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Screening whole spine magnetic resonance imaging in multiple myeloma
Author(s) -
Wight J.,
Stillwell A.,
Morris E.,
Grant B.,
Lai H. C.,
Irving I.
Publication year - 2015
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12789
Subject(s) - medicine , magnetic resonance imaging , multiple myeloma , spine (molecular biology) , radiology , nuclear magnetic resonance , bioinformatics , physics , biology
Background M agnetic resonance imaging ( MRI ) is the most sensitive method for detecting focal spinal disease ( FSD ) in multiple myeloma ( MM ). It is unclear whether whole spine MRI ( WS‐MRI ) should be employed as a screening test at diagnosis of MM . Aim To determine the utility of screening WS‐MRI at diagnosis of MM . Methods A retrospective analysis of data from J anuary 2008 to J anuary 2013 at the T ownsville H ospital was performed. At this centre, WS‐MRI is used routinely in all newly diagnosed MM . The findings of WS‐MRI in patients with and without an agreed guideline indication for WS‐MRI were compared. Clinical predictors of FSD were determined. Results Seventy‐one patients were included in the analysis. Forty‐four (62%) had an agreed indication for MRI ; 33 (75%) of these had FSD . Within this group, 17 required urgent intervention and 13 had spinal plasmacytomas. Within a second group without a guideline indication, 4 of 27 (15%) were found to have FSD on MRI – none required urgent intervention and or had plasmacytomas. Three of eight smouldering myeloma patients were reclassified as symptomatic myeloma by documenting lytic lesions not identified on plain film. The strongest predictors of FSD were back pain ( P < 0.001) and vertebral compression fracture ( P = 0.003). Conclusion WS‐MRI in patients without a guideline indication did not detect any lesions that threatened the spinal cord. WS‐MRI is essential in those with guideline indications. WS‐MRI is of benefit to patients with smouldering myeloma where documentation of lesions not seen on plain film will result in treatment rather than observation.