Type:
Educational Exhibit
Keywords:
Not applicable, Multidisciplinary cancer care, Cancer, Staging, CT, Oncology, Haematologic, Oncologic Imaging
Authors:
R. Gu1, A. Amlani1, A. Pascoal1, D. Hodson1, U. Haberland2, I. dregely1, M. Streetly1, O. A. Westerland1, V. Goh1; 1London/UK, 2Frimley Camberley/UK
DOI:
10.26044/ecr2020/C-03964
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 standard whole body CT and also increases diagnostic confidence, although there is a relative paucity of evidence.
A PubMed search revealed 4 original scientific papers regarding DECT in myeloma. A prospective study by Thomas et al. (2) of 32 patients compared CT, DECT, and WB-MRI in MGUS and myeloma patients. DECT demonstrated improved sensitivity for diffuse disease detection compared with standard CT, particularly in higher disease burden. Specificity may be reduced, however.
Kosmala et al. (3, 4) also found increased sensitivity of DECT compared to standard CT (91% vs 70%) and derived cut-off density values to differentiate between infiltrated and non-infiltrated bone marrow.