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Overview of Standard Imaging Tests for Myeloma

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Published on March 3, 2020

Key Takeaways

  • Depending on what your doctor is observing, options for imaging tests for myeloma include a PET or CT scan, or an MRI. 
  • Experts recommend having an SPEP, blood and urine test when looking at MRD status.
  • The International Myeloma Working Group removed skeletal surveys from their guidelines on imaging and myeloma.

At a recent Town Meeting in Houston, Texas, noted experts Dr. Krina Patel and Dr. Sagar Lonial  joined Patient Power to discuss the standard imaging tests for someone diagnosed with multiple myeloma and what they help doctors evaluate. Watch as the myeloma experts explain why a skeletal survey may not be the best option and what tests are recommended.

This town hall meeting is sponsored by Janssen Biotech, Inc. and Karyopharm Therapeutics with additional support to our partner, Myeloma Crowd (MCR), from Takeda Oncology and Foundation Medicine. These organizations have no editorial control, and Patient Power is solely responsible for the content. It is produced by Patient Power in partnership with The University of Texas MD Anderson Cancer Center.

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Myeloma Crowd The University of Texas MD Anderson Cancer Center

Transcript | Overview of Standard Imaging Tests for Myeloma

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Dr. Patel:                     

I think at diagnosis, everybody should have imaging of some sort. I believe and I think most people would believe that skeletal surveys are probably not the best way. So, for us, we either do a PET scan to look for the metabolic reaction of these cells so we can see if it’s really hot and does it go down, does it go away completely versus MRIs. 

The standard is MRIs of the spine, but now, we have whole body MRIs. Actually, at MD Anderson, we just got whole body MRIs a few months ago. It looks like the bone is a little bit better. There are certain questions. They don’t do the same exact thing, but they are much more sensitive than just skeletal surveys, number one. Most of the time, right now, we’re still learning a lot of data on which one we do, but they’re both options. 

It helps if you don’t have any bone disease, technically, we don’t need to keep getting them every few months or even regularly in my opinion. We need them, especially if you have new pain or anything that seems concerning, but if you have bone disease, then it helps us follow that bone disease throughout your treatment. 

So, initially, for MRD, yes, we want the bone marrow to go away. We want the SPEP and the blood test and the urine test. We also want to make sure that if there was one extramedullary disease, meaning its’s outside of the bone or the bone marrow, if it’s in the lung or the liver, we want to make sure that went away. 

Then we also want to make sure the bone lesions are better, especially if there was one that could potentially cause fracture in the future or anything like that. As we treat, the idea is that we get these bone lesions stronger. 

There are points where they’re still weak and if we need to do a nailing or something like that to help support, it sort of helps all of those things for prognostic, once again, but also, for quality of life to make sure we don’t miss something that’s changing. 

Jack Aiello:                 

Okay. Dr. Lonial, kind of the same? 

Dr. Lonial:                  

I agree. I think the International Myeloma Working Group just published their new guidelines on imaging and myeloma. They’ve actually removed skeletal survey from that list now. The lowest level of imaging that’s sort of acceptable, if you will, is low-dose whole body CT scan, which does let you get a sense for the bones. 

There is this controversy about MRI versus PET/CT. What I like about PET/CTs is it doesn’t necessarily—it helps me to differentiate old versus new disease a little bit better than I think an MRI does. I think that’s a debate that’s ongoing. 

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