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Re: How important is a PET scan?
Radiographic skeletal surveys frequently miss lytic lesions which PET CT's and other more sophisticated modalities pick up. Clearly, PET CT's are better than simple x rays.
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terryl1 - Name: Terry
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August 10, 2011
- Age at diagnosis: 49
Re: How important is a PET scan?
I personally think so, at least that or a full-body MRI. I was due to get a follow-up routine full-body xray last month, but my doc and I finally decided to postpone imaging to this fall (given my current, decent numbers) and to instead opt for a PET/CT.
Going forward, I will probably end up doing a PET/CT every second or third imaging session for routine follow up. But if my numbers change dramatically, that might change things. The big downside to PET/CTs are the amount of radiation they involve.
Note:
"Researchers Review Current Diagnostic Imaging Techniques For Multiple Myeloma," The Myeloma Beacon, May 2, 2014
"Regular imaging for smoldering myeloma - what type?", Beacon forum discussion
Also note that the IMWG is currently in the process of revamping its recommendations for imaging.
"Highlights Of The 2014 International Myeloma Working Group Annual Summit," Dr. S. Vincent Rajkumar, The Myeloma Beacon, June 26, 2014.
The bone working group decided to collaborate and compile data on how best to use new imaging modalities in the diagnosis and management of myeloma.
Going forward, I will probably end up doing a PET/CT every second or third imaging session for routine follow up. But if my numbers change dramatically, that might change things. The big downside to PET/CTs are the amount of radiation they involve.
Note:
"Researchers Review Current Diagnostic Imaging Techniques For Multiple Myeloma," The Myeloma Beacon, May 2, 2014
"Regular imaging for smoldering myeloma - what type?", Beacon forum discussion
Also note that the IMWG is currently in the process of revamping its recommendations for imaging.
"Highlights Of The 2014 International Myeloma Working Group Annual Summit," Dr. S. Vincent Rajkumar, The Myeloma Beacon, June 26, 2014.
The bone working group decided to collaborate and compile data on how best to use new imaging modalities in the diagnosis and management of myeloma.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: How important is a PET scan?
This is a good question. I have read that PET scans/MRI are far more sensitive and x-ray will only show lytic lesions when there's 30% or more destruction (I'm very new and not knowledgeable so if this is wrong, please let me know).
That said, I understand they usually do full body x-ray and if nothing shows up, they don't do PET/MRI. Evidently there's a high cost (and radiation?) involved in the more sensitive testing, so would insurance cover it?
I don't know.
That said, I understand they usually do full body x-ray and if nothing shows up, they don't do PET/MRI. Evidently there's a high cost (and radiation?) involved in the more sensitive testing, so would insurance cover it?
I don't know.
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Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: How important is a PET scan?
It is my understanding that the PET/CT scans are to check for tumors in the soft tissue.
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gmarv - Name: marvin
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: aug.2012
- Age at diagnosis: 57
Re: How important is a PET scan?
PET scans are usually given with (after) a sugar/ Flouridine tracer infusion is administered.
It seems tumors get "Happy" with the presence of sugar/sucrose--so they light up nicely on a Positron Scan. Not great definition mind you, but atleast you know where the buggers are "Hiding".
MRI's are the second best--but a full body MRI is technically much harder to do (ie..Lay the hell, still--patient! ) For 50 minutes. And they MRI's also "Miss" some tumors.
A PET scan is of shorter duration and is more forgiving to patient movement, etc. ("Eyeballs--to ankles,"...as the saying goes.)
Given the choice, I'd do a PET scan in a minute...over a MRI. I'm claustrophobic and the bore size of a PET scanner is much more comfortable, than the odiously tight nacelle of an MRI tube.
PET scans are also "Std of Care" for workup / monitoring of multiple myeloma.
They were very helpful to my case--due to radiation as the next treatment.
Good luck.
It seems tumors get "Happy" with the presence of sugar/sucrose--so they light up nicely on a Positron Scan. Not great definition mind you, but atleast you know where the buggers are "Hiding".
MRI's are the second best--but a full body MRI is technically much harder to do (ie..Lay the hell, still--patient! ) For 50 minutes. And they MRI's also "Miss" some tumors.
A PET scan is of shorter duration and is more forgiving to patient movement, etc. ("Eyeballs--to ankles,"...as the saying goes.)
Given the choice, I'd do a PET scan in a minute...over a MRI. I'm claustrophobic and the bore size of a PET scanner is much more comfortable, than the odiously tight nacelle of an MRI tube.
PET scans are also "Std of Care" for workup / monitoring of multiple myeloma.
They were very helpful to my case--due to radiation as the next treatment.
Good luck.
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Rneb
Re: How important is a PET scan?
The 30 % (bone destruction/alteration) premise only applies to ordinary AP/Lateral style x-rays.
