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MRI done. Suspected for multiple myeloma. Blood test and x-ray done. How to detect myeloma?

Nov 2013
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Hello. On a 44 years male, a MRI showed some hyper intense to intermediate lesions on a STIR sequence. A multiple myeloma diagnosis was suggested. However, none of the blood tests were showing the presence of the disease, including M protein, 24 hours urine, etc.

On the X-ray, no lytic lesion was identified, however a pretty severe osteoporosis is present.

What do you think?

Posted Sun, 3 Mar 2013 in Cancer
Answered by Dr. Sudhir Kumar 2 hours later

Thank you for posting your query.

MRI findings are pretty non-specific for a diagnosis of multiple myeloma. So, a doubt was raised, which warranted further investigations.

The more specific tests for myeloma are- M band on serum protein electrophoresis, Bence XXXXXXX protein in urine, and plasma cells. As they are normal, a diagnosis of multiple myeloma can be safely excluded here.

Changes in MRI due to osteoporosis may mimic myeloma, and as the X-Rays also suggest osteoporosis, that is the most likely diagnosis. Absence of lytic lesions on the bones (especially skull and pelvis) also is a point against a diagnosis of multiple myeloma.

Bone densitometry (DEXA) scan of lumbar spine and hips can help in confirming the diagnosis of osteoporosis.

I hope it helps. Please get back if you have any more queries.

Best wishes,
Dr Sudhir Kumar MD DM

Above answer was peer-reviewed by
Follow-up: MRI done. Suspected for multiple myeloma. Blood test and x-ray done. How to detect myeloma? 58 minutes later
Hello again,

I have attached all the test results, including blood tests, X-Ray, DEXA and MRI.

This is all I have so far. Please send me your opinion based on the results. Also, I have a back pain that suddenly started 12 months ago with muscular spasms and intense pain. As for now, my symptoms are only the lumbar and sometimes thoracic pain. I also had some hands pain and tingling but it went away after about 3-4 days. Also, when my back skin is touched, I feel some kind of burning but not very painful.

No headaches, I haven't lost appetite. The back pains are only present when I move.

Thank you, XXXXXXX
Answered by Dr. Sudhir Kumar 14 minutes later

Thank you for getting back with more information.

I have gone through these reports.

MRI findings as described can also occur in osteoporosis. Moreover, normal protein electrophoresis and absence of lytic lesions on X-rays virtually exclude a diagnosis of multiple myeloma.

Back pan can be explained on the basis of osteoporosis.

However, the only thing remains to be found out is the reason for osteoporosis at a relatively young age of 44 in a male.

Have you taken corticosteroids? Is there a vitamin D deficiency?

In any case, you would improve with treatment of osteoporosis.

Best wishes,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by
Follow-up: MRI done. Suspected for multiple myeloma. Blood test and x-ray done. How to detect myeloma? 22 minutes later

I haven't taken any corticosteroids. Did not have vitamin D tested yet.

What kind of disease could be related to the osteoporosis? Can the MRI indicated a malign disease?
On the other hand, I have taken a lot of anti-inflammatory medication for my back pain since 2012. Could it be related to the loss of bone calcium?

If multiple myeloma excluded, what else could be the reason?

Thank you. XXXXXXX
Answered by Dr. Sudhir Kumar 11 minutes later
Thank you for getting back.

Please get vitamin D tested, as a vitamin D deficiency could be the underlying reason for osteoporosis in your case. Vitamin D deficiency is common now-a-days due to lack of exposure to sunlight (about 80% of population may have varying degrees of Vitamin D deficiency). In my clinic, most young males (even in 20s and 30s) have very low vitamin D levels.

Vitamin D deficiency may lead to loss of bone calcium.

As I mentioned, the MRI findings are non specific. These can occur in multiple myeloma, malignancy, and osteoporosis (I got the report of MRI checked by my wife too, who is a radiologist). So, the definitive diagnosis depends on other investigations and tests (which were all done in your case).

So, I think, as of now, you require treatment for osteoporosis.

Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology)
Above answer was peer-reviewed by
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