Fig. 6

Image examples of myeloma and metastasis which were misdiagnosed by radiologist, and application of nomogram to predict probability 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 myeloma by the International Myeloma Working Group Diagnostic Criteria. The experienced radiologist incorrectly rendered diagnosis of metastasis. (c, d) MRI shows the single lesion in the spine, which presents homogenous appearance and irregular shape on MRI. Patient was diagnosed with metastasis by pathological evaluation. The experienced radiologist incorrectly rendered diagnosis of myeloma. (e) Nomogram shows determination of risk of metastasis in both patients. For patient in a, b (red arrows), nomogram yields total of 61.1 points and corresponding risk of metastasis of less than 0.4. For patient in c, d (blue arrows), nomogram yields total of 123.3 points and corresponding risk of metastasis of greater than 0.7. Thus, nomogram rendered correct diagnosis in both patients