Monday, April 16, 2012

Radiographic Skeletal Survey and Low-Dose Whole Body CT for Multiple Myeloma

Anyone who's plugged through a radiographic skeletal survey can appreciate the subjectivity that often goes into interpreting these radiographs. Whole-body MRI is very sensitive and has been shown to demonstrate many more lesions than radiography; however, it an expensive and time consuming procedure. Low-dose whole body CT has been proposed as an alternative, with doses in the range of skeletal surveys, but with the advantage of less discomfort for the patients and quicker scan times. Using bone marrow biopsy and whole-body magnetic resonance imaging as gold standards, Gleeson et al. arrived at the following performance statistics for radiographic skeletal surveys and low-dose whole body CT.
  Skeletal Survey CT
Sensitivity 100% 100%
Specificity 29% 56%
PPV 65% 88%
NPV 100% 100%
Accuracy 69% 90%


Gleeson TG, Moriarty J, Shortt CP, Gleeson JP, Fitzpatrick P, Byrne B, McHugh J, O'Connell M, O'Gorman P, Eustace SJ. Accuracy of whole-body low-dose multidetector CT (WBLDCT) versus skeletal survey in the detection of myelomatous lesions, and correlation of disease distribution with whole-body MRI (WBMRI). Skeletal Radiol. 2009 Mar;38(3):225-36.

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