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

Hillengaß, Jens; Moulopoulos, Lia A.; Delorme, Stefan; Koutoulidis, Vassilis; Mosebach, Jennifer; Hielscher, Thomas; Drake, Matthew T.; Rajkumar, S. Vincent; Øestergaard, Brian; Abildgaard, Niels; Hinge, Maja; Plesner, Torben; Suehara, Yasuhito; Matsue, Kosei; Withofs, Nadia; Caers, Jo; Waage, Anders; Goldschmidt, Hartmut; Dimopoulos, Meletios Α.; Lentzsch, Suzanne; Durie, Brian G.M.; Terpos, Evangelos

doi:10.1038/bcj.2017.78

Cited by 140 publications

(120 citation statements)

References 27 publications

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“…[1][2][3] Recent guidelines from the International Myeloma Working Group (IMWG) 4 and the European Myeloma Network 5 have incorporated the use of low-dose MDCT for evaluating the extent of lytic bone involvement in MM. MDCT also provides information on bone marrow involvement in the appendicular skeleton (AS).…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of bone marrow abnormalities in the appendicular skeleton of patients with multiple myeloma

Matsue¹,

Kobayashi²,

Matsue

et al. 2018

Blood Advances

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Key Points• Bone marrow abnormalities were detected in the AS of 196 consecutive symptomatic patients with MM.• Medullary abnormalities in the AS were associated with a poor prognosis, independent of other clinical parameters.We aimed to determine the clinical and prognostic significance of medullary abnormalities detected by low-dose whole-body multidetector computed tomography ( 1.12-3.31; P 5 .018) were independent predictors of progression-free survival. Age and focal (HR, 2.51; 95% CI, 1.14-5.56; P 5 .023) and diffuse (HR, 4.12; 95% CI, 1.74-9.77; P 5 .001) patterns were also independent predictors of OS. The addition of marrow pattern to preexisting risk factors was associated with a net reclassification improvement for predicting OS (to 0.37, P 5 .015). Medullary abnormalities in the AS (detected by low-dose whole-body MDCT) are associated with a poor prognosis, independent of other clinical variables.

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Section: Introductionmentioning

confidence: 99%

Prognostic significance of bone marrow abnormalities in the appendicular skeleton of patients with multiple myeloma

Matsue¹,

Kobayashi²,

Matsue

et al. 2018

Blood Advances

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“…Additionally, the examination time is significantly shorter in LDWBCT. 6,7 It has been shown that MRI is superior to CT with regard to marrow infiltration. 11 Nevertheless, LDWBCT is often used for the primary assessment of patients with MM because of its superior feasibility.…”

Section: Discussionmentioning

confidence: 99%

“…For our study, we graded the β₂-microglobulin levels into three stages as described in the Materials and Methods section. For the evaluation of the CT scans, we staged the patients according to the Durie and Salmon PLUS staging system depending on the number of lesions into stage I (<5), stage II (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and stage III (>20) ( Figure 4A,B).…”

Section: Discussionmentioning

confidence: 99%

Tumor load in patients with multiple myeloma: β₂‐microglobulin levels versus low‐dose whole‐body CT

