Table II.
Comparison of imaging modalities in multiple myeloma.
| Modality (radiation exposure) | Radiologic detection of
|
Advantages | Disadvantages | ||
|---|---|---|---|---|---|
| Osteolytic lesions | Bone marrow focal lesions | Extramedullary disease | |||
| Skeletal survey (2.1 mSv) | Y | N | N | Widely available Historical standard Low cost |
Needs frequent patient repositioning Poor sensitivity, poor quantitation Poor inter-observer reliability Limited areas of visualization |
| MDCT (25–30 mSv), LDCT (5 mSv) | Y | N | N | Whole body imaging in one test Detects more lytic lesions Provides detailed information on bony involvement in multiple myeloma in anatomically complex regions Widely available Faster scan than standard skeletal survey Provides 3D reconstruction images |
High radiation dose exposure in MDCT Low sensitivity in detecting bone marrow involvement or osteopenia |
| WB-MRI (0 mSv) | Y | Y | Y | Sensitive to bone marrow focal lesions No radiation exposure |
Higher cost Prolonged acquisition time Problematic in patients with metallic objects in their body May not be widely available Inferior to MDCT in the detection of bone lesions |
| 18F-FDG PET/CT (14–16 mSv) | Y | Y | Y | Detects extramedullary disease Detects focal bone marrow lesions Whole body imaging in one test Able to distinguish benign vs. malignant findings |
Tracer not always available High cost Limited detection of sub-centimeter lesions Detects areas of inflammation and infection |
| 18F-NaF PET/CT (14–16 mSv) | Y | Y | Y | Preferentially concentrates at malignant sites Sensitive to osteoblastic and osteolytic activity |
Tracer not widely available Limited studies available |
| 99mTc-sestamibi (6.2 mSv) | N | Y | N | Able to detect focal bone marrow lesions | Limited sensitivity Underestimates degree of BM infiltration in low stage disease |
| 11C-methionine PET/CT (14 to 16 mSV) | Y | Y | Y | Detects extramedullary disease Detects focal bone marrow lesions Whole body imaging in one test Able to detect osteolytic lesions |
Tracer not widely available Limited studies |
MDCT, multidetector computed tomography; LDCT, low dose CT; WB-MRI, whole body magnetic resonance imaging; 18F-FDG PET/CT, fluorine-18 fluorodeoxyglucose positron emission tomography CT; 18F-NaF PET/CT, fluorine-18 sodium fluoride PET/CT; BM, bone marrow.