Imaging tests can be important during the diagnosis and staging of multiple myeloma. This type of cancer occurs when lymphocytes (white blood cells) called plasma B cells begin to grow in a rapid, uncontrolled way.
Imaging tests like X-rays offer vital clues about the health of the bones and internal organs. They help diagnose new cases of myeloma and allow physicians to monitor treatment response in individuals who have already been diagnosed with the disease. Imaging tests can show everything from bone lesions to bone marrow involvement. Imaging tests can also help track the progress of conditions like osteoporosis that often accompany multiple myeloma.
Here’s what you need to know about some of the most common imaging tests used for people with multiple myeloma, including what they involve, what they tell your doctors, and what to expect before going in for testing.
X-rays are the most common imaging tests for people with multiple myeloma, especially when it comes to the initial diagnosis. These fast and painless tests create radiographic images (radiographs) of the inside of the body — especially the bones, which appear dense and opaque on X-ray imaging.
X-rays give your doctor important information about your bones because multiple myeloma can cause bone damage or even bone destruction. X-rays can show evidence of bone loss or thinning (also called osteoporosis or osteopenia), holes known as lytic lesions, or even fractures due to bone weakness.
X-rays don’t generally require special preparation. Most of the time, only the area of the body being X-rayed will be exposed to a radiation dose. Before undergoing X-rays, let your doctor know if you are pregnant (or if there is any possibility you might be pregnant) and if you have any metal inside your body, such as pins or a device like a pacemaker.
Computed tomography (CT) scans (also called CAT scans) are scans taken from multiple angles to offer a more complete image of body structures than conventional radiography. To do this, CT scans use tomography — a method of computer processing that creates cross-sectional images of body parts, including what is inside them.
Because multiple myeloma affects the bone marrow, CT scans can be very important for evaluating and treating the condition. Once the images of the cross-sections have been taken, the computer combines them to create detailed, three-dimensional images. Imaging specialists (radiologists) then read these images to check for abnormalities or tumors inside your bones.
Positron emission tomography (PET) scans involve injecting a radiotracer into the body. The radiotracer shows up on the resulting scans, helping to highlight the parts of your body the radiology specialist needs to see.
In a PET scan, the radiotracer is a radioactive sugar solution called fluorodeoxyglucose (FDG). Cells use FDG for energy, and cancer cells use more energy than healthy cells. When FDG uptake occurs, the cancerous cells glow, making them easier to see.
Magnetic resonance imaging (MRI) has been part of the diagnostic criteria for people with multiple myeloma since 2014. This imaging test uses magnetic fields instead of X-rays or tomography to create images of the body. MRI has extremely high sensitivity when it comes to soft tissue, making it invaluable for determining whether myeloma cells are present in the bone marrow (known as bone marrow infiltration).
The two most common types of MRI are closed or open MRI. A closed MRI is the one most people are familiar with — the machine is shaped like a long tube that is open on one end. An open MRI machine is open on all four sides. Both types of MRI are effective for finding evidence of multiple myeloma, including determining the size of tumors and locating myeloma lesions in the bones. You and your doctor can talk about both options to decide which MRI is the best one for you.
There is a third kind of MRI known as a whole-body (or full-body) MRI. This type of MRI was invented in 1977 and has been found to more successfully detect bone lesions in their early stages than whole-body, low-dose CT scans.
Although it has existed for more than 40 years, full-body MRI is still considered an emerging technology. Some of the reasons for that are concerns about standardization, availability, and especially cost. Most health insurance policies don’t cover whole-body MRIs. Out-of-pocket costs for this kind of scan can be anywhere from several hundred to several thousand dollars, making it out of reach for most people.
The right kind of imaging for you depends on many factors, including the stage of your myeloma, your medical concerns, and your preferences and needs. You and your doctor may discuss any or all of these imaging studies throughout your treatment for multiple myeloma. You and your doctor will decide together which kind of imaging is best for you.
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