每天朗读一段医学影像学英语文章
History：73-year-old male with diffuse bone pain.
Findings：Sagittal T1-weighted (scan 1), fast spin-echo T2-weighted (scan 2) and enhanced T1 FS (scan 3) images show multiple focal marrow-replacing lesions in the fused vertebral bodies of T11 and T12 and spinous process of L2. There are ballooning and subtle fractures of the endplates.
Diagnosis: Multiple myeloma
Multiple myeloma is the most common primary malignant neoplasm in adults. It is a multifocal disease characterized by neoplastic proliferation of plasma cells. When solitary it is referred to as plasmacytoma, but it most commonly presents as multiple nodules replacing normal marrow in patients over the age of 40 (age range 40-70.)
Myeloma is rare in children. The majority of patients are male (70%) and radiographically the most common finding is osteopenia. The characteristic punched out appearance of multiple osteolytic lesions throughout the skull and spine is almost pathognomonic. Adjunctive imaging is often very helpful because plain films may not reveal the characteristic lesions. Bone scan is positive in only 10% of the cases, and is not utilized for diagnosis of myeloma.
Typically myeloma will affect the axial skeleton (spine, pelvis, and skull) and MRI can identify lesions that are radiographically occult.
In the present case, the differential diagnosis must include metastases. The MRI signal characteristics are not specific. Rather it is the patient's clinical presentation, multifocal appearance, and biopsy that will confirm the diagnosis.
The features that favor myeloma over metastatic carcinoma include:
(1) presence of paraspinal soft tissue masses that may produce scalloping of the bodies,
(2) radiographically punched out lesions,
(3) the pedicle is involved late compared to early in metastatic disease.
Notes:
myeloma [ˌmaɪəˈloʊmə] n. 骨髓瘤
ballooning [bəˈlʊnɪŋ] n. 鼓胀
neoplasm ['ni:oʊplæzəm] n. 肿瘤; 赘生物
plasma [ˈplæzmə] n. 血浆
plasmacytoma [plæzmə'sɪtəmə] 浆细胞瘤
marrow [ˈmæroʊ] n. 骨髓
osteopenia [ɒsti:oʊ'pi:nɪr] 骨质减少
osteolytic ['ɒstɪrli:tɪk] 溶骨的
pathognomonic [pəˌθɒgnə'mɒnɪk] adj. 特殊（病征）的，特定的
occult [ˈɑ:kʌlt] adj. n. vt. 隐蔽
metastases [mə'tæstəsi:z] n. 转移(metastasis的复数)
paraspinal [pæ'rɑ:spɪnl] 脊柱旁的
scalloping ['skɒləpɪŋ] n. 扇形
pedicle ['pedəkəl] n. 蒂
来源：每天朗读一段医学影像学英语文章
圈主
深圳市人民医院放射科副主任医师杨敏洁
联系客服
