RATIONALE AND OBJECTIVES: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: WBLD-CT reliably excludes findings compatible with myeloma in MGUS and thereby complements hematologic laboratory analysis.
RATIONALE AND OBJECTIVES: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: WBLD-CT reliably excludes findings compatible with myeloma in MGUS and thereby complements hematologic laboratory analysis.
Authors: Manisha Bhutani; Baris Turkbey; Esther Tan; Neha Korde; Mary Kwok; Elisabet E Manasanch; Nishant Tageja; Sham Mailankody; Mark Roschewski; Marcia Mulquin; Ashley Carpenter; Elizabeth Lamping; Alex R Minter; Brendan M Weiss; Esther Mena; Liza Lindenberg; Katherine R Calvo; Irina Maric; Saad Z Usmani; Peter L Choyke; Karen Kurdziel; Ola Landgren Journal: Leuk Lymphoma Date: 2016-04-07
Authors: M Zacchino; P A Bonaffini; A Corso; V Minetti; A Nasatti; C Tinelli; R Dore; F Calliada; S Sironi Journal: Eur Radiol Date: 2015-05-20 Impact factor: 5.315
Authors: A H Vija; P A Bartenstein; J W Froelich; T Kuwert; H Macapinlac; C P Daignault; N Gowda; O Hadjiev; J Hephzibah; P Huang; H Ilhan; A Jessop; M Cachovan; J Ma; X Ding; D Spence; G Platsch; Z Szabo Journal: Eur J Hybrid Imaging Date: 2019-06-28
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