Doctors have several different techniques at their disposal for diagnosing multiple myeloma and detecting bone disease. A new study, “Role of radiography, MRI and FDG-PET/CT in diagnosing, staging and therapeutical evaluation of patients with multiple myeloma,” suggests newer imaging techniques are better for diagnosis than traditional X-rays. The study, published September 18 in Annals of Hematology, examined several different imaging methods.

Reinier Raymakers, a coauthor of the study, noted better diagnosis techniques could lead to earlier treatment.

“You can prevent fractures, pain, spinal cord lesions,” he said.

The authors observed that while multiple myeloma is usually diagnosed based on a bone marrow biopsy, 80 percent of patients also have bone lesions. Therefore, detecting these lesions can be critical to diagnosis and treatment.

X-rays have been widely used because of their low cost and wide availability, but X-rays have their drawbacks. They frequently miss lesions, particularly in the early stages of myeloma. X-rays also cannot provide information on the activity of cancer in the bones, and give no indication on how long cancer has been present.

“I think we are at the point to leave skeletal X-ray[s] as being too insensitive, especially for the spine, plasmocytomas, and ribs,” Raymakers added. “The use of more sensitive diagnostic procedures will result in a shift. More patients will be treated at an earlier point after diagnosis and after relapse.”

While examining different types of scans, the study authors found a technique involving fluorodeoxyglucose (FDG) to be most effective. FDG is a radioactive sugar that accumulates in tumors. Once it is injected into the body, tumors become visible on a positron emission topography (PET) scan.

Since tumor cells have a higher metabolism rate, they will accumulate more FDG and become distinguishable from healthy bone cells. Additionally, researchers found that FDG-PET scans become even more effective when combined with a computerized topography (CT) scan. PET scans are more sensitive, while CT scans give a better image of the full anatomy.

The main drawback of FDG-PET scans is they sometimes do not detect lesions that are less than half an inch in diameter. Furthermore, the study’s authors suggest that the best diagnosis technique often depends on the patient. For closer examination of bone marrow, the authors recommend magnetic resonance imaging (MRI) because it allows visualization of bone content.

For more information, please see the study in Annals of Hematology.