGUS or asymptomatic myeloma (also known as smouldering myeloma), neither of which require therapy outside the context of a clinical trial. Alternatively, the diagnosis may be made at a more advanced stage requiring active therapy, such as symptomatic MM or, rarely, plasma cell leukaemia. Skeletal involvement occurs in 80e90% of patients with MM,3 whereas extramedullary disease is relatively uncommon.4
* Guarantor and correspondent: A. Lasocki, Department of Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. Tel.: þ61 3 9656 1111; fax: þ61 3 9656 1406. E-mail address: [email protected] (A. Lasocki).
In a large series of 1003 patients with MM, Varettoni et al.4 reported extramedullary disease in 7% of patients at presentation and in a further 6% of patients later in their course, most commonly consisting of a single plasmacytoma, usually within soft tissues surrounding the axial skeleton.4 Treatment of MM typically involves chemotherapy and/or autologous stem cell transplantation. The chemotherapy regimen generally includes a combination of older agents (such as prednisolone and melphalan) and novel therapies (such as thalidomide, lenalidomide, and bortezomib).1 The majority of patients with plasma cell disorders have generalised disease, as outlined above, but a minority (
Contents lists available at ScienceDirect
Clinical Radiology journal homepage: www.clinicalradiologyonline.net
Pictorial Review
Intracranial involvement by multiple myeloma A. Lasocki a, b, *, S. Gangatharan c, F. Gaillard d, e, S.J. Harrison f, g a
Department of Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia c Department of Haematology, Fremantle Hospital, Fremantle, Western Australia, Australia d Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia e Department of Radiology, The University of Melbourne, Parkville, Victoria, Australia f Department of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia g Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia b
article in formation Article history: Received 31 October 2014 Received in revised form 18 February 2015 Accepted 24 March 2015
Intracranial involvement is a rare complication of multiple myeloma. It results either from direct extra-osseous spread from adjacent skeletal plasmacytomas or extra-medullary disease via haematogenous dissemination. The imaging appearances are non-specific, and dural, leptomeningeal, and parenchymal involvement can all occur. The purpose of this review is to illustrate the various neuroimaging appearances of this rare entity, focusing on MRI. Ó 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
Introduction Multiple myeloma (MM) is a neoplastic proliferation of plasma cells. The annual age-adjusted incidence is approximately 5.6 per 100,000, with a median age at diagnosis of approximately 70 years.1 In the majority of patients, it has been shown to evolve from monoclonal gammopathy of unknown significance (MGUS).2 Patients may present early with MGUS or asymptomatic myeloma (also known as smouldering myeloma), neither of which require therapy outside the context of a clinical trial. Alternatively, the diagnosis may be made at a more advanced stage requiring active therapy, such as symptomatic MM or, rarely, plasma cell leukaemia. Skeletal involvement occurs in 80e90% of patients with MM,3 whereas extramedullary disease is relatively uncommon.4
* Guarantor and correspondent: A. Lasocki, Department of Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. Tel.: þ61 3 9656 1111; fax: þ61 3 9656 1406. E-mail address: [email protected] (A. Lasocki).
In a large series of 1003 patients with MM, Varettoni et al.4 reported extramedullary disease in 7% of patients at presentation and in a further 6% of patients later in their course, most commonly consisting of a single plasmacytoma, usually within soft tissues surrounding the axial skeleton.4 Treatment of MM typically involves chemotherapy and/or autologous stem cell transplantation. The chemotherapy regimen generally includes a combination of older agents (such as prednisolone and melphalan) and novel therapies (such as thalidomide, lenalidomide, and bortezomib).1 The majority of patients with plasma cell disorders have generalised disease, as outlined above, but a minority (
