[Ruchi]

Are X-Rays more reliable for lesions or MRI

by Ruchi on Thu Jul 05, 2012 10:17 am

Are X-Rays more reliable for detecting lesions or MRI or CT scan? My mother was detected with Solitary non-secretary plasmacytoma last August after she had a fracture in her right shoulder. Her PET scan at that time had revealed that she had activity only in her right shoulder and nowhere else in the body.
This April she had a whole body MRI and that revealed that she had a lesion in her left shoulder as well as 2 in thighs. The MRI wasnt specific of what kind of lesion it was. The doctor took an X-Ray of those regions and they did not appear on the X-Rays. After looking at the MRI images the doctor said that those lesions were not similar to what a plasmacytoma would have caused.
So is it possible that MRI's being very sensitive, X-Rays should be more reliable for detecting lesions? Also my mother had 8 cycles of Velcade after that due to her high lambda/kappa ratio and now she is on thalidomide and is going to be shifted to Revlimid after 3 weeks. So if those that were detected in MRI were lesions caused by plasmacytoma, will Velcade cure those lesions?
What is the actual role of Velcade, thalidomide, Revlimid on bone lesions? I am a bit concerned because if those were lesions that were detected in MRI, will they be cured with this medications?

[Dr. Adam Cohen]

Re: Are X-Rays more reliable for lesions or MRI

by Dr. Adam Cohen on Thu Jul 05, 2012 11:01 pm

There are a number of imaging tests available to look for myeloma bone lesions, but unfortunately none of them are perfect. Several studies have shown that in general, MRI and PET scan are more sensitive and reliable in picking up bone lesions than plain x-rays (here's a link to one example: http://www.haematologica.org/content/92/1/50.full.pdf+html ). However, false-positives can occur. In addition, the tests are subject to some interpretation and the readings may vary based on the experience of the radiologist, so sometimes getting a second opinion may be helpful. In your mother's case, since her PET was positive previously when she had a plasmacytoma, it may be useful to repeat this to see if there is abnormal uptake in the areas that were abnormal on the MRI. Regarding treatment, Velcade, thalidomide, Revlimid, and other drugs used for myeloma can control the disease and promote bone healing, but are generally not cures.
Hope this is helpful.