ADC map of extramedullary plasmacytoma

Posted By Amrutha Ramachandran
ADC map of extramedullary plasmacytoma

A 77 year old male with extramedullary plasmacytomas of the left leg. (A) Axial DWI with b value = 50 sec/mm2 (B) Axial DWI with b value = 600 sec/mm2. The masses (arrows) show high signal intensity on DWI images, with progressively higher relative signal intensity on higher b-value images. (C) ADC map reveals homogeneously low ADC values of the tumors, ranging from 0.88 to 1.1, as compared to ADC values of approximately 1.7 for regional normal musculature, reflecting their highly cellular.

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  • Amrutha Ramachandran 2015-01-26 20:44:30

    While we acknowledge that extramedullary relapse of multiple myeloma is not itself a rare entity, it portends a particularly poor outcome. What is unique about this case is its characterization by DWI/ADC mapping, which fortunately does not require IV contrast - gadolinium was precluded in this patient, as in many other patients with multiple myeloma, by underlying renal failure. DWI in the musculoskeletal system is of emerging importance in the characterization of soft tissue masses by MRI. Since extramedullary myeloma is characterized histologically by sheets of plasma cells, the low values obtained on ADC map within this case exemplify the theory that highly cellular tumors result in restricted diffusion (and hence low ADC values). The relatively uniform imaging appearance of this tumor on MRI makes it particularly appealing to study with this technique, and we present the current case for consideration because there is no literature as yet on the appearance of this type of tumor on DWI/ADC mapping. Given these considerations and the fact that contrast does not have to be adminstered, we propose that as a subject for future investigations, such tumors could be followed with DWI for treatment response in myeloma patients. Thus, this case highlights 1) an infrequent and interesting tissue manifestation of a relatively common disease whose clinical significance radiologists should be aware of and 2) the utility of advanced MRI in characterizing the cellularity of tumors by a noninvasive means, without the need for IV contrast.


  • Roland Talanow 2015-01-12 02:39:16

    If you are applying for JRCR submission: Please explain what makes this case so special and provide more information about such entity. Thank you.