Pfahler

D’Anastasi

Dürr

et al. 2020

European J of Haematology

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Multiple myeloma (MM) or plasma cell myeloma (PCM) is a cytogenetically heterogeneous proliferative disorder of clonal plasma cells.The abbreviation "CRAB" denotes the most typical clinical manifestations of MM: hypercalcemia, renal failure, anemia, and lytic bone lesions. 1The detection of lytic bone lesions distinguishes asymptomatic from symptomatic MM, that requires treatment, even in the absence of clinical symptoms. [2][3][4] Although the radiographic skeletal survey was the standard imaging tool for detecting lytic bone lesions in MM patients for many years, low-dose whole-body CT (LDWBCT) imaging replaced the skeletal survey due to its higher sensitivity and quick and comfortable examination time in most centers. 3,5-7 Due to high-intrinsic bone contrast, the tube current can be significantly lowered (ie, 50-100 mA, depending on the weight of the patient), resulting in a low effective equivalent dose. 8Whole-body MRI (WBMRI) has been shown to have a higher specificity and sensitivity in lesion detection than the radiographic skeletal survey 9,10 and a higher sensitivity than MDCT. 11,12 However, WBMRI has its limitations due to a long acquisition time and availability. 13 MRI shows bone marrow involvement but is not able to detect osteolyses. CT shows osseous lesions as well as bone fractures and allows fracture risk assessment. 14 For these reasons, low-dose whole-body CT has become the most commonly performed imaging modality for MM across many centers. AbstractObjective: Beta-2-microglobulin is a serum marker of tumor burden in multiple myeloma (MM). Our aim was to correlate serum β₂-microglobulin levels in patients with MM to tumor burden determined by low-dose whole-body CT (LDWBCT). Materials and Methods:A total of 52 patients with newly diagnosed, untreated MM who underwent LDWBCT were included. LDWBCT scans were assessed by two musculoskeletal radiologists in consensus for focal lesions. The Durie and Salmon PLUS staging system was used for staging patients in stages I-III. β₂-microglobulin was also subdivided into stages I-III on the basis of the multiple myeloma International Staging System (ISS). Results: Using the Durie and Salmon PLUS staging system criteria for image evaluation, we were able to identify stage I MM in 17 patients, stage II MM in nine patients, and stage III MM in 26 patients. Eight of nine patients with stage II MM and 16 of 26 patients with stage III MM had normal β₂-microglobulin levels. Thus, 24 of 35 patients (68.6%) had 5 or more focal lesions and false-negative β₂-microglobulin levels. Conclusion: Serum β₂-microglobulin levels alone may not indicate the full extent of tumor burden in a significant subset of myeloma patients. K E Y W O R D S multiple myeloma, plasma cell neoplasms How to cite this article: Pfahler V, D'Anastasi M, Dürr H-R, Schinner R, Ricke J, Baur-Melnyk A. Tumor load in patients with multiple myeloma: β₂-microglobulin levels versus lowdose whole-body CT. Eur J Haematol. 2020;104:383-389.

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“…WBLDCT has been shown to have superior sensitivity than SS. [13][14][15] In a study comparing SS to WBLDCT the detection rates and diagnostic confidence were significantly higher with CT and CT led to a change in management in 18.2% of cases. 13 Table 1.…”

Section: Whole Body Low Dose Ctmentioning

confidence: 99%

“…In another study, WBLDCT led to change in staging in 61% (18 out of 38 cases) compared to skeletal survey. 14 In a further study comparing SS to WBLDCT in 212 smouldering myeloma/ myeloma patients, 25.5% of cases with negative SS had lytic lesions on CT. 15 In the cohort with smouldering myeloma the WBLDCT would have changed management in 20% cases. However, it was noted that SS can be complimentary in detecting humeral lesions in cases where the arms were at the edge of the field of view.…”

Section: The Imwg Updated Criteria For the Diagnosis Of Multiple Myelmentioning

confidence: 99%

Imaging in myeloma with focus on advanced imaging techniques

Barwick

Bretsztajn

Wallitt

et al. 2019

The British Journal of Radiology

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In recent years, there have been major advances in the imaging of myeloma with whole body MRI incorporating diffusion-weighted imaging, emerging as the most sensitive modality. Imaging is now a key component in the work-up of patients with a suspected diagnosis of myeloma. The International Myeloma Working Group now specifies that more than one focal lesion on MRI or lytic lesion on whole body low-dose CT or fludeoxyglucose (FDG) PET/CT fulfil the criteria for bone damage requiring therapy. The recent National Institute for Health and Care Excellence myeloma guidelines recommend imaging in all patients with suspected myeloma. In addition, there is emerging data supporting the use of functional imaging techniques (WB-DW MRI and FDG PET/CT) to predict outcome and evaluate response to therapy. This review summarises the imaging modalities used in myeloma, the latest guidelines relevant to imaging and future directions. 2 of 13 birpublications.org/bjr Br J Radiol;92:20180768 BJR Barwick et al 3 of 13 birpublications.org/bjr Br J Radiol;92:20180768 BJR Review article: Advanced imaging in myeloma

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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

Cited by 140 publications

References 27 publications

Prognostic significance of bone marrow abnormalities in the appendicular skeleton of patients with multiple myeloma

Prognostic significance of bone marrow abnormalities in the appendicular skeleton of patients with multiple myeloma

Tumor load in patients with multiple myeloma: β₂‐microglobulin levels versus low‐dose whole‐body CT

Imaging in myeloma with focus on advanced imaging techniques

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