What is the role of technetium-99m (99mTc) scintigraphy 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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Myeloma is a disease that results in overactivity of osteoclasts, with resultant liberation of bone and suppression of osteoblasts. Nuclear medicine bone scans rely on osteoblastic activity (bone formation) for diagnosis. As such, standard technetium-99m (99mTc) bone scans have underestimated the extent and severity of disease and should not be used routinely. [34]  The false-negative rate of standard 99mTc bone scintigraphy in diagnosing multiple myeloma is as high as 50%. Scans may be positive with normal radiographs, requiring another test for confirmation.

However, a study by Erten et al appeared to demonstrate that whole body scintigraphy with 99mTc 2-methoxy-isobutyl-isonitrile (99mTc-MIBI) may be a useful adjunct for the diagnostic imaging of multiple myeloma. [35] The authors reported that in 24 patients, 99mTc-MIBI demonstrated the extent and intensity of bone marrow infiltration as well as MRI did, and they suggested that 99mTc-MIBI may serve as an alternative to MRI in cases in which MRI is not readily available or when its use is limited. Another, larger study by Mele et al of 397 scintigrams showed a sensitivity of 77% and a specificity of 86% for MIBI. [36]

Khalafallah et al in 2013 reported that MIBI predicted overall disease outcome and mortality better than whole body MRI in their study of 62 patients. [37]

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