American Board of Internal Medicine (ABIM) Certification Practice Exam

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Which imaging technique is more sensitive for detecting bone lesions in multiple myeloma?

Skeletal survey
Plain radiographs
Magnetic resonance imaging (MRI)
Ultrasound

The correct answer is: Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) is particularly sensitive for detecting bone lesions in multiple myeloma. This sensitivity is due to MRI's ability to visualize not only bony changes but also the marrow involvement, which is critical in multiple myeloma. MRI can identify bone marrow lesions that may not yet show up as structural changes on plain radiographs or skeletal surveys. Typically, in multiple myeloma, extramedullary disease and focal lesions can be detected earlier with MRI, allowing for better assessment of disease burden. Furthermore, MRI can differentiate between benign and malignant lesions based on their characteristics and enhances the evaluation of the extent and impact of the disease on the bone marrow, which is essential for staging and treatment planning. The other imaging techniques have limitations in sensitivity. Skeletal surveys and plain radiographs primarily identify lytic lesions that are significant enough to cause cortical bone loss, which may miss early changes seen in the marrow. Ultrasound is generally not utilized for evaluating bone lesions in this context as it does not penetrate bone effectively and is not standardized for this purpose.