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Routinely, CSS has been used as the standard imaging technique for the detection of bone disease in Multiple Myeloma (MM), and involves conventional X-ray of several skeletal sites. Limitations of this method have become apparent, with new techniques such as computed tomography (CT) proving more sensitive and able to provide three-dimensional information of the scanned areas. In addition, protocols using lower doses of radiation and whole body scanning have been developed, and provide enhanced sensitivity. However, it has been argued that such enhanced detection may lead to patients with smoldering multiple myeloma (SMM) being classified as having progressive MM much earlier and treated as such with no added benefit.
In a recent study published in Blood Cancer Journal, a comparison was made between conventional skeletal survey (CSS) and whole body computed tomography (WBCT), in terms of sensitivity levels and whether the identification of additional lesions was of prognostic relevance. The study was carried out by Jens Hillengass from the Department of Hematology and Oncology, University Hospital Heidelberg, Germany, and supported by the International Myeloma Working Group.
Due to the enhanced sensitivity of CT imaging, this is now included in the new IMWG guidelines for the diagnosis of MM. This study reinforces that decision and showed that in 20–25% of patients with negative CSS, WBCT can detect destructive bone lesions. Differences between WBCT and CSS were dependent on the location of the lesions. WBCT was overall more superior, especially in the axial skeleton, although CSS was more effective at identifying lesions in the humeri. To maximise the potential of WBCT for plasma cell disorders, it has been suggested that the patients’ arms should be placed alongside the body so that the scans include both the skull up to the vertex, as well as the entire femora and knees.
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