Role of whole-body low-dose multidetector row-CT in the diagnosis and follow up of multiple myeloma: an alternative to conventional radiography

Abstract

Multiple myeloma (MM) is an incurable plasma cell malignancy of the bone marrow. MM has 3 components: diffuse marrow infiltration, focal bone lesions, and soft-tissue (extramedullary) disease. Durie and Salmon (Durie and salmon, 1975) showed that lytic bone lesions, hemoglobin, serum calcium and the monoclonal component blood levels significantly correlate with tumor mass and patient eventual survival. Conventional Radiography (CR) still represents the “gold standard” of the staging procedure of newly diagnosed and relapsed MM patients. However, the sensitivity is not sufficient to detect early osteolytic lesions (CR shows osteolytic bone lesions only when the cortical bone damage is more than 30% - 50%). Underestimation of bone lesions by conventional radiography could lead to misclassification of multiple myeloma patients. Particularly, in patients with reduced bone density, depiction of bone involvement in anatomically complex regions like the axial skeleton, thoracic cage, and pelvis can be difficult, delivering in many cases inaccurate diagnosis. Therefore, intensive search for alternatives to the conventional X-ray survey in staging multiple myeloma has been done in the last two decades. The superiority of CT over conventional X-ray diagnosis in imaging skeletal lesions is a methodical one and must not be questioned. The major limitation of MDCT is the radiation dose delivered to patients, in comparison with conventional radiographs. An alternative imaging approach in multiple myeloma patients could represent a low-dose whole-body CT-survey. The purpose of this study was to investigate the ability of whole-body low-dose multidetector row-CT (MDCT) investigation protocol