Abstract
This thesis concerns radiological evaluation of bone marrow transplanted multiple myeloma (MM) patients. The diagnostic radiological modalities evaluated are: conventional radiography (RG); bone scintigraphy (BS); bone marrow scintigraphy (MS); magnetic resonance imaging (MRI). The 242 included examinations are: 91 RG, 85BS, 33 MS and 33 MRI. The 42 patients included have been treated with chemotherapy as well as with total body irradiation before bone marrow transplantation.
In paper I RG is compared to BS with correlation to clinical data. The results showed that RG depicted more lesions than BS, while BS depicted fractures at sites not optimally seen on RG. RG and BS gave no information of prognostic value. In paper II MS is compared to RG and BS. The results showed that MS only gave a marginal increase of information on focal lesions. MS was superior for depicting the sites of prior focal radiotherapy. MS showed that the majority of the patients had peripheral red bone marrow expansion. At MS, a monoclonal antibody radiopharmaceutical (which is specific for the granulopoietic system) was superior to a nanocolloid (which is specific for the reticulo-endothelial system) for the detection of lesions.
In paper III dynamic registration at BS and MS is evaluated. The results showed that no additional information was revealed at dynamic registrations when these were compared to static registrations or to RG and MRI. In paper IV the location and cause of radionuclide activity noted occasionally in the abdominal region at MS is analysed. The conclusion was that the activity was localised to the gastro-intestinal tract and that the activity was considered to be at least partly due to an in vivo degradation of the radiopharmaceutical. In paper V the use of MRI is evaluated. The results showed that a greater spread of lesions was found with MRI than with RG. For MM patients the optimal sequences were SET1-weighted and TIR, performed without intra-venous contrast media.
The conclusions are:・RG is the base for detecting Iytic skeletal lesions;・BS is an auxiliary method for detecting suspected skeletal lesions;・MS depicts the entire distribution of red bone marrow; and・MRI is the optimal method for depicting the entire patient, except for the bony skeleton. It has a high sensitivity but a low specificity.
