P-065: WHOLE BODY LOW DOSE CT (WBLDCT), AS INITIAL IMAGING MODALITY FOR NEWLY DIAGNOSED MULTIPLE MYELOMA PATIENTS: EXPERIENCE FROM A TERTIARY CARE CENTER IN NORTH INDIA

Introduction: For decades, the main imaging modality to detect bony lesions in multiple myeloma was whole body skeletal survey by X ray. However, x ray had limited sensitivity and specificity. Hence, CT, MRI and PET CT came to Fore-front with better sensitivity and specificity as well as detection of extramedullary soft tissue disease. The disadvantage with CT was the high radiation dose required; hence, whole body low dose CT protocols were developed and have become the one of the investigation of choice to detect lytic lesions in multiple myeloma along with whole body MRI. We herein present Whole body low dose CT (WBLDCT) findings in Serial patients of plasma cell dyscrasia for past 1 year.

Methods: We retrospectively collected the data from Hospital information system (HIS) & Radiology department for our serial patients of plasma cell dyscrasia from Jan 2022 to Dec 2022

Results: The patients included were 38, out of which 29 cases of multiple myeloma, 5 cases of MGUS, 1 case of smoldering multiple myeloma, 1 case of non secretory myeloma, 1 case of plasmacytoma and 1 case of plasma cell leukemia. There was presence of lytic lesions in 20 out of the 29 patients of multiple myeloma. The most commonly affected site was vertebra (36.8%) followed by sacrum and pelvis (28.9%), ribs and sternum (26.3%), skull (21.1%) and long bones (21.1%). In 7 patients (18.4%), lytic lesions were involving 3 or more sites. In 4 patients, bone lesions were the only CRAB feature present, which upgraded the diagnosis from SMM to multiple myeloma. Extramedullary disease was detected in 5 patients (13.2%). 17 out of the 20 patients (85%) with bone lesions were ISS Stage 3 whereas only 11 such patients (55%) belonged to R ISS Stage 3. We further analyzed the 7 patients who had 3 or more lytic lesions. Extramedullary disease was present in only 2 of the 7 patients. On serum immunofixation, 3 of these patients were IgG kappa, 2 were kappa light chain, 1 was IgA lambda and 1 was lambda light chain. FISH panel did not reveal any mutations in 5 patients while the rest of the 2 patients had gain 1q. All of the 7 patients belonged to ISS Stage 3. 4 patients had R ISS Stage 2 while 3 patients had R ISS Stage 3.

Conclusions: Imaging plays a very important role in the initial diagnosis and Surveillance of multiple myeloma patients. Although our study was limited by a small sample size, this is one the first studies describing Whole body low dose whole body CT in myeloma patients in Indian Scenario.