A 65-year-old patient with known multiple myeloma has a whole-body low-dose CT scan. Which feature on CT best differentiates an active myeloma lesion from a sclerotic metastasis?
- A Purely lytic 'punched-out' lesion without sclerotic rim ✓
- B Sclerotic halo surrounding a lytic centre
- C Vertebral end-plate sclerosis
- D Ivory vertebra appearance
Explanation
Multiple myeloma produces purely lytic 'punched-out' lesions with a narrow zone of transition and no sclerotic rim, because plasma cell infiltration destroys bone via osteoclast activation without osteoblastic response. Whole-body low-dose CT (WBLDCT) has replaced skeletal survey in myeloma guidelines (IMWG/NICE) because it detects more lesions. Sclerotic metastases (from prostate, breast) show sclerotic halos or diffuse sclerosis. Ivory vertebra (uniformly sclerotic vertebral body) is typical of lymphoma or Paget's disease. POEMS syndrome is a rare cause of sclerotic myeloma lesions.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.