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Cicero KI, Banerjee R, Kwok M, Dima D, Portuguese AJ, Chen D, Chalian M, Cowan AJ. Illuminating the Shadows: Innovation in Advanced Imaging Techniques for Myeloma Precursor Conditions. Diagnostics (Basel) 2025; 15:215. [PMID: 39857099 PMCID: PMC11765077 DOI: 10.3390/diagnostics15020215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 01/06/2025] [Accepted: 01/16/2025] [Indexed: 01/27/2025] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM), the asymptomatic precursors to multiple myeloma, affect up to 5% of the population over the age of 40. Bone involvement, a myeloma-defining event, represents a major source of morbidity for patients. Key goals for the management of myeloma precursor conditions include (1) identifying patients at the highest risk for progression to MM with bone involvement and (2) differentiating precursor states from active myeloma requiring treatment. Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT with [18F]fluorodeoxyglucose (FDG) have improved sensitivity for the detection of myeloma bone disease compared to traditional skeletal surveys, and such advanced imaging also provides this field with better tools for detecting early signs of progression. Herein, we review the data supporting the use of advanced imaging for both diagnostics and prognostication in myeloma precursor conditions.
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Affiliation(s)
- Kara I. Cicero
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; (K.I.C.); (R.B.); (M.K.); (D.D.); (A.J.P.)
- Division of Hematology and Oncology, School of Medicine, University of Washington, Seattle, WA 98115, USA
| | - Rahul Banerjee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; (K.I.C.); (R.B.); (M.K.); (D.D.); (A.J.P.)
- Division of Hematology and Oncology, School of Medicine, University of Washington, Seattle, WA 98115, USA
| | - Mary Kwok
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; (K.I.C.); (R.B.); (M.K.); (D.D.); (A.J.P.)
- Division of Hematology and Oncology, School of Medicine, University of Washington, Seattle, WA 98115, USA
| | - Danai Dima
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; (K.I.C.); (R.B.); (M.K.); (D.D.); (A.J.P.)
- Division of Hematology and Oncology, School of Medicine, University of Washington, Seattle, WA 98115, USA
| | - Andrew J. Portuguese
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; (K.I.C.); (R.B.); (M.K.); (D.D.); (A.J.P.)
- Division of Hematology and Oncology, School of Medicine, University of Washington, Seattle, WA 98115, USA
| | - Delphine Chen
- Department of Radiology, University of Washington, Seattle, WA 98115, USA; (D.C.); (M.C.)
| | - Majid Chalian
- Department of Radiology, University of Washington, Seattle, WA 98115, USA; (D.C.); (M.C.)
| | - Andrew J. Cowan
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; (K.I.C.); (R.B.); (M.K.); (D.D.); (A.J.P.)
- Division of Hematology and Oncology, School of Medicine, University of Washington, Seattle, WA 98115, USA
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Spinnato P, Rimondi E, Facchini G. Percutaneous CT-Guided Biopsy of the Craniovertebral Junction: Safety, Diagnostic Yield, and Technical Notes. Diagnostics (Basel) 2022; 12:diagnostics12010168. [PMID: 35054335 PMCID: PMC8774633 DOI: 10.3390/diagnostics12010168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 02/01/2023] Open
Abstract
The craniovertebral junction defined as the occiput, the atlas, and the axis is a complex bony region that contains vital neural and vascular structures. We report the experience of a single academic institution regarding CT-guided biopsy of this skeletal region. We reviewed all of the CT-guided biopsies performed in our department, completed in the craniovertebral junction. We collected data in regard to biopsy procedures, patients’ vital statistics, and histopathological diagnosis. In total, 16 patients (8M and 8F; mean age 52; range 16–86 years old) were included in this series. In eight patients, the lesions were located in the atlas vertebra (8/16—50%), in six patients in the axis (37.5%), and in two patients in the occiput (12.5%). No complications were observed during or after the procedures. All of the procedures were technically successful. The biopsy was diagnostic in 13/16 patients (81.3%): four metastatic lesions (25%—three breast and one prostate cancers), four multiple myeloma bone lesions (25%), three aneurismal bone cysts (18.8%), one aggressive hemangioma (6.3%), and one pseudogout (6.3%). Moreover, in two-thirds (66.6%) of non-diagnostic histological reports, malignancies were excluded. CT-guided percutaneous biopsy is a safe tool and allows obtaining a histological diagnosis, in most cases, even in the most delicate site of the human skeleton—the craniovertebral junction.
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