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Can whole-body low-dose multidetector CT exclude the presence of myeloma bone disease in patients with monoclonal gammopathy of undetermined significance (MGUS)?Spira D; Weisel K; Brodoefel H; Schulze M; Kaufmann S; Horger MAcad Radiol 2012[Jan]; 19 (1): 89-94RATIONALE AND OBJECTIVES: To determine the benefit of using whole-body low-dose computed tomography (WBLD-CT) in patients with monoclonal gammopathy of undetermined significance (MGUS) for exclusion of multiple myeloma (MM) bone disease. MATERIALS AND METHODS: Seventy-one consecutive patients with confirmed MGUS (as defined by the latest criteria of the International Myeloma Working Group) who underwent WBLD-CT for diagnosis were identified retrospectively by a search of our institution's electronic medical record database (2002-2009). Patients were classified as low-risk or intermediate/high-risk and followed over a >/=2-year period with additional CT imaging and/or laboratory parameters. Presence of osteolysis, medullary, or extramedullary abnormalities compatible with involvement by MM was recorded. A diffuse or focal increase in medullary density to Hounsfield unit (HU) values >20 HU/>0 HU was considered suspicious for bone marrow infiltration if no other causes identifiable. RESULTS: The presence of osteolysis was excluded in all 71 patients with MGUS at initial diagnosis and patients were surveilled for >/=2 years. Lytic changes were observed at follow-up in 1/71 patients that progressed to MM and were detectable via WBLD-CT at an early stage (even before a significant rise in M-protein was recorded). In 3/71 patients with MGUS (4%) suspicious bone marrow attenuation values were measured, disclosing disease progression to smoldering myeloma in another patient and false-positive results in 2/71 patients. Bone marrow attenuation assessment resulted in a specificity and negative predictive value of 97%, respectively. No significant difference with respect to bone marrow attenuation was observed in patients with low-risk MGUS versus intermediate- to high-risk MGUS. One of 71 patients showed serologic disease progression to active MM without bone abnormalities detectable. CONCLUSION: WBLD-CT reliably excludes findings compatible with myeloma in MGUS and thereby complements hematologic laboratory analysis.|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Bone Neoplasms/*diagnostic imaging[MESH]|Diagnosis, Differential[MESH]|Humans[MESH]|Middle Aged[MESH]|Monoclonal Gammopathy of Undetermined Significance/*diagnostic imaging[MESH]|Multiple Myeloma/*diagnostic imaging[MESH]|Radiation Dosage[MESH]|Reproducibility of Results[MESH]|Sensitivity and Specificity[MESH]|Tomography, X-Ray Computed/*methods[MESH]|Whole Body Imaging/*methods[MESH] |
