I'm due to have a full skeletal X-RAY survey done of my body next month as part of my ongoing SMM monitoring, which involves x-rays every 6 months and blood/urine tests every 2 months. The last time I had an x-ray survey, I ended up getting a follow up PET/CT Scan to determine whether I truly had lytic lesions that were "found" during my X-Ray (I ended up not having any according to my follow-up PET/CT scan, nor could any other radiologist confirm what the original radiologist "found" on my original X-ray).
I understand that an MRI or PET/CT scan can be more informative than an X-RAY when it comes to lytic lesions.
However, is it true that one does not get a full-body MRI, but rather an MRI is only used for looking at specific, targeted areas that may have been found to be suspicious via x-ray or earlier radiological exams?
I also understand that a PET/CT scan apparently exposes one to a LOT of radiation, so it ought to be used sparingly.
My bottom line question is should I be getting full skeletal x-ray surveys as part of my ongoing monitoring (later to be corroborated by MRI or PET/CT if something is found on the X-Ray), or should I be asking for another type of up-front radiological exam as part of my overall monitoring? If the x-ray does turn up something, should I insist on an MRI or on a PET/CT scan (I'd just as soon not have all the repeated radiation exposure associated with PET/CT or X-Ray, but I also don't want to have hidden lesions that go undetected).
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: MRI, PET/CT or Skeletal X-Ray Survey?
I have had two whole body skeletal surveys done where "enumerable multiple lytic lesions” where found throughout my all my major bones and cranium, but they were all small or very tiny in size. The first one noted general osteoporosis, the second did not. And what does “enumerable” mean? Ten, or maybe even hundreds of lesions? The two different radiologists did the reports over a year apart and it is hard to tell from their individual assessment and descriptions if my skeletal health has gotten worse, stayed the same or improved. I think to do this you would need a single radiologist look at both skeletal surveys and assess the difference, but that was not done.
My understanding is that both whole body skeletal survey gives a gives a pretty sizable dose of radiation, and PET/CT scans even more. I completely understand not doing them unless it is deemed necessary. I have never had CT/PET scan for myeloma treatment myself, just the two whole body skeletal surveys. I have wondered though if the reason is to avoid unnecessary radiation exposure or simply to save cost. MRIs do not expose any radiation. I suggested and asked about getting an MRI done to assess skeletal health but both my Oncologist rejected that idea as unnecessary. A fortunate has been spent on me so far in my treatment and a MRI or CT/PET scan would not add much at all to the total cost, so I am trusting that the reasons for not doing them is they were deemed as being unnecessary and not for cost savings.
My understanding is that both whole body skeletal survey gives a gives a pretty sizable dose of radiation, and PET/CT scans even more. I completely understand not doing them unless it is deemed necessary. I have never had CT/PET scan for myeloma treatment myself, just the two whole body skeletal surveys. I have wondered though if the reason is to avoid unnecessary radiation exposure or simply to save cost. MRIs do not expose any radiation. I suggested and asked about getting an MRI done to assess skeletal health but both my Oncologist rejected that idea as unnecessary. A fortunate has been spent on me so far in my treatment and a MRI or CT/PET scan would not add much at all to the total cost, so I am trusting that the reasons for not doing them is they were deemed as being unnecessary and not for cost savings.
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Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
Re: MRI, PET/CT or Skeletal X-Ray Survey?
Hi Multibilly,
The clarity of an MRI and PET/CT scan is better than a full skeletal X-ray however, you're right the radiation exposure is much higher and who knows how many you will be requiring in the coming years. The former scans are better for targetting specific areas but you have to know what area to target. At the moment you are monitoring for progression of the disease so an image that can show the radiologist that there either has been no change or there has been change is all that is required. A skeletal X-ray can achieve this particularly if you have scans taken 6 months ago. Have there been any changes? If there are any regions that need further clarity a follow up CT scan can always be done. Remember that the scan is done in conjunction with your blood/urine tests, the results of these will also indicate whether your disease is progressing.
What are you going to do with the information you gain from the scans? For instance if your disease progresses will your treatment regimen be the same if you have one lesion or multiple lesions? (I have just read the news article "Bone lesions detected by MRI can predict progression of smoldering myeloma) If treatment is going to be the same then the clarity of the picture is not going to make much difference. I am assuming that you want to make sure if there is a lesion that it is detected. But to have a lesion you need to have a lot of myeloma cells (I have no idea how many) and their products should be detected in the blood/urine tests. I am hoping if your disease progresses that it will be picked up by a blood test as you are having them every 2 months and not because you have a fracture in your spine.
I have had all three scans (more than one of each) during my myeloma journey. The first was a CT to determine if it was L3 or L4 that had the prolapsed disk. Only 6 disks were looked at
so it meant I needed a full skeletal X-ray to determine what other bones were involved and the extent of the damage up the spine. Then an MRI to focus in on the fractures. The latter was also to determine if there was any pinching of the spinal cord as I was losing some sensation in my legs. The clarity of the pictures from the MRI was great - you dont need to be a radiologist to see which ones are damaged (I couldn't tell on the X-ray).
