Normally I would relegate information like this to my MyelomaNews.com site. But this is important–really important.
For me, skeletal surveys–sometimes referred to as bone mapping or bone surveys–are practically a waste of time. When I was originally diagnosed, X rays showed almost nothing–no bone damage. There was a possible fracture at my T-12 vertebra, But that was barely visible, and the first doctor who looked at the films missed it.
Fast forward ahead a week. I finally get a full body MRI at one of those stand-alone imaging centers where you can get a standing MRI without contrast. Just enough to give docs a different perspective.
A different perspective? Even without contrast, the MRI showed lesions oozing out between a half dozen vertebra, inches of missing rib, a two inch hole in my hip, missing–that’s right, missing–sections of five or six vertebrae, along with a number of other damaged spots large enough to measure.
Ever since, I have followed and viewed my bone survey films. Look the same to me? But again, an MRI–this time with contrast–found a new, one inch lesion in that same right hip. A subsequent PET scan revealed seven different “hot spots” where myeloma had most likely become active.
Why are doctors so reluctant to use MRIs, CTs and PET scans? Read this article from MedPage Today. It basically agrees with everything I included in my rant above, except the piece compares CTs to skeletal surveys:
CT Tops X-Ray to Spot Lesions in Myeloma
By Charles Bankhead, Staff Writer, MedPage Today
Published: May 03, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
Whole-body CT detected almost four times as many bone lesions in multiple myeloma patients as did radiographic skeletal surveys, according to a study of patients imaged by both modalities.
Based on whole-body CT scan results, 51 patients had a total of 968 osteolytic lesions, whereas radiographs showed 248. After excluding nine patients who had no lesions by either imaging technique, 39 of the remaining 42 patients had more lesions detected by CT than by radiographs.
Results of whole-body CT would have led to upstaging for a majority of the patients, as reported at the American Roentgen Ray Society meeting in Vancouver.
“Thirteen patients would have been upstaged from stage I to stage II, nine would have been upstaged from stage I to stage III, and nine patients would have been upstaged from stage II to stage III based on additional lesions detected on the low-dose whole-body CT,” Kelechi Princewill, MD, of the University of Maryland in Baltimore, said in a statement.
Traditionally, staging of multiple myeloma has relied on the ability of radiographic skeletal survey to detect lesions. The radiographic technique had good accuracy for identifying lesions in the appendicular skeleton and skull, but may lose its diagnostic accuracy in the evaluation of the axial skeleton, according to Princewill and colleagues.
Whole-body CT has made strides in Europe as a preferred imaging method for myeloma staging and has been shown to be superior to radiographic skeletal survey, Princewill continued.
To compare whole-body CT and radiographic skeletal survey in a U.S. population, investigators retrospectively reviewed records on 300 patients with multiple myeloma and identified those who were imaged by both techniques, between 2004 and 2011.
They identified patients who underwent radiographic skeletal survey and PET/CT scans less than 3 months apart, either as part of initial staging or for surveillance. The group limited the analysis to the low-dose, whole-body CT portion of the PET/CT studies.
The CT protocol evaluated in the study exposed patients to a total radiation dose of 4.1 mSv, compared with 1.8 mSv for the radiographic skeletal survey.
“The average CT dose used in our study was approximately nine times lower than doses used in the acquisition of standard body-CT studies,” Princewill said.
Radiographic skeletal survey included the skull, spine, sternum, clavicle, scapula, pelvis, and proximal long bones. Two radiologists independently assessed images produced by both imaging modalities and recorded all identifiable osteolytic lesions.
The final analysis included 51 patients who had a mean age of 56. The interval between imaging techniques averaged 26 days.
Whole-body CT detected significantly more lesions as compared with radiographic skeletal survey (P<0.001). Nine patients had no lesions by either imaging technique.
Comparing results with the two imaging methods, investigators determined that the initial disease staging by radiographic would have been upgraded after CT in 31 of the 51 patients (61%). Eight of the 31 patients had lesions detected by whole-body CT that were not visible on radiographic skeletal survey.
“Whole-body CT is superior to radiographic skeletal survey for detecting osteolytic lesions of multiple myeloma and is especially useful for detecting lesions in the spine, sternum, ribs, and flat and long bones, as compared with radiographic skeletal survey,” Princewill and colleagues concluded.
So go ahead and smile as you are getting your annual skeletal survey. Then if you feel bone pain or think something’s up (like your M-protein marker!) remember that it’s time for an MRI or CT scan.
Aren’t MRI’s safer? Less radiation? Regardless, either one will show soft tissue damage and lesions too new to be seen on X ray.
Good luck! Feel good and keep smiling! Pat
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