Accuracy of whole-body low-dose multidetector CT (WBLDCT) versus skeletal survey in the detection of myelomatous lesions,and correlation of disease distribution with whole-body MRI (WBMRI) |
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Authors: | T G Gleeson J Moriarty C P Shortt J P Gleeson P Fitzpatrick B Byrne J McHugh M O’Connell P O’Gorman S J Eustace |
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Institution: | T. G. Gleeson, J. Moriarty, C. P. Shortt, J. P. Gleeson, P. Fitzpatrick, B. Byrne, J. McHugh, M. O’Connell, P. O’Gorman and S. J. Eustace |
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Abstract: | Aim The aim of the study is to assess the feasibility of whole-body low-dose computed tomography (WBLDCT) in the diagnosis and
staging of multiple myeloma and compare to skeletal survey (SS), using bone marrow biopsy and whole-body magnetic resonance
imaging (WBMRI; where available) as gold standard.
Materials and methods Patients referred over an 18-month period for investigation of suspected multiple myeloma or restaging of myeloma were randomized
to undergo one of two WBLDCT protocols using high kVp, low mAs technique (140 kVp, 14 mAs; or 140 kVp, 25 mAs). Recent WBMRI
scans were reviewed in 23 cases. Each imaging modality was assessed by two radiologists in consensus and scored from 0–3 (0 = normal,
1 = 1–4 lesions, 2 = 5–20 lesions, 3 ≥ 20 lesions/diffuse disease) in ten anatomical areas. Overall stage of disease, image
quality score, and the degree of confidence of diagnosis were recorded. Diagnostic accuracy of skeletal survey and WBLDCT
were determined using a gold standard of bone marrow biopsy and distribution of disease was compared to WBMRI.
Results Thirty-nine patients were evaluated. WBLDCT identified more osteolytic lesions than skeletal survey with a greater degree
of diagnostic confidence and led to restaging in 18 instances (16 upstaged, two downstaged). In those with recent WBMRI, distribution
of disease on WBLDCT showed superior correlation with WBMRI when compared with SS. Overall reader impression of stage on WBLDCT
showed significant correlation with WBMRI (κ = 0.454, p < 0.05). WBLDCT provided complementary information to WBMRI in nine patients with normal marrow signal following treatment
response, but which were shown to have diffuse residual cortical abnormalities on CT.
Conclusion WBLDCT at effective doses lower than previously reported, is superior to SS at detecting osteolytic lesions and at determining
overall stage of multiple myeloma, and provides complementary information to WBMRI. |
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Keywords: | Multiple myeloma Whole-body imaging Radiographs Computed tomography MRI Radiation dosage |
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