Abstract
e18554 Background: Current recommendations for the evaluation of MM include a skeletal survey (SS) and possibly an MRI. The literature documents a discrepancy in the detection of important skeletal lesions between these two techniques. There is limited data on the relationship between symptoms and spinal MRI findings. We analyzed the correlation of symptoms with an abnormal MRI in our patients. Methods: We analyzed 66 unselected,retrospectively identified patients with MM using lab values, ISS scores, the initial SS, and MRI. Skeletal symptoms, interval between studies, discordance between imaging by modality, and interventions were also tabulated. Risk ratios (RR) were calculated for the probability of radiologic abnormalities based on symptoms. Fischer's exact test was applied. Results: The baseline characteristics by age, gender, race, ISS score, and other lab values were similar between groups. 53% (35/66) of patients had an MRI at diagnosis. 51.4% (18/35) of these had different findings from the SS (95% CI, 35.6% - 67.0%). 30.8% (8/26) of patients with an MRI abnormality were asymptomatic or had symptoms in a different location than seen on MRI (95% CI, 16.3% - 50.1%). 15.4% (4/26) of these patients were asymptomatic at presentation (95% CI, 5.5% - 34.2%). (RR) for patients with any reported symptom and abnormal MRI finding is 2.6 (95% CI, 1.1 - 5.6, p< 0.01), while the RR for a symptom corresponding to its anatomic area on MRI is 1.3 (95%CI .8 - 2.1, p = 0.23). Conclusions: 30% of our patients with an abnormal MRI were asymptomatic or reported symptoms in a different area. The RR for an abnormal MRI result in patients with any symptom was significant, but the symptomatic area did not correlate with the anatomic MRI abnormality. This suggests that a significant amount of disease is missed because imaging may be confined to the symptomatic area and asymptomatic patients are less likely to have an MRI. Within this limited data set, there appears to be an advantage to performing routine initial MRI
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