Transcript:

This week’s “Ask Dr. Durie” comes from a lady who is confused about what type of scan or X-ray to get. She’d been advised by her doctor that she needed to get an MRI of the spine and pelvis done, but she was aware that there were other kinds of testing: whole body CT scan, PET/CT scan, and wants to know, “What is the current recommendation for different types of scans and X-rays?”

And so, the simplest way to approach this is to look at the three major types of scans. The first type is what’s called, “whole body low dose X-rays,” and this scans all of the bones in the body to see if there are myeloma lesions picked up by the CT. And this is much better than using regular X-rays, what we have called up to now a “skeletal survey.”

And so, this is now the most important test to be done at diagnosis to see if the myeloma is starting to destroy bone and is creating some small bone lesions.

Thereafter, for ongoing monitoring, there are two types of tests: MRI of the spine and pelvis is particularly helpful to assess the amount and distribution of lesions within the bone marrow throughout the body.

Now, those lesions may or may not cause bone damage, but the MRI shows where the lesions are and the size and shape and maybe if they’re causing pressure in the spine area or against a nerve or something and most, most helpful to show the distribution of the myeloma.

And then, the third type of test, is a PET/CT test. And this is a particularly useful test for ongoing monitoring of the myeloma, particularly if there has been an excellent response. At that level, it’s important to know, “Is there any residual active myeloma?” And with the PET scan, one can assess if the radioactive sugar, the glucose which is given to the patient, is taken up by any little spots of myeloma. And this gives a positive PET scan.  

And so to assess the amount of any remaining disease, or if there has been reoccurrence of an early relapse with a new lesion, PET CT is extremely useful to assess what’s going on.

The CT scan part of this is to assess if at the site of the sugar update, where there’s obviously lesion, has there been any bone damage? And so this is obviously a key aspect of understanding the myeloma. Is it active and/or is it causing new bone damage?

And so, those are the three types of imaging. And the BOTTOM LINE is that you need to talk about these carefully with your doctor and see what is the most appropriate, depending on your current situation.

But I would like to emphasize that it’s also important to be aware that these different tests may or may not be fully reimbursed within your healthcare coverage. So please discuss two things: one, “Which is the best one?” but also to make sure “Will it be fully covered within your healthcare plan?” So that you don’t have an unexpected large bill because some of those tests can be quite expensive, in the thousands of dollars, so please be sure to clarify that point first.

Dr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.