Fig. 3

Overview of the 1.5-Tesla MRI scanning protocol using whole-body conventional anatomical MRI sequences (a–e), spinal dynamic contrast-enhanced MRI (f), and spinal diffusion-weighted imaging (g). A 77-year-old male patient with double hit high-risk IgGκ multiple myeloma with Salmon-Durie Plus and Revised International Staging System (second revision, R2-ISS) stadium II is presented, which was unresponsive to therapy and passed away 1.8 years after diagnosis. Regarding SLIM-CRAB criteria, a monoclonal bone marrow plasmacytosis of 50%, a light-chain involved/uninvolved ratio of 42, a total number of 19 focal MRI lesions > 5 mm (largest: 22 mm), a normocalcaemia, a mildly reduced renal function (glomerular filtration rate 60 mL/min/1.72 m², CKD stage G2) and a macrocytic anemia were observed. Suspected focal lesions of more than 5 mm in the 10th thoracic, 1st lumbar, and 1st sacral vertebra and the right iliac bone (white arrows) and diffuse abnormal signal intensities on all sequences are observed. A combined skeletal score of 11/13 with a combined focal and diffuse bone marrow invasion pattern can be observed. The b1000 diffusion-weighted images show severe diffusion restriction in all vertebrae and in the focal lesions of the 1st lumbar and 1st sacral vertebra (white arrows in g). The suspected focal lesion in the 10th thoracic vertebra does not show diffusion restriction (white dotted circle) or contrast enhancement, depicting its benign character due to a recent compression fracture. The spinal dynamic contrast-enhanced MRI sequence, 50 s after gadolinium contrast administration (Gadovist 7.5 mL, gadobutrol 1.0 mmol/mL, 0.1 mmol/kg, Bayer), shows intense and fast contrast uptake in the entire spine and especially in the focal lesions (white arrows in f). Cor coronal, DCE-MRI dynamic contrast-enhanced magnetic resonance imaging, DWI diffusion-weighted imaging, FS fat-saturated, Gd gadolinium, sag sagittal, STIR short tau inversion recovery, T1 T1-weighted, T2 T2-weighted