Radiological evaluation of bone marrow transplanted multipel myeloma patients

Abstract: This thesis concerns radiological evaluation of bone marrowtransplanted multiple myeloma (MM) patients. The diagnosticradiological modalities evaluated are: conventional radiography (RG);bone scintigraphy (BS); bone marrow scintigraphy (MS); magneticresonance imaging (MRI). The 242 included examinations are: 91 RG, 85BS, 33 MS and 33 MRI. The 42 patients included have been treated withchemotherapy as well as with total body irradiation beforebone-marrow transplantation In paper I RG is compared to BS with correlation to clinical data.The results showed that RG depicted more lesions than BS, while BSdepicted fractures at sites not optimally seen on RG. RG and BS gaveno information of prognostic value. In paper ll MS is compared to RG and BS. The results showed thatMS only gave a marginal increase of information on focal lesions. MSwas superior for depicting the sites of prior focal radiotherapy. MSshowed that the majority of the patients had peripheral red bonemarrow expansion. At MS, a monoclonal antibody radiophammaceutical(which is specific for the granulopoietic system) was superior to ananocolloid (which is specific for the reticulo-endothelial system)for the detection of lesions. In paper 11l dynamic registration at BS and MS is evaluated. Theresults showed that no additional information was revealed at dynamicregistrations when these were compared to static registrations or toRG and MRI. In paper IV the location and cause of radionuclide activity notedoccasionally in the abdominal region at MS is analysed. Theconclusion was that the activity was localised to thegastro-intestinal tract and that the activity was considered to be atleast partly due to an in vivo degradation of theradiopharmaceutical. In paper V the use of MRI is evaluated. Theresults showed that a greater spread of lesions was found with MRIthan with RG. For MM patients the optimal sequences were SET1-weighted and TIR, performed without intra-venous contrast media.The conclusions are: ' - RG is the base for detecting Iytic skeletal lesions ' - BS is an auxiliary method for detecting suspected skeletal lesions - MS depicts the entire distribution of red bone marrow ' - MRI is the optimal method for depicting the entire patient, except for the bony skeleton. It has a high sensitivity but a low specificity. ISBN 91-628-2609-3