Multiple myeloma (MM) is a hematologic cancer characterized by clonal proliferation of plasma cells within the bone marrow. It is the most serious form of plasma cell dyscrasias, whose complications—hypercalcemia, renal failure, anemia, and lytic bone lesions—are severe and justify the therapeutic management. Imaging of bone lesions is a cardinal element in the diagnosis, staging, study of response to therapy, and prognostic evaluation of patients with MM. Historically, the skeletal radiographic workup (SRW), covering the entire axial skeleton, has been used to detect bone lesions. Over time, new imaging techniques that are more powerful than SRW have been evaluated. Low-dose and whole-body computed tomography (CT) supplants SRW for the detection of bone involvement, but is of limited value in assessing therapeutic response. Bone marrow MRI, initially studying the axial pelvic-spinal skeleton and more recently the whole body, is an attractive alternative. Beyond its non-irradiating character, its sensitivity for the detection of marrow damage, its capacity to evaluate the therapeutic response and its prognostic value has been demonstrated. This well-established technique has been incorporated into disease staging systems by many health systems and scientific authorities. Along with positron emission tomography (PET)-18 fluorodeoxyglucose CT, it constitutes the current imaging of choice for MM. This article illustrates the progress of the MRI technique over the past three decades and situates its role in the management of patients with MM.
The temporomandibular joint (TMJ) is considered a bicondylar diarthrosis type joint. Imaging evaluation is a fundamental part of its assessment, which should include both bony and soft tissue characteristics and the relationship between them. Magnetic resonance imaging (MRI) represents the gold standard for the study of soft tissues; however, up to now, its main application continues to be the visualization of the articular disc. For this reason, the present article aimed to point out the information available in the literature regarding the visualization of the joint capsule in MRI and to evaluate it as an independent structure.
Objective: To evaluate the imaging features of spondyloarthritis on magnetic resonance imaging (MRI) of the sacroiliac (SI) joints in terms of topography (in thirds) and affected margin, since this aspect is rarely addressed in the literature. Methods: Cross-sectional study with MRI (1.5 T) evaluation of the SI in 16 patients with diagnosis of axial spondyloarthritis regarding the presence of acute (subchondral bone edema, enthesitis, synovitis and capsulitis) and chronic changes (erosions, subchondral bone sclerosis, bone bridging and fatty replacement), performed by two radiologists, blinded to clinical data. MRI findings were correlated with clinical data including age, disease duration, medications, HLA-B27, BASDAI, ASDAS-VHS and ASDAS-PCR, BASMI, BASFI, and mSASSS. Results: Bone edema pattern and erosions showed predominance in the upper third of SI (p = 0.050, p = 0.0014, respectively). There was a correlation between the time of disease and structural changes by affected third (p = 0.028-0.037), as well as the presence of bone bridges with BASMI (p = 0.028) and mSASSS (p = 0.014). Patients with osteitis of the lower third had higher ASDAS values (ESRV: p = 0.011 and CRP: p = 0.017). Conclusion: Chronic inflammatory changes and the pattern of bone edema predominated in the upper third of the SI, but there was also concomitant involvement of the middle or lower thirds of the joint. The localization of involvement in the upper third of the SI was insufficient to differentiate between degeneration and inflammation.
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