Carrie E Bolton MD, Presenter: Nothing to Disclose

Javier Munoz MD, Abstract Co-Author: Nothing to Disclose

Joseph Gerard Craig MD, Abstract Co-Author: Nothing to Disclose

Nishant De Quadros MD, Abstract Co-Author: Nothing to Disclose

Mishal Mendiratta-Lala MD, Abstract Co-Author: Nothing to Disclose

Vrushali Dabak MD, Abstract Co-Author: Nothing to Disclose

Philip Kuriakose, Abstract Co-Author: Nothing to Disclose

Michael James Flynn PhD, Abstract Co-Author: Nothing to Disclose

Marnix T. van Holsbeeck MD, Abstract Co-Author: Consultant, General Electric Company Consultant, Koninklijke Philips Electronics NV Stockholder, General Electric Company Grant, Reed Elsevier

To determine if digital tomosynthesis provides more accurate staging in multiple myeloma compared with traditional radiographic staging by skeletal bone survey.

Patients with newly diagnosed multiple myeloma or monoclonal gammopathy of uncertain significance (MGUS) were enrolled to obtain both skeletal bone survey (SBS) and digital tomosynthesis (DT) of the pelvis, thoracic and lumbar spine. Imaging studies were performed within 90 days of each other. Informed consent was obtained and the study was performed with IRB approval. 27 patients have been enrolled. A senior radiology resident and staff radiologist reviewed the DT, recording the number of lytic lesions suggestive of multiple myeloma. A different staff radiologist reviewed the SBS and the number of lesions on each modality was compared. The interpreting radiologist was blinded to the result of the other study. Simple statistical analysis of results was performed to determine the percentage of patients in which DT demonstrated additional lesions not detected on SBS and the percentage of patients in which additional lesions resulted in a change in Durie-Salmon staging.

18 male and 9 female patients were studied. The average time period between studies was 5.3 days. DT demonstrated additional lesions not seen by skeletal SBS in 12/27 (44%) of patients. This resulted in change in staging and management for 5/27 (18.5%) of patients. One patient was upstaged from IA to IIIA, one from IB to IIIB, one from MGUS to IIIA, one from smoldering myeloma to IA and one from smoldering myeloma to IIA. The most common locations for new lesions were the scapula, sacrum, vertebral spinous process and laminae, ilium and ischium. All lesions seen on SBS were seen by DT, with the exception of locations not included in the DT (humeri, clavicles, distal femurs). 14/27 (52%) of patients had no lesions on skeletal bone survey or tomography.

Imaging plays an important role in staging multiple myeloma and evaluating for potential pathologic fractures. Digital tomography of the pelvis, thoracic and lumbar spine is an alternative in radiologic staging which has a higher sensitivity for detecting myeloma lesions and results in more accurate staging.

The benefit of DT relative to traditional radiography is increased sensitivity and more accurate staging.

Bolton, C, Munoz, J, Craig, J, De Quadros, N, Mendiratta-Lala, M, Dabak, V, Kuriakose, P, Flynn, M, van Holsbeeck, M, The Role of Digital Tomography vs Skeletal Bone Survey in Staging Newly Diagnosed Multiple Myeloma: Preliminary Data.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11003047.html