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This is a case of a 73-year-old male

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who got into a car accident and was evaluated

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With a CT neck and chest

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And was found to have a lytic lesion at T two.

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He also had poor renal function

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for which an ultrasound was done.

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And in that ultrasound they also saw splenomegaly.

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The blood work showed elevated capite chain

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and an abnormal ratio as well as an M spike of 1.5

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and therefore the pit CT was requested for the

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evaluation of multiple myeloma.

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And uh, we're gonna start with the

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MIP images here.

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You can see that there's multiple areas of

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Abnormality, But the striking finding is the intensity

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of uptake in the bone marrow of the axial skeleton

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and also pendular skeleton.

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Aside from the diffuse uptake, we can see areas that have fo

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greater tracer uptake.

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We will go through The findings in detail shortly.

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There's also abnormal tracer uptake in the spleen,

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which also looks enlarged.

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Moving on to the case,

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and we're gonna start with axial view.

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As you can see, in cases of multiple myeloma,

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we include the entire body to make sure

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that we don't exclude the skull

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or lower extremities as these may also

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Be Sites where disease can be found.

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Uh, it is important in the evaluation of the head

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to tailor the contrast to make sure that you can see

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where there are areas of uptake in the bones.

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For this case, we're gonna focus on the positive findings,

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and we're not gonna go through every detail, but just the

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Most Relevant findings.

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I don't see anything in the head and neck. Another way

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Of looking At these would be in coronal,

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which gives you a easier differentiation of the

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calvarium, particularly on the vertex of the skull.

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Once you have clear the skull, we can move on lower down.

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As I mentioned earlier, he was found

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to have a lytic lesion in T two, which is this one.

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The lytic component is evident on the CT portion, but the

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Intensity of Uptake is quite striking.

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Many other areas of disease are seen, for instance,

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in this rip where the intensity

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of uptake is quite severe or intense,

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and we can see that there's subtle modeling of the cortex.

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Additional areas

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of abnormal uptake are seen in smaller bones.

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For instance, in this transverse process where the

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CT finding is not as obvious.

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For instance, if we look at the pelvic bones, we can see

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that the uptake is diffusely abnormal.

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Some areas have greater uptake.

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Let's focus our eyes on the right iliac bone, where we see

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that there's a lytic lesion with soft tissue component

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that is breaking through the bone.

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In some areas, this has abnormal tracer uptake as well.

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And here more anteriorly in that same bone,

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there is a soft tissue lesion.

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This was a plasmacytoma.

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The soft tissue component is extending into

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the iliac as muscle.

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If we looked at it only on the pit, maybe it would be harder

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to pinpoint the abnormality on the axial alone.

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So that's why correlation with CT

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and the separate read of the CT portion is, is crucial.

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I wanted to mention that

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as we can see in the femur, there are two types

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of abnormality.

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One is the diffuse bone marrow, and then more focal.

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There's three lesions that we can see,

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and this is a combination of involvement

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of the bone marrow compartment,

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but also more focal lesions

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where there probably are cluster of plasma cells.

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Looking at the femoral physes,

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and particularly on the left, we can see

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that there is diffused tracer uptake,

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but also there are areas of more focal tracer avidity.

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This is a combination of diffusely abnormal bone marrow

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with focal lesions.

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In this patient, we also mentioned

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that the spleen is abnormal.

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Not only the diffuse uptake is increased

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and is higher than the liver, which is abnormal,

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but also the size of the spleen is enlarged

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and measures 20 centimeters.

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When we focus ourselves on the evaluation of the spine.

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In this case or other cases, I use the

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sagittal plane a lot

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because it allows me to see in one view

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how heterogeneous are the vertebral bodies.

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In this case, we can see that they are diffusely, FDG Abit,

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but in addition, there are areas

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of more focal abnormal t trace or uptake.

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For instance, in this thoracic vertebra,

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which if we take a closer look, responds to a lytic lesion,

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while at other levels,

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even though the the uptake is increased, we cannot

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identify any specific lesions.

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So to recap, we have a case of

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multifocal multiple myeloma

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With diffuse bone marrow disease as well

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as osseous lesions with extramedullary involvement

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as demonstrated by plasmacytoma

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and likely involvement of the spleen.