MRI's, PET scans, and CT scans are much more defined and are thus not limited by the Density problems faced by Mdme Curie's discovery. ( Plain X-rays)
That is why MRI's ( Electrons) are used over CT scans (radiation) in routine bone / soft-tissue workups.
Panarex films are still good to use when doing an Oral exam --Mandibular/ maxillary series/ base of Skull.
Good luck.
MRI's, PET scans, and CT scans are much more defined and are thus not limited by the Density problems faced by Mdme Curie's discovery. ( Plain X-rays)
That is why MRI's ( Electrons) are used over CT scans (radiation) in routine bone / soft-tissue workups.
Panarex films are still good to use when doing an Oral exam --Mandibular/ maxillary series/ base of Skull.
Good luck.
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Rneb
Re: How important is a PET scan?
I think though, a complete bone survey xray is standard procedure at least when they do the initial work up, right? I'm only MGUS, but I had a DEXA bone study and a full body x-ray and that's it.
So do they do the PET scan only if either of these show suspicious activity?
hopeful27 asked: "Should everyone have a PET scan if just normal x-rays were taken?"
Since this was the original question. I think it's a good one too, because from all we've read, there could be lesions that are just undetectable by regular x-ray. Yet the SOP is x-ray, not PET.
So do they do the PET scan only if either of these show suspicious activity?
hopeful27 asked: "Should everyone have a PET scan if just normal x-rays were taken?"
Since this was the original question. I think it's a good one too, because from all we've read, there could be lesions that are just undetectable by regular x-ray. Yet the SOP is x-ray, not PET.
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Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: How important is a PET scan?
Xray is still the "gold standard" for initial and relapsed diagnosis and staging , as stated by the IMWG. From the link below:
"Conventional radiography still remains the 'gold standard' of the staging procedure of newly diagnosed and relapsed myeloma patients"
http://www.ncbi.nlm.nih.gov/pubmed/19421229
Full text can be found here:
http://www.nature.com/leu/journal/v23/n9/full/leu200989a.html
Now, whether one agrees with the above statement is a different matter
But what the IMWG says has an impact on the imaging coverage policies set up by insurance companies.
Also, remember that the above is currently in the process of being revised.
However, note that the policies for coverage of PET/CT with multiple myeloma vary between insurance providers. My insurance company is pretty liberal on the subject of PET/CT and largely leaves it to the discretion of the doctor based on whether or not he considers it material to managing the disease....it was pretty easy for me to get approval for the last time my doc requested it....hopefully, it will be just as easy to get pre-approved the next time he asks for it.
In my case, I got my initial PET/CT scan to actually disprove the results of my first xray, which had been falsely interpreted to have shown bone lesions that didn't exist. Based on my initial xray results, I went through several weeks of thinking I was symptomatic until I found out I wasn't when I got my PET/CT results. Hooray for PET/CT!
Unfortunately, folks also have the opposite happen to them, where they think they have no bone involvement based on the results of an xray, only later to find that they do have lesions when they get a PET/CT.
But always remember that PET/CTs use a LOT of radiation, which carries real health risk. So if you argue for their use, be sure to use them sparingly.
"Conventional radiography still remains the 'gold standard' of the staging procedure of newly diagnosed and relapsed myeloma patients"
http://www.ncbi.nlm.nih.gov/pubmed/19421229
Full text can be found here:
http://www.nature.com/leu/journal/v23/n9/full/leu200989a.html
Now, whether one agrees with the above statement is a different matter
But what the IMWG says has an impact on the imaging coverage policies set up by insurance companies. Also, remember that the above is currently in the process of being revised.
However, note that the policies for coverage of PET/CT with multiple myeloma vary between insurance providers. My insurance company is pretty liberal on the subject of PET/CT and largely leaves it to the discretion of the doctor based on whether or not he considers it material to managing the disease....it was pretty easy for me to get approval for the last time my doc requested it....hopefully, it will be just as easy to get pre-approved the next time he asks for it.
In my case, I got my initial PET/CT scan to actually disprove the results of my first xray, which had been falsely interpreted to have shown bone lesions that didn't exist. Based on my initial xray results, I went through several weeks of thinking I was symptomatic until I found out I wasn't when I got my PET/CT results. Hooray for PET/CT!
Unfortunately, folks also have the opposite happen to them, where they think they have no bone involvement based on the results of an xray, only later to find that they do have lesions when they get a PET/CT.
But always remember that PET/CTs use a LOT of radiation, which carries real health risk. So if you argue for their use, be sure to use them sparingly.
Last edited by Multibilly on Tue Jul 22, 2014 6:29 pm, edited 2 times in total.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: How important is a PET scan?
Thanks MG - that's what I thought.
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Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
18 posts
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