Skeletal survey in advanced multiple myeloma: radiographic versus MR imaging survey

In an attempt to compare the sensitivity of bone radiographs and bone marro w magnetic resonance (MR) imaging for bone lesion detection in patients wit h stage III multiple myeloma (MM) and to evaluate the possible consequences of the replacement of the conventional radiographic skeletal survey (RSS) by an MR survey of the spinal and pelvic bone marrow in these patients, we obtained MR studies of the thoracic and lumbar spine, pelvis and proximal f emurs in addition to the conventional RSS (including radiographs of the sku ll, entire spine, pelvis, ribs, humerus and femurs) in 80 consecutive patie nts with newly diagnosed stage III MM according to the Durie and Salmon sta ging system (based on blood tests and on the RSS), The performance of MR an d radiographic studies to detect bone lesions in given anatomic areas and i n given patients were compared. The consequences on MM staging following th e substitution of the RSS by the MR survey were assessed, MR imaging was su perior to radiographs for lesion detection in the spine (76% v 42% of patie nts) and pelvis (75% v 46% of patients). The RSS was superior to the limite d MR imaging survey for the detection of bone involvement in the patient po pulation (87.5% v 79%: of patients). If the RSS had been replaced by the MR imaging survey for patient staging, 7/80 patients would have been categori zed as stage I and one as stage II MM on the basis of normal MR findings an d biological findings consistent with these stages, Substitution of the RSS by a limited spinal and pelvic marrow MR survey wou ld lead to 'understaging' of 10%; of patients with otherwise stage III MM o n the basis of blood tests and the conventional RSS.