Multiple myeloma CT

Multiple myeloma Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2]; Haytham Allaham, M.D. [3]; Shyam Patel [4]

Overview

CT scan does not have a major role in the diagnosis of disseminated multiple myeloma but low-dose whole-body CT may be helpful. CT scan may also be useful for diagnosis of thrombotic-related complications and bony destruction from multiple myeloma. CT carries a high risk for radiation and should not be performed in pregnant patients.

CT Scan

• CT scan does not have a major role in the diagnosis of disseminated multiple myeloma but low-dose whole-body CT may be helpful.
• CT scan in combination with PET imaging is highly useful for the diagnosis of osseous lesions. Osseous lytic lesions will be fluorodeoxyglucose (FDG)-avid (hypermetabolic) on PET/CT. PET/CT is very sensitive for the diagnosis of lytic lesions of multiple myeloma.
• CT scan may be useful in the detection of thrombotic complications related to multiple myeloma, including pulmonary embolism or mesenteric venous thrombosis.
• CT scan may be useful to determine the extent of extra-osseous soft tissue component (plasmacytoma) in patients with a large disease burden.
• Contrast CT scan may lead to renal failure in multiple myeloma more frequently than otherwise. Hence, other modalities are preferred over CT scan for patients with multiple myeloma.
• CT scan carries a high risk for radiation exposure and subsequent malignancies. In contrast, MRI carries no radiation risk, and MRI may thus be more appropriate for some patients.
• CT scan is less expensive than MRI but more expensive than X-ray. Clinical judgement should be used when decided which imaging modality to use.
• CT scan should not be done in pregnant patients with multiple myeloma, given the risk of radiation exposure. Instead, MRI can be done.