title: Role of whole-body 64-slice multidetector computed tomography in treatment planning for multiple myeloma.
abstract: OBJECTIVE
  The authors evaluated the role of whole-body 64-slice multidetector computed tomography (WB-MDCT) in treatment planning for multiple myeloma.
  
  
  METHODS
  This was a prospective study of 28 consecutive patients with multiple myeloma (19 men, nine women; age range, 51-73 years; mean age, 60 years) who underwent WB-MDCT and conventional radiography (CR) of the skeleton. The images were interpreted for the presence of bony lesions, medullary lesions, fractures and extraosseous lesions. We evaluated any changes in treatment planning as a result of WB-MDCT findings.
  
  
  RESULTS
  WB-MDCT was superior to CR for detecting bony lesions (p=0.001), especially of the spine (p=0.001) and thoracic cage (p=0.006). WB-MDCT upstaged 14 patients, with a significant difference in staging (p=0.002) between WB-MDCT and CR. Medullary involvement either focal (n=6) or diffuse (n=3) had a positive correlation with the overall score (r=0.790) and stage (r=0.618) of disease. Spine fractures were better detected at WB-MDCT (n=4) than at CR (n=2). Extraosseous soft tissue lesions (n=7) were detected only at WB-MDCT. Findings detected at the WB-MDCT led to changes in the patient's treatment plan in 39% of cases. Upstaging of seven patients (25%) altered the medical treatment plan, and four of 28 (14%) patients required additional radiotherapy (7%) and vertebroplasty (7%).
  
  
  CONCLUSIONS
  We conclude that WB-MDCT has an impact on treatment planning and prognosis in patients with multiple myeloma, as it has high rate of detecting cortical and medullary bone lesions, spinal fracture and extraosseous lesions. This information may alter treatment planning in multiple myeloma due to disease upstaging and detection of spine fracture and extraosseous spinal lesions.
authors.affiliation: Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt. arazek@mans.edu.eg
authors.forename: Ahmed Abdel Khalek Abdel
authors.initials: AA
authors.lastname: Razek
authors.forename: Amany
authors.initials: A
authors.lastname: Ezzat
authors.forename: Emad
authors.initials: E
authors.lastname: Azmy
authors.forename: Nehal
authors.initials: N
authors.lastname: Tharwat
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009101:Multiple Myeloma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D010347:Patient Care Planning; D011446:Prospective Studies; D051598:Whole Body Imaging