| Skeletal survey |
Standard plain radiograph series |
|
Low sensitivity and detection rate Only detects advanced bone disease Cannot assess marrow Long image acquisition time Patient discomfort from multiple repositioning
|
| WB- Low dose CT |
Protocols should be optimised locally but typical parameters are:
120 kV
<100 mAs dose modulation and iterative reconstruction
Vertex to knees |
Widely available Relatively inexpensive compared to MRI/PET Mores sensitive than SS Quick to perform/ patient comfort Good cortical detail for orthopaedic planning
|
Less sensitive than MRI (cannot assess for diffuse/early marrow disease) Cannot differentiate between active vs treated disease Higher radiation dose than SS (but offset by diagnostic gain)
|
| WB- MRI |
Typical protocol:
Sagittal T
1 and T
2 spine.
Axial DIXONS
Axial Diffusion (b 50 & b900)
Post processing-ADC map, knitting of axial sequences (automated by some vendors), inverted b 900 MIP
Total body – vertex to toes |
DWI more sensitive than conventional MRI sequences DWI allows differentiation between active vs treated disease Detection of cord/ neural compromise and soft tissue disease Lesion number prognostic No radiation exposure
|
Limited MR availability/ capacity Time (scanner/ reporting) Challenging for claustrophobic patients Some patients MR incompatible
|
| FDG PET/CT |
Standard preparation.
Total body vertex to toes arms down
CT parameters - bone reconstructions as well as soft tissue |
|
Radiation dose Less sensitive than DW-MRI Low avidity of some myeloma and some negative Limited spatial resolution Steroid therapy in cases of spinal cord compromise, prior to PET reduces sensitivity Limited evaluation of diffuse marrow involvement
|
