[MoLinJo]

Should husband have MRI?

by MoLinJo on Fri Sep 06, 2013 9:02 pm

My husband was diagnosed with multiple myeloma (stage 2) despite absence of CRAB symptoms. He has no bone lesions showing on xrays but he has alot of bone pain anyway. Dr's think this is caused by another condition he has, not the multiple myeloma. How can they verify that? Should he have an MRI? I read that MRI's can show MM-caused problems that don't show up on xrays.

[terryl1]

Re: Should husband have MRI?

by terryl1 on Sat Sep 07, 2013 5:26 am

Hi, the traditional radiographic skeletal survey tends to be more inaccurate at finding lytic lesions compared to more advanced imaging like the PET CT and MRI. Also, since myeloma is a cancer of the bone marrow, these latter modalities can look inside the bone to see what activity is occurring in the marrow itself. In my case, I had a skeletal survey which found no lesions but the PET CT done the same week found a lytic lesion on my skull. Also, why is your husband stage II if he has no CRAB symptoms? Good luck. Terry L.

[Dr. Ken Shain]

Re: Should husband have MRI?

by Dr. Ken Shain on Sat Sep 07, 2013 2:10 pm

A stated above a bone survey remains the standard of care for defining lesions. However, one needs a 30% reduction in cortical bone to see a lesion. That is why we are continuing to integrate MRIs and/or PET/CTs into diagnostic work-ups. Anyone with myeloma who has back pain should have an MRI or CTL spine (cervical, thoracic, and lumbar spine) to assess for lesions not identified by a skeletal survey.

As to the critical nature of smoldering myeloma vs active myeloma - it is important to demonstrate the absence (or presence) of lesions (and other CRAB criteria).

[kdboca]

Re: Should husband have MRI?

by kdboca on Sat Sep 07, 2013 3:15 pm

Unless the patient is severely claustrophobic, has no insurance, or is extremely sensitive to the car in the next lane that is blasting the bass line of some recent piece of "music", I don't think there is anything to fear from an MRI. There are reports that MRI is becoming a better tool in multiple myeloma diagnosis. Personally, I'd rather have an MRI than expose myself to radiation in CT or PET. In fact, my onc wants a new bone scan and I've asked to have an MRI instead.

[Dr. Ken Shain]

Re: Should husband have MRI?

by Dr. Ken Shain on Sun Sep 08, 2013 9:45 am

I would still get both tests - Bone surveys still reveal a lot about the cortical bone health. I still feel more comfortable assessing the involvement of cortical bone from them. The importance of this is really to define lesion that may need prophylactic orthopedic rod placement and the like (significant loss (>50%) in cortical bone in femurs, and humeri).

If disease is stable or controlled -without new pain. Bone surveys are quite adequate and much less expensive for follow-up.