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目的：为了提高对多发性骨髓瘤（ Ｍ Ｍ） 和骨转移瘤的影像学（ Ｘ 线、 Ｃ Ｔ） 的鉴别诊断水平。方法：收集经骨髓涂片或局部病灶活检病理证实的 Ｍ Ｍ４４ 例。经手术、病理证实原发肿瘤并骨质破坏者７１ 例；骨破坏灶穿刺病理为骨转移瘤５ 例。将上述两组病例的 Ｘ 线及 Ｃ Ｔ 表现进行回顾性分析对比。结果：颅骨病变发生率 Ｍ Ｍ 为８５ ％ ，骨转移瘤为２１４３ ％ ，两者比较 Ｐ＜ ０００５ ；下颌骨破坏 Ｍ Ｍ 为５０ ％ ，骨转移瘤为７１４ ％ ，两者比较 Ｐ＜ ００１ 。脊柱附件骨质破坏部位两病不同， Ｍ Ｍ 仅破坏椎弓，转移瘤不仅破坏椎弓，还破坏椎弓以外附件。膨胀性骨破坏的 Ｃ Ｔ 表现， Ｍ Ｍ 骨破坏部位为密度均匀边缘清楚的软组织影替代，残留骨壳排列规则，对邻近软组织仅为压迫性改变。骨转移瘤骨膨胀性改变轻，对邻近软组织为浸润性改变，在病变内见分布不规则高密度的斑点状残留骨或肿瘤骨。结论：颅骨破坏且为多发病灶及下颌骨破坏，对诊断 Ｍ Ｍ 有重要价值。脊椎骨质破坏灶累及椎弓及椎弓以外附件及病灶范围内见斑点状高密影者，首先考虑为骨转移瘤。
Objective: To improve the differential diagnosis of multiple myeloma (M M) and bone metastases imaging (X ray, C T). Methods: M M44 cases confirmed by biopsy of bone marrow smears or local lesions were collected. 71 cases of primary tumor and bone destruction were confirmed by operation and pathology, and 5 cases of bone metastasis. The X-ray and CT manifestations of the above two groups of patients were retrospectively analyzed and compared. Results: The incidence of skull lesions was 85% for M and 85% for bone metastases, P <0005 for both cases, 50% for mandibular destruction and 714% for bone metastases Compare P <001. Spine attachment bone destruction site two different diseases, M M damage only the pedicle, metastases not only damage the pedicle, but also destroy the attachment of the pedicle. C T expansive bone destruction showed that the M M bone destruction site was a uniform density of soft tissue imaging edge of the clear replacement of the rules of the residual bone shell arrangement, adjacent to only compressive changes in soft tissue. Bone metastasis of bone expansion of light changes, infiltration of adjacent soft tissue changes in the lesion see the irregular distribution of high-density spot-like residual bone or tumor bone. Conclusion: The destruction of the skull and the destruction of multiple lesions and mandibles are of great value in the diagnosis of M M. Spinal destruction of bone lesions involving the vertebral arch and other non-pedicle attachment and lesion see spot-like high density shadow, first considered as bone metastases.