The bottom line for me is have the full skeletal X-ray survey as part of ongoing monitoring in conjunction with your blood/urine tests and if further information is required then have an MRI or CT scan.
I hope you get the all clear,
Libby
The clarity of an MRI and PET/CT scan is better than a full skeletal X-ray however, you're right the radiation exposure is much higher and who knows how many you will be requiring in the coming years. The former scans are better for targetting specific areas but you have to know what area to target. At the moment you are monitoring for progression of the disease so an image that can show the radiologist that there either has been no change or there has been change is all that is required. A skeletal X-ray can achieve this particularly if you have scans taken 6 months ago. Have there been any changes? If there are any regions that need further clarity a follow up CT scan can always be done. Remember that the scan is done in conjunction with your blood/urine tests, the results of these will also indicate whether your disease is progressing.
What are you going to do with the information you gain from the scans? For instance if your disease progresses will your treatment regimen be the same if you have one lesion or multiple lesions? (I have just read the news article "Bone lesions detected by MRI can predict progression of smoldering myeloma) If treatment is going to be the same then the clarity of the picture is not going to make much difference. I am assuming that you want to make sure if there is a lesion that it is detected. But to have a lesion you need to have a lot of myeloma cells (I have no idea how many) and their products should be detected in the blood/urine tests. I am hoping if your disease progresses that it will be picked up by a blood test as you are having them every 2 months and not because you have a fracture in your spine.
I have had all three scans (more than one of each) during my myeloma journey. The first was a CT to determine if it was L3 or L4 that had the prolapsed disk. Only 6 disks were looked at
so it meant I needed a full skeletal X-ray to determine what other bones were involved and the extent of the damage up the spine. Then an MRI to focus in on the fractures. The latter was also to determine if there was any pinching of the spinal cord as I was losing some sensation in my legs. The clarity of the pictures from the MRI was great - you dont need to be a radiologist to see which ones are damaged (I couldn't tell on the X-ray).
The bottom line for me is have the full skeletal X-ray survey as part of ongoing monitoring in conjunction with your blood/urine tests and if further information is required then have an MRI or CT scan.
I hope you get the all clear,
Libby
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LibbyC - Name: LibbyC
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 2009
- Age at diagnosis: 43
Re: MRI, PET/CT or Skeletal X-Ray Survey?
Has anybody had a whole body MRI? How long do they take? I've had a Xray skeletal survey and whole body PET/CT, but not an MRI.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: MRI, PET/CT or Skeletal X-Ray Survey?
i have had 2 mri full body scans and they took between one and a half hours to two hours.
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gmarv54
Re: MRI, PET/CT or Skeletal X-Ray Survey?
gmarv:
This is great. Not a whole lot longer than doing an xray survey series and less time than a PET/CT. Thank you!
This is great. Not a whole lot longer than doing an xray survey series and less time than a PET/CT. Thank you!
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: MRI, PET/CT or Skeletal X-Ray Survey?
[quote="Multibilly"]gmarv: This is great. Not a whole lot longer than doing an xray survey series and less time than a PET/CT. Thank you![/quote]
Perhaps I spoke too soon.
Can't find anybody in Colorado that actually does whole body MRIs. At best, some facilities would agree to do an MRI of one's body section by section. There would be a LOT of separate sections that would have to be done piecemeal with different MRI coils at a considerable amount of time per section and you couldn't get it done in one visit.
Seems like there must be some very specialized MRI machine that is capable of efficiently performing a whole body MRI scan in one fell swoop that hasn't made it out to the Rockies yet?
Perhaps I spoke too soon.
Can't find anybody in Colorado that actually does whole body MRIs. At best, some facilities would agree to do an MRI of one's body section by section. There would be a LOT of separate sections that would have to be done piecemeal with different MRI coils at a considerable amount of time per section and you couldn't get it done in one visit.
Seems like there must be some very specialized MRI machine that is capable of efficiently performing a whole body MRI scan in one fell swoop that hasn't made it out to the Rockies yet?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: MRI, PET/CT or Skeletal X-Ray Survey?
I find it interesting Colorado has no one who can do a full body MRI. I have had 1 full body MRI and it did find a lesion in my spine. I had this done after a full body X-ray. The MRI took around an hour and half to two hours. What did make it harder than the X-ray was the confinement. The tube is so tiny and you can't move. I could not scratch an itch and the top is inches from my face. I did okay though. Just closed my eyes.
Also, my test was considered a full body but it was done in sections. Particular attention to my skull, spine and hips.
Also, my test was considered a full body but it was done in sections. Particular attention to my skull, spine and hips.
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kjpoppit - Name: Kim Nelson
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Sept. 19th, 2013
- Age at diagnosis: 47
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