What imaging should be used to diagnose myeloma bone disease?

What imaging should be used to diagnose myeloma bone disease? Since myeloma is not one single tumor, not even a metastatic tumor, as far as we know, some people think it might be. Since myeloma can be in the whole skeleton, we recommend a whole body imaging. So from really from the skull to the feet or to the lower extremities. And for assessing the bone disease, CT either as a CT alone or CT as part of a PET CT are the best, is the best technique to detect that. We compared CT with X-ray and we found that 25% are positive in CT while they're negative in X-ray. So CT and best would be whole body CT and to save the patient from too much irradiation, we call it whole body low dose CT. That's the best technique to assess bone disease in myeloma. When you are diagnosed with small ring multiple myeloma, it's very important to find out whether you have bone disease or not. For that reason, your doctor will do imaging of your skeleton. Ten years ago, or I would say several years ago, we still used the skeletal survey and many of you might have a skeletal survey. This is an X-ray of all your long bones, including the spine, the skull, and also the pelvis. But we know that an X-ray is not really very sensitive to find little holes in your bone, little lesions. And we know that especially in your pelvis and also in your spine, the sensitivity of an X-ray by a skeletal survey is very low. So that's why recently we started to use other techniques for the detection of bone disease, such as a CT scan. And usually what I recommend my patients when they are diagnosed with multiple myeloma, it's not quite clear whether they have small ring myeloma or overt multiple myeloma that requires treatment. Usually those patients have a PET CT in my practice. Alternatively, if your insurance doesn't pay for a PET CT or if you don't feel comfortable to have a PET CT that have a little bit more radiation exposure, CT scan, a whole body CT scan is a good alternative to detect the deglesions. And the International Myeloma Working Group is really establishing criteria for the diagnosis of bone disease and for the imaging. And one imaging technique that all patients should have and that will be included in the criteria will be a PET CT.