Abstract
For decades, conventional skeletal survey (CSS) has been the standard imaging technique for multiple myeloma (MM). However, recently whole-body computed tomography (WBCT) has been implemented into the diagnostic criteria of MM. This analysis compares sensitivity and prognostic significance of WBCT and CSS in patients with smoldering MM (SMM) and MM. Fifty-four of 212 patients (25.5%) had a negative CSS and a positive WBCT for osteolytic lesions (P<0.0001). Of 66 patients with SMM based on CSS, 12 (22.2%) had osteolytic lesions on WBCT. In comparison, WBCT failed to detect some bone destructions in the appendicular skeleton possibly due to limitations of the field of view. Presence of lytic bone lesions in WBCT was of borderline prognostic significance (P=0.051) for SMM patients, with a median time to progression of 38 versus 82 months for those without bone destructions. In conclusion, WBCT identifies significantly more sites of bone destruction than CSS. More than 20% of patients with SMM according to CSS have in fact active MM detectable with WBCT. On the basis of this and other studies, WBCT (either computed tomography (CT) alone or as part of a positron emission tomography-CT protocol) should be considered the current standard for the detection of osteolytic lesions in MM.
Highlights
Conventional skeletal survey (CSS) has been the standard imaging technique for the detection of myeloma bone disease.[1,2] It consists of conventional X-rays of multiple skeletal sites
In 103 patients (48.6%), no lytic bone lesions were detected with either technique, and in 43 patients (20.3%) lesions were detected with both conventional skeletal survey (CSS) and whole-body Computed tomography (CT) (WBCT)
Detection differences of CSS and WBCT for lytic bone lesions based on anatomic location The difference in detection sensitivity for WBCT and CSS was dependent on the location of the lesions in the skeleton
Summary
Conventional skeletal survey (CSS) has been the standard imaging technique for the detection of myeloma bone disease.[1,2] It consists of conventional X-rays of multiple skeletal sites (skull, spine, pelvis, chest, femora and humeri). Several studies have already investigated the use of whole-body CT (WBCT) in patients with monoclonal plasma cell disorders, showing that WBCT is more sensitive for detecting skeletal lesions than plain X-ray films.[6,7,8,9] more modern cross-sectional imaging techniques have been implemented into the updated guidelines of the IMWG for the diagnosis of multiple myeloma (MM).[10] concerns have been raised that due to the higher sensitivity of WBCT, bone changes might be detected earlier but might not yet be clinically relevant. Patients would be classified as having symptomatic myeloma but would not benefit from earlier initiation of treatment
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