Is a bone scan an appropriate study for a 65 year old with multiple myeloma?
Bone scans generally are not sensitive for lytic bone lesions, and patients who show findings of multiple myeloma or other lytic osseous abnormalities on CT or radiography should not be referred for a bone scan. Instead, evaluation with either a bone survey using multiple radiographs, a magnetic resonance imaging (MRI) scan, or an 18 F-fluorodeoxyglucose (FDG) PET/CT scan is performed. Patients with certain cancers that lead to mixed lytic and blastic osseous metastases may still benefit from a bone scan. Also, patients with multiple myeloma with lytic disease in weight-bearing bones that are susceptible to pathologic fracture may still benefit from a bone scan, as a fracture would show up as a focus of increased radiotracer uptake. If a nuclear medicine scan is needed to better detect or characterize the osseous lesions, FDG PET/CT is the most appropriate choice as this directly reveals sites of cancer in the bone marrow whether or not there is associated bone lysis or sclerosis rather than the indirect effects of cancer upon the surrounding bones.