Computed Tomography in the Early Detection of Skeletal Involvement With Multiple Myeloma

IT IS generally accepted that approximately 25% to 50% of the trabecular spongiosum in the vertebrae must be resorbed or destroyed to be detected by conventional roentgenography. 1 Radionuclide bone scanning is more sensitive in detecting focal osseous destruction based on the dynamic state of reactive osteoblastic activity and/or increased regional bone blood flow. Specifically, however, in multiple myeloma, bone scans are frequently falsely negative, and conventional roentgenography continues to be the principal imaging modality to assess skeletal involvement. 2-4 This case illustrates a potentially sensitive method of detecting early skeletal destruction in multiple myeloma using high-resolution computed tomography (CT). Report of a Case A 43-year-old woman with known multiple myeloma had low-back pain and sciatica. Conventional roentgenograms of the lumbosacral spine demonstrated mild generalized demineralization but no focal abnormalities (Fig 1); CT of the lumbar spine was performed to evaluate lumbar disk disease. Serial scans disclosed a protruding disk