Low-Dose Whole-Body CT Finds More Lesions in Multiple Myeloma Patients

The modality bests the U.S. standard of care, radiographic skeletal survey, in assessing the extent of the disease.

Low-dose whole-body CT is significantly better than radiographic skeletal survey in detecting lesions in patients with multiple myeloma, said researchers from the University of Baltimore in Maryland. Their study findings were reported this week at the American Roentgen Ray Society Annual Meeting in Vancouver, Canada.

The U.S. standard is to use radiographic skeletal survey to assess the extent of disease in patients with multiple myeloma. However, in Europe, low-dose whole-body CT is accepted as an accurate alternative to radiographic skeletal survey.

For this study, the researchers examined the results of 51 patients with the disease who had both low-dose whole-body CT examinations and radiographic skeletal surveys. CT discovered 968 lesions compared with 248 detected by the radiographic skeletal survey. CT was significantly better in detecting lesions in the spine, ribs, sternum, and flat bones, said Kelechi Princewill, MD, the study’s lead author.

These findings are important because patient treatment depends on staging, researchers said.

“The study found that in 31 patients, the stage of disease would have been different with low-dose whole-body CT. Thirteen patients would have been upstaged from stage I to stage III and nine patients would have been upstaged from stage II to III, based on additional lesions detected on the low dose whole body CT,” said Princewill.

There may be concern among radiologists in the United States regarding radiation doses while using low-dose whole-body CT, Princewill said.

“Our study employed a low-dose protocol, with an average recorded CT dose of 4.1 mSv,” he noted. “That compares to 1.8 mSv for the radiographic skeletal survey. Using modified protocols and exposure parameters, we were able to significantly reduce the radiation doses to our patients without significantly compromising the image quality required to detect myeloma lesions. The average CT dose in our study was approximately nine times lower than doses used in the acquisition of standard body CT scans.”

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