Skeletal survey in advanced multiple myeloma: radiographic versus MR imaging survey

Abstract

Summary.In an attempt to compare the sensitivity of bone radiographs and bone marrow magnetic resonance (MR) imaging for bone lesion detection in patients with stage III multiple myeloma (MM) and to evaluate the possible consequences of the replacement of the conventional radiographic skeletal survey (RSS) by an MR survey of the spinal and pelvic bone marrow in these patients, we obtained MR studies of the thoracic and lumbar spine, pelvis and proximal femurs in addition to the conventional RSS (including radiographs of the skull, entire spine, pelvis, ribs, humerus and femurs) in 80 consecutive patients with newly diagnosed stage III MM according to the Durie and Salmon staging system (based on blood tests and on the RSS). The performance of MR and radiographic studies to detect bone lesions in given anatomic areas and in given patients were compared. The consequences on MM staging following the substitution of the RSS by the MR survey were assessed.MR imaging was superior to radiographs for lesion detection in the spine (76% v 42% of patients) and pelvis (75% v 46% of patients). The RSS was superior to the limited MR imaging survey for the detection of bone involvement in the patient population (87´5% v 79% of patients). If the RSS had been replaced by the MR imaging survey for patient staging, 7/80 patients would have been categorized as stage I and one as stage II MM on the basis of normal MR ®ndings and biological ®ndings consistent with these stages.Substitution of the RSS by a limited spinal and pelvic marrow MR survey would lead to`understaging' of 10% of patients with otherwise stage III MM on the basis of blood tests and the conventional RSS.

Biochemical markers of bone turnover in diagnosis of myeloma bone disease

“…Therefore, early detection of bone involvement is essential for adequate treatment necessary to prevent associated morbidity. Sensitivity of skeletal surveys in detecting spinal and pelvic lesions is low (42 and 46%, respectively) [14]. In this study, the sensitivity of X-rays in detecting bone lesions was found as 50%, and the levels of bone turnover markers of the patients with positive and negative X-rays were similar.…”

Transverse syndrome as the dominant feature of solitary cervical plasmocytoma with dissemination

“…6 Usually, plasmocytomas produce a monoclonal immunoglobulin in blood, urine, or both (M-component), and cause lytic bone lesions. 12 In 3 ± 7% of the cases, plasmocytoma occurs as a single solitary bone tumour. 3,5,6,8,9,13 Among these, 25 ± 60% occur within the spine, most frequently in the thoracic and lumbar vertebra.…”

“…5,8 Staging of plasmocytoma is necessary for optimising therapeutic strategies, and relies on the number of lytic bone lesions, the amount of serum haemoglobin, serum calcium, and monoclonal immunoglobulins. 12 These variables are used because they have been shown to correlate with the tumour mass and survival time. 3 A good prognostic factor of solitary plasmocytomas is the absence of an M-component, found in half of the patients.…”

Minimal residual disease testing after stem cell transplantation for multiple myeloma

“…48 These imaging modalities have also been explored in defining response to treatment and impact on prognosis; however, they have not yet been incorporated into the IMWG consensus response guidelines. [49][50][51] Positron emission tomography-computed tomography FDG-PET/CT is a functional imaging modality that can show focal osteolysis (CT), focal or diffuse areas of abnormal FDG uptake or CT soft tissue masses (intra-or extramedullary). Although FDG-PET/CT has low spatial resolution (6-8 mm), the combined CT component allows for a direct anatomic correlation of focal FDG uptake and provides high-resolution bone images that are superior to X-ray in detecting lytic bone lesions.…”

“…MRI can detect marrow infiltration and epidural extension of myeloma cells, rather than just bony destruction. In a comparison of axial MRI and WBXR, Lecouvet et al 51 found that MRI more frequently detected lytic lesions. However, WBXR was deemed superior, because it demonstrated more appendicular lesions.…”