Есть ли миелома?

As described above, direct assessment of bone marrow plasma cell infiltra- tion as afforded by MRI is possible before bone lytic lesion (s) appear on WBXR and/or CT (Baur-Melnyk et al, 2005). Therefore, MRI is more sensitive than WBXR in the early detection of MM-related bone destruction. Moreover, MRI is the gold standard technique for the assessment of myeloma- tous involvement of the spine, for several reasons. Firstly, it provides excellent imaging due to its improved sensitivity over conventional radiography (Lecouvet et al, 1999). Sec- ondly, it accurately shows the presence of any spinal cord and/or nerve root compression, and enables the recognition of soft tissue masses (Joffe et al, 1988). Thirdly, MRI can predict the risk of vertebral fracture, even though it does not help in predicting the level of fracture. It has been reported that the risk of vertebral collapse is 6-fold to 10-fold higher in patients with more than 10 FLs on MRI in comparison with those with a normal bone marrow pattern or <10 FLs (Lecouvet et al, 1997, 1998a). Fourthly, it is the best tool for distinguishing between benign and malignant osteoporosis- induced vertebral fractures. This is of great help in clinical practice because the appearance and distribution of vertebral fractures is similar between patients with benign osteoporosis and those with MM. Fifthly, MRI can accurately evaluate the percentage of vertebral height loss before percutaneous vertebroplasty or kyphoplasty (Van Gelderen et al, 1997; Diamond et al, 2004). Finally, MRI allows us to detect complications of the disease, such as soft tissue amyloid deposits, and is the standard technique to be used in the diagnosis of avascular necrosis of the femoral head (Lafforgue et al, 1993).