How to choose the examination program for skeletal imaging? Prof. Zhang Yi|: The examination of skeletal lesions is the most important and critical part of multiple myeloma diagnosis. Traditionally, there are general X-ray examinations. With the development of new imaging technologies, CT, MRI (Magnetic Resonance Imaging) and PET-CT can be used in the imaging of multiple myeloma, each with its own advantages and disadvantages. General X-ray and CT are localized examinations, and if we want to detect systemic lesions, we need to check the bones in all parts of the body, but CT can detect early bone destruction, while general X-ray examination cannot; MRI, especially for lumbar and thoracic vertebrae, can be specialized in checking the spinal mass; PET-CT is a whole-body examination in itself, which can not only detect the location of bone destruction, but also can see PET-CT itself is a systemic examination, which can not only find out the location of bone destruction, but also all parts of the whole body, including lesions of bone entities, bone marrow lesions and lesions of soft tissues around the bone, and even other solid tumors, and can also find out the characteristics of the tumor’s activity to determine the progress of the disease, which is the current examination that can more comprehensively reflect the activity of the tissue lesions and foci, with the disadvantage of being relatively more expensive. Patients can choose the appropriate imaging program according to their own disease symptoms and economic conditions, and doctors should also grasp the advantages and disadvantages of various skeletal imaging programs to avoid misdiagnosis or missed diagnosis. Do I need to examine the whole body or wherever there is pain or swelling? Prof. Zhang Yixing: In principle, local bone destruction should be examined first, and if bone destruction is identified, it will be extended to the whole body accordingly, and all patients need to observe the bone destruction to determine the stage of the tumor, so it is necessary to examine more comprehensively. Can multiple myeloma be ruled out directly if there is no abnormality in the general X-ray examination? Prof. Zhang Yibu: It cannot be ruled out completely. Many early bone damage or bone marrow lesions cannot be detected immediately by general X-ray examination, and it is necessary to use CT, or it is better to do lumbar and thoracic MRI when there are spinal symptoms. Considering the invasive nature of bone marrow aspiration, under what circumstances should it be done? Prof. Zhang Yibu: Bone marrow aspiration is a key diagnostic indicator for multiple myeloma, and the bone marrow pathology examination after aspiration not only involves bone marrow morphology and plasma cell count, but also FISH, which is very helpful in determining the prognosis of multiple myeloma. Bone marrow aspiration is a minimally invasive and routine procedure. But after all, it is an invasion of the bone marrow, so it is understandable that the patient may sound scared and fearful. But in fact, bone marrow aspiration does not cause too much damage to the patient’s body. If the patient has a high suspicion of multiple myeloma, and the previous blood and urine biochemistry tests also show positive signs, it is necessary to consider a bone marrow aspiration, because bone marrow aspiration and bone marrow biopsy are the necessary tests to confirm the final diagnosis of multiple myeloma patients. Bone marrow aspiration is not recommended if the patient’s blood and urine biochemistry and bone imaging tests have not been done, or if the tests do not indicate much likelihood of multiple myeloma. How is the site of puncture determined? Prof. Zhang Yixing: The site of bone marrow aspiration is usually the ilium, which is very safe and accurate, and can be performed under local anesthesia without much pain to the patient. Is it necessary to perform multiple punctures? Prof. Zhang Yixing: In most cases, patients can be found in one puncture, and it is extremely rare for patients to need multiple punctures. However, for some rare cases of multiple myeloma, since the tumor cells are only localized to the bones and not distributed all over the body, if the puncture site is not accurate enough, another puncture may be needed to find the exact site.