What are the limitations of a skeletal survey in the diagnosis of multiple myeloma?

Updated: Mar 15, 2019
  • Author: Michael E Mulligan, MD; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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The skeletal survey has limitations. Most importantly, a large number of patients diagnosed with asymptomatic myeloma may have radiographically occult myeloma deposits. At least 30% cancellous bone loss is required to visualize an intramedullary destructive process, such as myeloma, with radiographs and no extramedullary disease can be shown. The value in relapsing disease is limited because lesions persist post treatment, which restricts the capacity to distinguish between old, inactive skeletal lesions and new, active ones. [18]  In addition, myeloma is a disease of older patients; it can present with diffuse demineralization, which may be indistinguishable from the pattern found in patients with simple senile osteoporosis.

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