The benefit of using whole‐body, low‐dose, nonenhanced, multidetector computed tomography for follow‐up and therapy response monitoring in patients with multiple myeloma

Abstract

BACKGROUND. The objectives of this study were to assess the status and clinical course of patients with multiple myeloma based on the direct visualization of changes in medullary, extramedullary, and focal osteolytic myeloma involvement by using whole‐body, low‐dose, multidetector computed tomography (WBLD‐MDCT) and to compare those results with an assessment based on conventional hematologic parameters. METHODS. Between June 2002 and December 2005, WBLD‐MDCT scans were obtained from 131 consecutive multiple myeloma patients with or without therapy, resulting in a total of 439 examinations. The number and size of osteolytic lesions and the number, size, and density of focal or diffuse medullary and extramedullary lesions were analyzed. Those results and the results at follow‐up were related to current laboratory tests for myeloma. Validation was achieved by the combined reading of both hematologic and radiologic parameters at follow‐up. RESULTS. Association between both diagnostic modalities was assessed by using European Group for Blood and Marrow Transplantation response criteria, resulting in an agreement of κ = 0.70. Hematologic parameters proved correct in 84% of all examinations, whereas WBLD‐MDCT resulted in correct assessment in 94% of all examinations. Among 91 of 439 examinations that produced discrepant findings (21%), WBLD‐MDCT proved correct in 68 of 91 examinations (75%), as determined at further follow‐up (95% confidence interval, 66–83%; P = .000003; sign test). The combination of WBLD‐MDCT with conventional, laboratory‐based follow‐up resulted in significantly greater diagnostic accuracy compared with laboratory testing alone. CONCLUSIONS. The results from this study indicated that WBLD‐MDCT represents a reliable, imaging‐based method for the direct monitoring of the course of patients with myeloma under specific therapy, and it showed good concordance with established hematologic parameters. It is noteworthy that, in the current investigation, WBLD‐MDCT proved to be even more reliable than conventional, laboratory‐based follow‐up. Cancer 2007. © 2007 American Cancer Society.

Prognostic significance of bone marrow abnormalities in the appendicular skeleton of patients with multiple myeloma

“…[1][2][3] Recent guidelines from the International Myeloma Working Group (IMWG) 4 and the European Myeloma Network 5 have incorporated the use of low-dose MDCT for evaluating the extent of lytic bone involvement in MM. MDCT also provides information on bone marrow involvement in the appendicular skeleton (AS).…”

“…[6][7][8] However, in myeloma patients, the intramedullary space is often infiltrated by neoplastic plasma cells (PCs), with such medullary infiltrations often improving after successful antimyeloma treatment. 1,2 In addition, medullary abnormalities may be associated with myeloma cell burden, as assessed by laboratory parameters, although little information is available regarding the incidence and prognostic value of such abnormalities in patients with monoclonal gammopathy of undetermined significance and MM. Previously, we reported the prognostic implications of medullary abnormalities of the AS in patients with MM and related diseases.…”

Whole-body low-dose computed tomography in multiple myeloma staging: Superior diagnostic performance in the detection of bone lesions, vertebral compression fractures, rib fractures and extraskeletal findings compared to radiography with similar radiation exposure

“…The superiority of cross-sectional imaging methods including whole body computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET) in detecting osteolytic lesions (resulting in up-or downstaging of disease) in individual patients has previously been established in several studies (6)(7)(8)(9). However, knowledge remains limited concerning quantitative comparison of region-based detection mismatch between conventional radiography (CR) and whole-body low-dose CT (WBLDCT), with similar radiation exposure using hybrid iterative reconstruction technique, inter-observer agreement, as well as the evaluation of skeletal fractures, vertebral compressions and extraskeletal pathology, and the utility of lesion characterization by its attenuation.…”

Appearance of monoclonal plasma cell diseases in whole‐body magnetic resonance imaging and correlation with parameters of disease activity

“…However, myeloma infiltrates inside cancellous bone are difficult to detect as long as stimulation of osteoclast activity has not yet taken place to a major extent and the bone trabeculae are still preserved. [9][10][11] …”