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Plasmacytoma only seen on MRI
Hi Everyone! I was hoping someone can help me understand why an MRI detected a plasmacytoma in C7 (which started my journey!), but it did not show up on either the bone scan (no tracer in C7) or the skeletal survey xrays. Thank you!
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gardengirl - Name: gardengirl
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Nov. 2013
- Age at diagnosis: 47
Re: Plasmacytoma only seen on MRI
Hey Gardengirl,
So, I'm not a total expert here, so please follow up with your doc on this.
X-rays provide just rudimentary imaging and lytic lesions aren't always caught by an xray (or the radiologist interpreting the xray). In fact, many folks with multiple myeloma are misdiagnosed as being lesion-free by virtue of relying purely on x-rays. An MRI or PET/CT is a more accurate way of finding lytic lesions. In particular, MRIs provide much better imaging detail than an xray and can often pick up details that just won't show up in an xray.
A nuclear bone scan relies on the lesion picking up the radioactive tracer in order for the lesions to appear as hot spots. However, the lesions associated with multiple myeloma tend not to have the specific properties that are required for the bone scan to pick up the lesions as hot spots. You may want to see this article (p 218) for more of a discussion on the topic.
http://interactive.snm.org/docs/cg_ch11.pdf
I guess the question now becomes whether any further tests are required to verify the nature of the lesion based on your MRI results? And then there is the question of whether this is just a solitary (single) plasmacytoma, which is usually just treated with radiation and not chemo. Again, you should discuss all this with your doc.
So, I'm not a total expert here, so please follow up with your doc on this.
X-rays provide just rudimentary imaging and lytic lesions aren't always caught by an xray (or the radiologist interpreting the xray). In fact, many folks with multiple myeloma are misdiagnosed as being lesion-free by virtue of relying purely on x-rays. An MRI or PET/CT is a more accurate way of finding lytic lesions. In particular, MRIs provide much better imaging detail than an xray and can often pick up details that just won't show up in an xray.
A nuclear bone scan relies on the lesion picking up the radioactive tracer in order for the lesions to appear as hot spots. However, the lesions associated with multiple myeloma tend not to have the specific properties that are required for the bone scan to pick up the lesions as hot spots. You may want to see this article (p 218) for more of a discussion on the topic.
http://interactive.snm.org/docs/cg_ch11.pdf
I guess the question now becomes whether any further tests are required to verify the nature of the lesion based on your MRI results? And then there is the question of whether this is just a solitary (single) plasmacytoma, which is usually just treated with radiation and not chemo. Again, you should discuss all this with your doc.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Plasmacytoma only seen on MRI
Bone scan requires new bone formation to be occurring to pick up an abnormality. Often with myeloma, this is not occurring.
Plain X ray is reasonably good to identify lytic lesions but is not as good of a test as MRI is. Especially for smaller lesions or if there is extramedullary (outside the bone) spread of the plasmacytoma.
Plain X ray is reasonably good to identify lytic lesions but is not as good of a test as MRI is. Especially for smaller lesions or if there is extramedullary (outside the bone) spread of the plasmacytoma.
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Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
Re: Plasmacytoma only seen on MRI
Thank you, Multibilly and Dr. Valent! So, to be sure I'm clear, a bone scan is not really useful in myeloma? And the x-rays will only show lytic lesions, not plasmacytomas? So, if that is true, should myeloma patients be getting full-body MRIs?
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gardengirl - Name: gardengirl
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Nov. 2013
- Age at diagnosis: 47
Re: Plasmacytoma only seen on MRI
I would think that would depend on each individual. I just had an X-ray scan in response to a clavicle break. I have multiple myeloma, that's a given, and I think my doctor wants to know if I have any other bones in immediate danger of fracture.
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Wayne K - Name: Wayne
- Who do you know with myeloma?: Myself, my sister who passed in '95
- When were you/they diagnosed?: 03/09
- Age at diagnosis: 70
Re: Plasmacytoma only seen on MRI
OK, now I am really confused (but in a good way!)
I had a repeat MRI and the report says the lesion is most compatible with an ATYPICAL hemangioma! (The initial MRI said that it does NOT correspond with a TYPICAL hemangioma). However, the two myeloma specialists feel it's a plasmacytoma.
Who do I believe? If it walks like a duck and talks like a duck, could it be a swan?
This is such an important distinction because it changes my diagnosis from Stage 1 to SMM, and therefore changes my treatment plan!
Thanks for listening!
I had a repeat MRI and the report says the lesion is most compatible with an ATYPICAL hemangioma! (The initial MRI said that it does NOT correspond with a TYPICAL hemangioma). However, the two myeloma specialists feel it's a plasmacytoma.
Who do I believe? If it walks like a duck and talks like a duck, could it be a swan?
This is such an important distinction because it changes my diagnosis from Stage 1 to SMM, and therefore changes my treatment plan!
Thanks for listening!
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gardengirl - Name: gardengirl
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Nov. 2013
- Age at diagnosis: 47
Re: Plasmacytoma only seen on MRI
Hey Gardengirl,
First off, I'm not sure if what I'm about to say is medically accurate, but these are the two questions that would occur to me to ask my doc:
1. If it is unclear whether this is a plasmacytoma or hemagioma, wouldn't a biopsy be able to confirm this one way or the other? Can one easily do a biopsy on C7?
2. Would a PET/CT (or other imaging modality) be better at distinguishing between the two?
First off, I'm not sure if what I'm about to say is medically accurate, but these are the two questions that would occur to me to ask my doc:
1. If it is unclear whether this is a plasmacytoma or hemagioma, wouldn't a biopsy be able to confirm this one way or the other? Can one easily do a biopsy on C7?
2. Would a PET/CT (or other imaging modality) be better at distinguishing between the two?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Plasmacytoma only seen on MRI
Hey Multibilly!
As I was driving home, I wondered why they haven't recommended a biopsy, so I plan to email my doctor. It did not show up on the PET scan, but the note on my report says "the sensitivity of PET-CT for intra medullary lesions of myeloma is about 61%". I am scheduled for an MRI of the thoracic and lumbar spine to look for other lesions.
What are the chance that I have BOTH myeloma and an atypical hemangioma? I think it's too coincidental!
As I was driving home, I wondered why they haven't recommended a biopsy, so I plan to email my doctor. It did not show up on the PET scan, but the note on my report says "the sensitivity of PET-CT for intra medullary lesions of myeloma is about 61%". I am scheduled for an MRI of the thoracic and lumbar spine to look for other lesions.
What are the chance that I have BOTH myeloma and an atypical hemangioma? I think it's too coincidental!
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gardengirl - Name: gardengirl
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Nov. 2013
- Age at diagnosis: 47
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