Fig. 5

Image examples of typical myeloma and metastasis, and application of nomogram to predict probability of metastasis. Nomogram shows points assigned for each predictor. Total number of points is calculated by adding points assigned for all variables and is then used to determine corresponding risks of metastasis. (a, b) MRI shows multiple lesions in the spine. And some of the lesions presents heterogeneous appearance and irregular shape on MRI. Patient was diagnosed with metastasis by pathological evaluation. The experienced radiologist correctly rendered diagnosis of metastasis. (c, d) MRI shows multiple lesions in the spine. And some of the lesions presents homogenous appearance and regular shape on MRI. Patient was diagnosed with myeloma by the International Myeloma Working Group Diagnostic Criteria. The experienced radiologist correctly rendered diagnosis of myeloma. (e) Nomogram shows determination of risk of metastasis in both patients who had multiple lesions on MRI. For patient in a, b (red arrows), nomogram yields total of 136.5 points and corresponding risk of metastasis of greater than 0.9. For patient in c, d (blue arrows), nomogram yields total of 65.5 points and corresponding risk of metastasis of less than 0.4. Thus, nomogram rendered correct diagnosis in both patients