Multiple myeloma (MM) is a clonal plasma cell neoplasm frequently accompanied by destructive bone disease, which constitutes a major source of morbidity through pain, pathologic fractures, hypercalcemia, and spinal cord compression. Bone involvement results from uncoupled remodeling characterized by heightened osteoclast activity and suppressed osteoblast function, producing purely osteolytic lesions without sclerotic reaction. This cross-sectional study assessed the spectrum of radiologic bone changes in 68 patients with newly diagnosed or suspected MM at a tertiary medical center in Tashkent, Uzbekistan. Conventional skeletal survey identified bone abnormalities in 72.1% of cases, with classic “punched-out” lytic lesions most prevalent in the skull (55.9%), vertebrae (50.0%), and pelvis (41.2%). Whole-body low-dose CT (WBLDCT), performed in a subset of 42 patients, detected additional osteolytic lesions in 21.4% of those with negative or equivocal skeletal surveys. MRI demonstrated focal or diffuse marrow infiltration patterns in 80% and 40% of examined cases, respectively, often before overt cortical destruction. A significant positive correlation was observed between the number of lytic lesions and Durie-Salmon stage (r = 0.54, p < 0.01), as well as negative correlations with hemoglobin levels (r = −0.58, p < 0.01) and positive correlations with β2-microglobulin (r = 0.51, p < 0.01). These results emphasize the limitations of traditional skeletal survey and the superior sensitivity of modern whole-body imaging techniques (WBLDCT and MRI) for accurate detection and staging of bone disease in MM. Early radiologic diagnosis using advanced modalities is critical for risk stratification, prevention of skeletal-related events, and optimization of therapeutic strategies, particularly in resource-variable settings.

Multiple myeloma, osteolytic bone lesions, punched-out lesions, skeletal survey, whole-body low-dose CT, magnetic resonance imaging, bone marrow infiltration, myeloma bone disease

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