Can Whole-body Low-dose Multidetector CT Exclude the Presence of Myeloma Bone Disease in Patients with Monoclonal Gammopathy of Undetermined Significance (MGUS)?
ABSTRACT To determine the benefit of using whole-body low-dose computed tomography (WBLD-CT) in patients with monoclonal gammopathy of undetermined significance (MGUS) for exclusion of multiple myeloma (MM) bone disease.
Seventy-one consecutive patients with confirmed MGUS (as defined by the latest criteria of the International Myeloma Working Group) who underwent WBLD-CT for diagnosis were identified retrospectively by a search of our institution's electronic medical record database (2002-2009). Patients were classified as low-risk or intermediate/high-risk and followed over a ≥2-year period with additional CT imaging and/or laboratory parameters. Presence of osteolysis, medullary, or extramedullary abnormalities compatible with involvement by MM was recorded. A diffuse or focal increase in medullary density to Hounsfield unit (HU) values >20 HU/>0 HU was considered suspicious for bone marrow infiltration if no other causes identifiable.
The presence of osteolysis was excluded in all 71 patients with MGUS at initial diagnosis and patients were surveilled for ≥2 years. Lytic changes were observed at follow-up in 1/71 patients that progressed to MM and were detectable via WBLD-CT at an early stage (even before a significant rise in M-protein was recorded). In 3/71 patients with MGUS (4%) suspicious bone marrow attenuation values were measured, disclosing disease progression to smoldering myeloma in another patient and false-positive results in 2/71 patients. Bone marrow attenuation assessment resulted in a specificity and negative predictive value of 97%, respectively. No significant difference with respect to bone marrow attenuation was observed in patients with low-risk MGUS versus intermediate- to high-risk MGUS. One of 71 patients showed serologic disease progression to active MM without bone abnormalities detectable.
WBLD-CT reliably excludes findings compatible with myeloma in MGUS and thereby complements hematologic laboratory analysis.
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ABSTRACT: To determine the different computed tomography (CT) findings of lymphedema, cellulitis, and generalized edema in the lower leg. CT images of 44 patients with confirmed lymphedema (n = 19), cellulitis (n = 11), or generalized edema (n = 14) were retrospectively reviewed. The following characteristics were evaluated: extent of edema, laterality, skin thickening, honeycombing, taller than wide appearance, muscle edema, conglomeration of septum of fat lobule, fluid collection, fascial enhancement, inguinal lymph node (LN) enlargement, medullary fat obliteration of inguinal LN, trunk subcutaneous edema, and bone marrow edema. Fisher's exact test with Bonferroni correction was used for multiple comparisons. Honeycombing and taller than wide appearance of fat lobules were more common in lymphedema (P < 0.01). Fat obliteration of inguinal LN and inguinal LN enlargement at the affected side were more common in cellulitis (P < 0.01). Bone marrow and subcutaneous edema of the trunk were more common in generalized edema (P < 0.01). Honeycombing is commonly seen in lymphedema, but is not a specific finding. Inguinal LN enlargement is a specific sign of cellulitis. Truncal edema and bone marrow edema were specific findings of generalized edema.The international journal of cardiovascular imaging 11/2013; 29(S2). DOI:10.1007/s10554-013-0332-5 · 2.15 Impact Factor
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ABSTRACT: Objective: The purpose of this study was to identify the frequency and grading of non osseous incidental findings (NOIF) in non contrast whole body low dose CT (LDCT) in patients with multiple myeloma. Methods: In the time period from 2010 to 2013, 93 patients with multiple myeloma were staged by non contrast whole body LDCT at our radiological department. LDCT images were analyzed retrospectively for NOIF, which also included unsuspected extramedullary manifestation of multiple myeloma. All NOIF were classified as major or clinically significant, moderate or possibly clinically significant, and minor or not clinically significant. Medical records were analyzed regarding further investigation and follow-up of the identified NOIF. Results: In the 93 patients, 295 NOIF were identified (on average 3.2 NOIF per patient). Most of the NOIF (52.4%) were not clinically significant, 25.8% of the NOIF were possibly clinically significant, and 21.8% of the NOIF were clinically significant. Clinically significant NOIF were investigated further by CT after intravenous administration of contrast medium and/or by ultrasound or magnetic resonance imaging. In 34 of these cases, extramedullary relapse of myeloma, occult carcinoma or infectious/septic incidental findings were diagnosed (11.5% of all NOIF). In the remaining 10.3% of the NOIF classified as clinically significant, various benign lesions were diagnosed. Conclusion: LDCT detected various non osseous lesions in patients with multiple myeloma. 36.6% of the patients had clinically significant NOIF. These findings underline the importance to check LDCT examinations in patients with multiple myeloma carefully for the presence of NOIF.British Journal of Radiology 07/2014; 87(1041):20140185. DOI:10.1259/bjr.20140185 · 1.53 Impact Factor
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ABSTRACT: To assess the role of whole-body low-dose computed tomography (WBLDCT) in the diagnosis and staging of patients with suspicion of multiple myeloma (MM). A total of 138 patients (76 male and 62 female; mean age 63.5 years, range 50-81 years), with early MM, underwent WBLDCT protocol study, performed on 16-slice scanner (Brilliance, Philips Medical System, Eindhoven, The Netherlands): tube voltage 120kV; tube current time product 40mAs. Diagnosis of osteolytic lesions was performed on the basis of axial and multiplanar reformatted images, whereas the assessment of spinal misalignment and fracture was done by using multiplanar reformatted images. The overall dose delivered to each patient was 4.2mSv. Every patient gave personal informed consent, as required by our institution guidelines. The diagnosis was established either by histopathology or imaging follow-up (size increase of over a period time). In all 138 patients, image resolution was diagnostic, enabling correct classification of multiple myeloma patients. WBLDCT showed a total of 328 pathologic bone findings in 81/138 patients. CT scanning resulted in complete evaluation of the bone lesions in these areas of the skeleton: skull (42), humerus (15), femur (20), ribs (7), scapulae (13), pelvis (35), clavicle (13), sternum (10), cervical (39), dorsal (65), lombar (48) and sacral rachis (21). In 40/81 bone involvement detected by CT was the only CRAB criterion present. Furthermore, WBLDCT demonstrated pleuro-pulmonary lesions in 20 patients (11 infective, 9 as MM localizations) and 1 renal neoplasia. WBLDCT, detecting bone marrow localizations and demonstrating extra-osseous findings, with a fast scanning time and high resolution images, is a reliable imaging-based tool for a proper management of MM patients.European journal of radiology 09/2013; 82(12). DOI:10.1016/j.ejrad.2013.08.036 · 2.65 Impact Factor