Multiple myeloma is a cancer of the plasma cells in bone marrow that can cause damage to the bones. X-rays can detect bone damage and lesions from multiple myeloma.

Doctors may use X-rays and other imaging tests to diagnose and assess multiple myeloma. For example, MRI scans can provide detailed images that may help doctors detect multiple myeloma in its early stages.

This article looks at how doctors use X-rays and other imaging tests to diagnose and monitor the severity of multiple myeloma.

Multiple myeloma affects cells in the bone marrow. Myeloma cells speed up the breakdown of old bones and prevent the production of new bones. Multiple myeloma can also cause lytic lesions, which are holes in the bone.

This damage weakens the bones and increases the risk of fractures. It also causes an increased release of calcium into the bloodstream.

Myeloma most commonly affects bones in the:

  • spine
  • pelvis
  • ribs
  • skull
  • limbs

X-rays can detect bone damage from multiple myeloma, but they lack the precision of certain other tests. Doctors may perform X-rays on most of the body, which they refer to as bone or skeletal surveys.

X-rays can show:

  • bone loss or thinning
  • fractures
  • lesions, which are holes in the bones

X-rays are a quick and easy type of imaging test, but they are poor at detecting bone damage from multiple myeloma. They also lack the sensitivity to show the difference between recent and older bone damage, such as active versus inactive myeloma sites.

X-rays can show lytic lesions in bones. According to experts, lytic lesions usually appear as holes or punched-out areas in flat bone, such as in the skull or pelvis.

When bone loss happens slowly, the body increases bone density and hardness to counteract the damage. Doctors refer to this as reactive sclerosis. This protective reaction is absent in lytic lesions.

In long bones of the arms or legs, an X-ray may show endosteal scalloping, where the outer bone layer erodes. Lytic lesions in these bones can be small or large, and there can be multiple holes.

X-rays can also show diffuse osteoporosis, where bone loss causes multiple areas of bone to become brittle and weak, usually in the spine.

A complete skeletal survey with an X-ray can show bone thinning, loss, and fractures. However, X-rays will only detect bone damage after 30% or more of the outer layer of bone has worn away.

There are no specific preparations for the X-ray. People will be able to eat, drink, or take any medications as usual. They may need to wear a hospital gown and remove any watches or jewelry.

During an X-ray, a radiographer will provide instructions that may include:

  • standing or lying down on a special bed
  • waiting while the radiographer aligns the X-ray machine
  • staying still during the X-ray to prevent any blurred images
  • waiting while the radiographer stands behind a protective screen and takes multiple scans

X-rays are short and painless procedures that should cause no side effects.

A doctor will get in contact once they receive results, which could take several weeks. Research suggests that X-rays will show bone changes in almost 80% of people with multiple myeloma, affecting the following areas:

  • vertebrae in 65% of people
  • ribs in 45% of people
  • skull in 40% of people
  • pelvis in 30% of people
  • long bones in 25% of people

The study estimates that around 10–20% of people with multiple myeloma will receive normal results from an X-ray survey.

Other imaging tests, such as CT or MRI scans, may be more precise than X-rays.

CT scans combine X-rays with computer imagery to provide more detailed 3D images inside the body. They can detect bone damage from multiple myeloma and show precise images of bone lesions.

MRI scans can create 2D or 3D images of internal structures within the body. MRI scans can detect myeloma in its early stages and show any abnormal sections of bone.

MRI scans can also show plasmacytomas. Plasmacytomas are a type of tumor that starts in plasma cells and may progress into multiple myeloma.

MRI scans are not suitable for people with metal implants due to the risk of excessive magnetic field interactions.

Most health insurance providers will cover the cost of X-rays, which are cheaper than MRI and CT scans. The Multiple Myeloma Research Foundation offers a resource page for financial assistance to anyone needing support with these medical costs.

X-rays are a cheap and effective way of diagnosing a bone disease and may also be helpful for diagnosing multiple myeloma. However, X-rays have some limitations and are unable to detect early-stage lesions. Doctors may also use other imaging tests for more precise results, such as MRI and CT scans.