Detecting bony infiltrates in patients with multiple myeloma – Is there a role for computered tomography (CT) as an alternative to the radiographic skeletal survey?

Using 2 case studies, the aim of this article is to discuss if there is a role for the computed tomography (CT) skeletal survey in patients with multiple myeloma. CT has increased sensitivity and demonstrates an ability to characterise trabecular anatomy in difficult areas such as scapulae, ribs and sternum, compared with conventional radiography. It also allows differentiation between benign and pathological compression fractures, and is superior in estimating fracture risk. Other advantages of CT include demonstration of unsuspected associated pathology such as lung disease, soft tissue and visceral masses and identifying suitable biopsy sites, detection of small osteolytic lesions, multiplanar reconstructions, radiotherapy planning and surgical intervention, shorter examination time, no repositioning of the patient and therefore increased patient comfort. CT has previously been associated with increased radiation dose with careful selection of the exposure parameters the effective radiation dose can be comparable to that of conventional radiography. These case studies and examples of scanning techniques will demonstrate that whole body low dose multidetector CT is a viable alternative to the skeletal survey in patients with multiple myeloma and bone pain.