[angiebaldy]

Best imaging to detect lytic lesions?

by angiebaldy on Fri Jun 06, 2014 11:27 am

I posted a few weeks ago about new pain in my jaw and bone loss [link to discussion thread]. Well, I saw my new heme/onc and he ordered a bone density and skeletal survey.

This is my question: What imaging is best to detect lytic lesions or a plasmacytoma in the mandible?

I seem to remember reading somewhere that plain films don't always detect lesions in the mandible if they are early.

Angie

[Rneb]

Re: Best imaging to detect lytic lesions?

by Rneb on Fri Jun 06, 2014 6:40 pm

Angie:

If your diagnosis is MGUS or "smoldering", I think it means you don't have active multiple myeloma.

No active multiple myeloma= No lesions? Kind of a definitional thing ...

The literature is full of articles re: bisphosphonates causing / contributing to mandibular necrosis / bone loss in healthy females age 45 and above.

I think your doc is close to spot on....?

Just my 2 cents.

[Dr. Heather Landau]

Re: Best imaging to detect lytic lesions?

by Dr. Heather Landau on Sat Jun 07, 2014 12:07 am

While skeletal survey is a standard imaging modality in multiple myeloma, when there is concern for subtle lytic disease, a PET scan (which images the whole body) would be a better test to look more generally. But because PET surveys the whole body, the clarity of the images at any one location may not be the best. Therefore, in your case, where there is a specific area of concern, it may be reasonable to examine the area with a dedicated CT scan of the mandible.

[coachhoke]

Re: Best imaging to detect lytic lesions?

by coachhoke on Sat Jun 07, 2014 7:29 am

Standard dental x-rays (as well as a panorex x-ray) will clearly show lytic lesions in the mandible.

You can have periodontitis resulting in bone loss around one tooth and not have it anywhere else in your mouth. It can be caused by a multitude of factors (ill-fitting crown, malocclussion, overhanging filling, irritation from smoking, sub-gingival plaque,or many other factors). I would bet the ranch that you have a periodontal problem and not a multiple myeloma one.

Coach Hoke, retired dentist

[angiebaldy]

Re: Best imaging to detect lytic lesions?

by angiebaldy on Sat Jun 07, 2014 10:52 pm

Thank you all so much for your replies! I am going to suggest a CT of my mandible and see what he says.

I also thought originally that the pain I was having in my jaw was either a cavity or problem with the roots because I had not been to the dentist in a while. My dentist said my teeth and gums look very healthy and she cannot account for the pain or bone loss. I have never smoked however I am on chronic steroid therapy for my lupus. It is entirely possible the bone loss is from the steroids but I really thought that would be generalized and not just one spot. I am also not sure the steroid therapy can explain the pain I am in.

Thanks again for your input! My bone density and skeletal survey are scheduled for this Thursday. I am going to call my new heme/onc and see if he would be agreeable to a CT of the mandible as well.

Angie

[cyom22]

Re: Best imaging to detect lytic lesions?

by cyom22 on Tue Jun 10, 2014 2:42 pm

My plasmacytomas in the jaw were found by 3rd cut imaging. Only one hurt, but they found several . Went on pom-dex and cleared them up.