Comparison of the Sensitivity of ^99mTc-Methyl Diphosphonate Bone Scan with the Skeletal X-Ray Survey in Multiple Myeloma

Abstract

In the diagnosis of multiple myeloma (MM), the radiological skeletal survey (RSS) was proven to be most useful for the detection of bone lesions. Since 1961, a new technique radioisotopic bone scan (RIBS), for the detection of such lesions, using ⁸⁵Sr and ^99mTc, has been shown to be highly sensitive for the detection of skeletal metastases of epithelial tumors. We have studied 30 patients with plasma cell dyscrasia (PCD) by both methods and concluded that RSS is clearly superior to RIBS in PCD. As RIBS detected less than 50% of the lesions demonstrated by RSS there seems to be no indication for a routine RIBS in the initial work-up of patients suspected to have PCD. However, due to the fact that RIBS is useful for the detection of new bone formation it has a certain value in the localization of pathological fractures in MM, mainly in vertebral compression.

Radiography and bone scintigraphy in bone marrow transplant multiple myeloma patients

“…Our finding that old vertebral lesions were seen better on conventional radiographies and fresh on bone scintigraphies is in accordance with the conclusion of others (9,14). However, our results differ from those who found bone scintigraphy to be equal to conventional radiography (10) or better (12).…”

“…The discrimination between fresh and old lesions has been discussed (4, 12,14). Bone scintigraphy is generally recommended for patients with skeletal pain (8, 11,12,13) and in particular for patients with pain in the ribs (4, 8,[10][11][12]16).…”

“…Lytic regions such as in MM lesions, with no osteoblastic activity, are both "cold" on scintigraphy and more difficult to detect than "hot" lesions. Conventional radiography is superior to bone scintigraphy since the characteristic punChed-out MM lesions can be seen on radiography, while scintigraphy is non-specific (14). On conventional radiography it is the difference in attenuation (due to calcification and decalcification) as well as irregularity in the trabecular pattern, which alerts the radiologist to the underlying pathology.…”

“…Bone scintigraphy of MM patients has been compared to conventional radiography by several investigators, who conclude that radiography is the better method. Their evaluation of the value of bone scintigraphy varies from very low to roughly equal to conventional radiography (3, 4, [8][9][10][11][12][13][14][15][16]. Studies comparing bone scintigraphy to conventional radiography in bone marrow transplant MM (TXMM) patients have to our knowledge not been published earlier.…”

Guidelines for the use of imaging in the management of myeloma

“…Bone scintigraphy is a radionuclide technique, using a technetium 99‐phosphorus compound, which is incorporated into bone areas of increased mineralisation. Owing to the excessive bone resorption/lack of osteoblastic activity that characterises the lytic lesions of myeloma, bone scintigraphy has lower sensitivity than conventional radiographs in the detection of osteolytic lesions in myeloma (Bataille et al , 1982; Ludwig et al , 1982; Nilsson‐Ehle et al , 1982; Tamir et al , 1983). However, bone scintigraphy may be helpful in evaluating areas of the skeleton that are not well demonstrated on plain radiography, such as the ribs and sternum (Ludwig et al , 1982; Nilsson‐Ehle et al , 1982; Otsuka et al , 1993).…”