Comparison of the diagnostic value of low dose computed tomography of the axial skeleton and skeletal radiography in patients with multiple myeloma

Abstract

Background:  Multiple myeloma (MM) is a plasma cell neoplasm characterized by bone marrow infiltration and clonal proliferation of plasma cells. The detection of lytic bone lesions represents a criterion defining a symptomatic and treatment-requiring MM. Aim of the study: To compare the accuracy of whole body low dose CT (WBLDCT) versus skeletal radiographs in detecting myeloma lesions and to establish the feasibility of (WBLDCT) protocol as an alternative to conventional X-ray imaging. Patients and Methods: A cross sectional analytical study had been conducted in Al- Yarmouk teaching hospital in Baghdad. A total of 41 patients, their ages range between 40 – 82 years, diagnosed with multiple myeloma, underwent WBLDCT and digital radiography (DR). Results: There was weak agreement between WBLDCT and X-ray in detection of lytic lesions in skull, spine and pelvic bones with (Kappa = 0.382, p = 0.007) for skull, (Kappa = 0.147, p=0.077) for spine, (Kappa = 0.223, p = 0.023) for pelvic bones. WBLDCT identified more osteolytic lesions than radiograph with total number of lesions detected with WBLDCT was 520 versus 152 for radiographs (p<0.001). Conclusion: Whole body Low-dose CT is superior to skeletal radiography with a comparable radiation dose for detection of lytic lesions of MM, with a fast scanning time and high resolution images.