IT IS generally accepted that approximately 25% to 50% of the trabecular spongiosum in the vertebrae must be resorbed or destroyed to be detected by conventional roentgenography.1 Radionuclide bone scanning is more sensitive in detecting focal osseous destruction based on the dynamic state of reactive osteoblastic activity and/or increased regional bone blood flow. Specifically, however, in multiple myeloma, bone scans are frequently falsely negative, and conventional roentgenography continues to be the principal imaging modality to assess skeletal involvement.2-4 This case illustrates a potentially sensitive method of detecting early skeletal destruction in multiple myeloma using high-resolution computed tomography (CT).
Report of a Case
A 43-year-old woman with known multiple myeloma had low-back pain and sciatica. Conventional roentgenograms of the lumbosacral spine demonstrated mild generalized demineralization but no focal abnormalities (Fig 1); CT of the lumbar spine was performed to evaluate lumbar disk disease. Serial scans disclosed a protruding disk