Imaging features of nodular hepatic multiple myeloma localizations: a review of the literature

INTRODUCTION: Multiple myeloma (MM) is characterized by the neoplastic proliferation of a single clone of plasma cells confined to the bone marrow. Extramedullary manifestations of multiple myeloma can occur in many different sites, including soft tissues and internal organs. Although rare, it is important to keep in mind the radiological features of nodular lesions of hepatic MM, especially in the presence of suggestive clinical manifestations. Considering that there are few studies describing this phenomenon, starting from a case report we conducted a review of the available literature on this topic. Therefore, the main purpose of this study is to describe the radiological characteristics of liver MM lesions using ultrasonography (US), computerized tomography (CT) and magnetic resonance imaging (MRI) scans.EVIDENCE ACQUISITION: A search on PubMed was conducted up to the end of January 2023. We included articles that reported radiological findings of nodular liver lesions in MM patients using at least one of ultrasound, computed tomography, and magnetic resonance imaging.EVIDENCE SYNTHESIS: Among the studies, the most frequent US pattern was hypoechoic nodules. Most studies described intrinsically hypodense lesions in unenhanced CT scans and varying degrees of enhancement in the arterial phase, suggesting hypervascularized lesions. We found only six articles in scientific literature reporting the MRI features of hepatic nodular myelomatous lesions, with very heterogeneous results.CONCLUSIONS: The vast majority of nodular manifestations of hepatic MM collected in our study were multiple, and only five studies, including ours, described them using the major imaging modalities available.