Learning objectives
1. Review the 2019 IMWG imaging recommendations in myeloma staging.
2. Review the evidence supporting the use of dual energy whole body CT (DECT) in myeloma.
3. Describe the technical aspects of image acquisition, optimization and post-processing.
4. Review of cases, highlighting pathological appearances and image interpretation pitfalls.
Background
In the 2019 IMWG consensus guidelines for imaging of monoclonal plasma cell disorders, whole body low dose CT is a recommended imaging test in suspected myeloma, confirmed new smoldering (asymptomatic) myeloma and plasmacytoma (1).
The presence of > 1 osteolytic bone lesion (> 5mm) is considered a myeloma-defining event (1). The International Myeloma Working Group has also issued guidelines regarding whole body CT acquisition and reporting.
Dual energy whole body CT (DECT) has been shown to increase diagnostic sensitivity for myeloma detection when compared with...
Findings and procedure details
The main advantage of dual energy CT is the selectiveextraction of materials with high atomic numbers from the images, made possible by acquiring the scan at two different kilovoltages simultaneously. In myeloma imaging, calcium can be removed from scans to generate a "virtual non-calcium map", which contain the fat/soft tissue partition of the bone marrow alone. This enables more accurate assessment of marrow infiltration.
Colour-coded overlay images allow for ready visualization of potential regions of bone marrow plasma cell infiltration. Density values can also be...
Conclusion
Whole body dual energy CT is an emerging imaging technique for myeloma. It may increase the sensitivity of standard whole body CT imaging however radiologists should be aware of potential image interpretation pitfalls.
Personal information and conflict of interest
O. A. Westerland; London/UK - nothing to disclose A. Amlani; London/UK - nothing to disclose A. I. Pascoal; London/UK - nothing to disclose D. Hodson; London/UK - nothing to disclose U. Haberland; Frimley Camberley/UK - nothing to disclose M. Streetly; London/UK - nothing to disclose V. Goh; London/UK - nothing to disclose I. Dregely; London/UK - nothing to disclose R. Gu; London/UK - nothing to disclose
References
1.Rajkumar, S. V. et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. The Lancet Oncology (2014). doi:10.1016/S1470-2045(14)70442-5
2. Thomas, C. et al. Dual-energy CT: Virtual calcium subtraction for assessment of bone marrow involvement of the spine in multiple myeloma. American Journal of Roentgenology (2015). doi:10.2214/AJR.14.12613
3. Kosmala, A. et al. Dual-energy CT of the bone marrow in multiple myeloma: diagnostic accuracy for quantitative differentiation of infiltration patterns. Eur. Radiol. (2018). doi:10.1007/s00330-018-5537-5
4. Kosmala, A. et al. Multiple Myeloma and Dual-Energy...
