Whole-body computed tomography versus conventional skeletal survey in patients with multiple myeloma: a study of the International Myeloma Working Group - Report - MDSpire
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Whole-body computed tomography versus conventional skeletal survey in patients with multiple myeloma: a study of the International Myeloma Working Group
Comparison of Whole-Body CT and Skeletal Surveys in Multiple Myeloma
Overview
This international multicenter study compared whole-body CT (WBCT) and conventional skeletal surveys (CSS) in 212 multiple myeloma patients, demonstrating that WBCT detects significantly more lytic bone lesions than CSS. Importantly, additional lesions identified by WBCT were shown to have prognostic relevance for disease progression.
Background
Conventional skeletal surveys have been the standard imaging modality for detecting myeloma bone disease but have limited sensitivity, only detecting lesions after substantial bone destruction. Whole-body CT offers three-dimensional imaging with higher sensitivity and lower radiation doses optimized for skeletal imaging. Despite its increased sensitivity, concerns exist that WBCT may detect clinically irrelevant lesions, potentially leading to overtreatment. This study aimed to compare the sensitivity of WBCT versus CSS and assess the prognostic significance of lesions detected by WBCT.
Data Highlights
Imaging Result
Number of Patients (n=212)
Percentage
No lytic lesions detected by either technique
103
48.6%
Lesions detected by both CSS and WBCT
43
20.3%
Lesions detected by CSS only
12
5.7%
Lesions detected by WBCT only
54
25.5%
Key Findings
WBCT detected lytic bone lesions in 25.5% of patients who had no lesions on CSS, with an odds ratio of 4.50 (95% CI 2.38–9.24; P<0.0001).
In 5.7% of patients, lesions were detected by CSS but not by WBCT.
WBCT provides higher sensitivity across multiple skeletal sites compared to CSS.
Lesions detected exclusively by WBCT were associated with prognostic relevance for time to progression in untreated patients.
The median age of patients was 66.1 years, with imaging performed within a median interval of 1 day between WBCT and CSS.
Clinical Implications
WBCT should be considered the preferred imaging modality for detecting myeloma bone disease due to its superior sensitivity and prognostic value. Earlier detection of lesions by WBCT can improve disease staging and guide timely treatment decisions. Clinicians should be aware that WBCT may identify lesions not visible on CSS, which are clinically relevant and not merely incidental findings.
Conclusion
Whole-body CT significantly outperforms conventional skeletal surveys in detecting lytic lesions in multiple myeloma patients, with additional lesions identified by WBCT carrying important prognostic implications. These findings support the integration of WBCT into routine diagnostic and staging protocols for multiple myeloma.
References
International Myeloma Working Group Study -- Comparison of Whole-Body CT and Traditional Skeletal Surveys in Multiple Myeloma
by J Hillengass, L A Moulopoulos, S Delorme, V Koutoulidis, J Mosebach, T Hielscher, M Drake, S V Rajkumar, B Oestergaard, N Abildgaard, M Hinge, T Plesner, Y Suehara, K Matsue, N Withofs, J Caers, A Waage, H Goldschmidt, M A Dimopoulos, S Lentzsch, B Durie, E Terpos
