Abstract
Objective:Cross-sectional imaging is now recommended by the National Institute for Health and Care Excellence (NICE) for patients with suspected and newly diagnosed myeloma instead of skeletal survey. The objectives of this study were: (1) To evaluate compliance of current UK imaging practice with reference to National Institute for Health and Care Excellence best-practice clinical guidelines for plasma cell malignancies. (2) To identify factors which may influence diagnostic imaging choices.Methods:We conducted a national online survey to assess compliance with guidelines and to identify challenges to implementation (endorsed by Myeloma UK, UK Myeloma Forum and the British Society of Skeletal Radiologists).Results:Responses were received from 31 district general and 28 teaching hospitals. For suspected and confirmed myeloma, skeletal survey remained the most frequent first-line imaging test (suspected myeloma 44.3%, confirmed myeloma 37.7%). Only 9.8 % of responders offered first-line whole body MRI.Conclusion:Significant challenges remain to standardisation of imaging practice in accordance with national best-practice guidelines.Advances in knowledge:This is the first publication to date evaluating current UK imaging practice for assessing myeloma since the publication of new guidelines recommending use of advanced cross-sectional imaging techniques. Skeletal survey remains the most commonly performed first-line imaging test in patients with suspected or confirmed myeloma and this is largely due to resource limitations within radiology departments.
Highlights
Whole body magnetic resonance imaging (WB-MRI) or whole body CT (WB-CT) or 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) are recommended by the National Institute for Health and Care Excellence [NICE 2016, NG 351] and the British Society of Haematology [2017 guidelines2] for evaluating patients with suspected and newly diagnosed myeloma and solitary plasmacytoma
Current International Myeloma Working Group guidelines include the detection of greater than one unequivocal bone lesion on MRI (> 5 mm) or one or more lytic bone lesion detected on CT scan, including WB-CT or 18F-FDG PET/CT, as sufficient to fulfill the criteria for myeloma-defining bone disease[3]
These guidelines acknowledge research showing that skeletal survey (SS) is inferior to WB-MRI, WB-CT or 18F-FDG PET/CT in the detection of myeloma related bone disease[4]
Summary
Whole body magnetic resonance imaging (WB-MRI) or whole body CT (WB-CT) or 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) are recommended by the National Institute for Health and Care Excellence [NICE 2016, NG 351] and the British Society of Haematology [2017 guidelines2] for evaluating patients with suspected and newly diagnosed myeloma and solitary plasmacytoma. NICE guidelines state that WBMRI (or WB-CT if patient declines or is unsuitable for MRI) should be considered as the first-line imaging test in patients with suspected myeloma. In patients with confirmed newly diagnosed myeloma, WB-MRI, WB-CT or 18F-FDG PET/CT should be considered to assess for myeloma-related bone disease and extramedullary plasmacytomas[1]. SS, the former gold standard imaging test, should only be considered in suspected myeloma if WB-MRI or WB-CT is unsuitable or declined by the patient. We hypothesized that there may be significant regional variations in imaging practice despite bestpractice recommendations
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