Complete Skeletal Bone Survey is used to identify the extent of bone disease caused by the myeloma and to evaluate any significant bone damage that may need immediate attention. X-rays of the hands, feet, arms, legs, back, pelvis, and skull will be obtained with low doses of radiation.
Bone Densitometry allows us to determine the status of bone strength and the amount of bone loss even when no symptoms exist. Bone densitometry testing also provides baseline information that is helpful for future treatment decisions. It is safe, painless, non-invasive, and does not require any special preparation. The patient lies down on the back with feet propped up, and no medication is needed unless the patient has new fractures that may hurt while lying on the back. The test involves delivery of a very low radiation exposure (about 1/5 of that of a chest x-ray). The forearm, hip, and spine usually are scanned. Bone densitometry testing takes about 30-40 minutes.
Magnetic Resonance Imaging (MRI) is a computerized scan of bone and bone marrow, conducted with computerized measurements of radio waves, that enables a close-up view of the bone marrow. It is more effective than standard x-rays for highlighting the presence of myeloma. MRI can identify the exact location and approximate volume of myeloma cells, and it can indicate whether the myeloma has spread. MRI is a safe procedure that does not involve x-rays, radiation, or surgery. In order to obtain clear images on the computer, dye may be intravenously administered to the patient. The patient is asked to lie still on a table that slides into the MRI machine while the computerized images are being obtained. The machine does not touch the patient, but it makes loud sounds while the images are being produced. Some patients may feel uneasy about the MRI, in which case the doctor might give the patient medication for relaxation before the procedure. A complete MRI for new patients takes about 3 hours, and a limited MRI for returning patients takes about an hour and a half. If lesions are seen during the MRI, the physician may order a fine-needle aspiration of the lesion for additional testing.
Positron Emission Tomography (PET) Scanning is used to show the presence of active cancer and other abnormalities that are too small to be shown by conventional methods. PET scanning enables detection of myeloma outside the bone marrow and evaluation of the presence of remaining myeloma after transplantation. Because PET uses a metabolic imaging technique, it works well to detect cancer cells, which are very metabolically active. PET is the only imaging technique that shows whether a tumor is benign or malignant, and reports in the scientific literature indicate that PET correctly identifies the detected lesions 97% of the time. It is an excellent test for monitoring recurrence of disease.
Patients cannot eat prior to having a PET scan, although they can have water and can take prescribed medications (except for insulin). Patients may experience slight discomfort from injection of radioactive dye. The scanning takes about 45 minutes.