Question: What is the efficacy of a bone scan in the diagnosis of multiple myeloma?

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Unique Identifier: 87285938

Authors: Ludwig H. Fruhwald F. Tscholakoff D. Rasoul S. Neuhold A. Fritz E.

Institution: Division of Hematology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.

Title: Magnetic resonance imaging of the spine in multiple myeloma.

Source: Lancet. 2(8555):364-6, 1987 Aug 15.

Abstract: The lower thoracic and lumbar spine of patients with multiple myeloma was examined by magnetic resonance imaging (MRI), plain radiography, and bone scintigraphy. Three independent investigators evaluated the power of these diagnostic methods to detect bone lesions in 192 vertebrae from 18 patients and in 60 vertebrae from 7 controls. 41 foci with abnormal signal intensity were detected by MRI; X-ray films showed osteolytic lesions in 4 vertebral bodies; and bone scanning was positive in 2 cases. The superiority of MRI in detecting myeloma-associated focal bone lesions was statistically significant, and in one case the lesions were confirmed at necropsy. Deviations in shape and height of vertebral bodies were slightly more easily visible on radiographs. Early detection of imminent medullary compressions in 2 patients led to successful radiotherapy before symptoms appeared.

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Unique Identifier: 82161590

Authors: Ludwig H. Kumpan W. Sinzinger H.

Institution: Arthritis Center, Thorndike Memorial Laboratories, Boston City Hospital, Massachusetts, USA.

Title: Radiography and bone scintigraphy in multiple myeloma: a comparative analysis.

Source: British Journal of Radiology. 55(651):173-81, 1982 Mar.

Abstract: The sensitivity of radionuclide imaging for detecting skeletal lesions was compared with that of radiography by evaluating 573 different anatomical sites in 41 patients with multiple myeloma. Radiography revealed a significantly greater number of myeloma-related bone lesions than did radionuclide imaging. Of the 179 myeloma-related bone lesions detected when both techniques were applied, 163 were seen by radiography and 82 by radionuclide imaging. Ninety-seven lesions were detected by radiography alone and 16 lesions seen by scintiscanning only, yielding a sensitivity of 91% for the former and of 46% for the latter technique. Radionuclide imaging proved superior to radiography only occasionally in the rib cage, and rarely in other anatomical sites. These findings suggest that radiography is the method of first choice in obtaining a skeletal survey in patients with multiple myeloma. In cases with continued pain, unexplained by standard radiography, the skeletal survey should be supplemented by tomography and radionuclide imaging.

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