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Blood Cancer J. 2017 Aug 25;7(8):e599. doi: 10.1038/bcj.2017.78.

Whole-body computed tomography versus conventional skeletal survey in patients with multiple myeloma: a study of the International Myeloma Working Group.

Author information

1
Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany.
2
Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
3
First Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Areteion Hospital, Athens, Greece.
4
Department for Biostatistics, German Cancer Research Center, Heidelberg, Germany.
5
Division of Endocrinology, Mayo Clinic, Rochester, MN, USA.
6
Division of Hematology, Mayo Clinic, Rochester, MN, USA.
7
Department of Hematology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
8
Department of Hematology, Vejle Hospital and University of Southern Denmark, Vejle, Denmark.
9
Division of Hematology and Oncology, Department of Medicine Kameda Medical Center, Kamogawa-shi, Japan.
10
Department of Nuclear Medicine, CHU de Liège, Belgium.
11
Department of Hematology, CHU de Liège, Belgium.
12
Department of Hematology, St Olavs Hospital, Norwegian University of Science and Technology, Trondheim, Norway.
13
Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra General Hospital, Athens, Greece.
14
Department of Medicine, Division of Hematology/Oncology, Columbia University Medical Center, New York City, NY, USA.
15
Cedars-Sinai Samuel Oschin Cancer Center, Los Angeles, CA, USA.

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.

PMID:
28841211
PMCID:
PMC5596388
DOI:
10.1038/bcj.2017.78
[Indexed for MEDLINE]
Free PMC Article

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