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Do you need a CT scan or is an MRI enough? Why don't we use CT guided bone marrow biopsies?
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• April 30, 2020
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Healthtree contact Jesus Berdeja, MD, Specialist

Jesus Berdeja, MD, Specialist

Tennessee Oncology - Nashville Southern Hills Clinic

Transcript
What imaging should I be getting to assess bone disease? I would say it depends on what you're looking for and also at what stage of the disease we're talking about. So in terms of assessing whether you have a lesion or not, MRI is actually much more sensitive to find those lesions in the bone and bone marrow itself. So if you had a MRI that is negative, you do not need a CT scan. Having said that, MRI can be difficult to do in all patients and the whole body. And so sometimes CT scan is easier and is a much faster tool to be able to do more frequently. Oftentimes we do CT PET and the difference here is the CT scan is basically a much more sensitive x-ray to look at your bones, looking for those lesions and looking for those punched out holes in your bones. And the PET is a functional study where we look to see if any of those lesions take up any of the sensor that often translates to an active lesion or active tumor. Because what happens is as we treat myeloma, the CTs and the x-rays may not change significantly. What we're looking for is that there's no new development of new lesions, but it doesn't tell us if something is a treated lesion or an active lesion. Whereas the PET scan, if it were positive before, you can use to follow the disease. And as you go on through treatment, if the PET basically becomes negative, then you know that those lesions are no longer active. And so PET CT is much better at using for following the disease than x-rays, CT without PET, and even MRI. It turns out that there may be a difference in your regular myeloma cells that are found throughout your bone marrow versus the cells that learn how to nest together and make a tumor. You may get different information from both, which is why if you come in, let's say you have back pain and you get a CT or MRI and it shows a lesion and a compression fracture with a lesion and you get a biopsy directly there, and we see that it's a plasma cytoma and your blood tests tell us this is multiple myeloma, we will still do a bone marrow biopsy. And the reason for that is because you can actually have just an isolated plasma cytoma that may not be full-blown myeloma versus myeloma that should be a much more diffused disease, but also because you might learn different genetics from the cells that are in your bone marrow blindly versus the ones that make lesions.

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