The primary objective of the present prospective study was to compare the diagnostic performance of conventional radiography (CR) and whole-body low-dose computed tomography (WBLDCT) with a comparable radiation dose reconstructed using hybrid iterative reconstruction technique, in terms of the detection of bone lesions, skeletal fractures, vertebral compressions and extraskeletal findings. The secondary objective was to evaluate lesion attenuation in relation to its size. A total of 74 patients underwent same-day skeletal survey by CR and WBLDCT. In CR and WBLDCT, two readers assessed the number of osteolytic lesions at each region and stage according to the International Myeloma Working Group (IMWG) criteria. A single reader additionally assessed extraskeletal findings and their significance, the number of vertebral compressions and bone fractures. The radiation exposure was 2.7±0.9 mSv for WBLDCT and 2.5±0.9 mSv for CR (P=0.054). CR detected bone involvement in 127 out of 486 regions (26%; P<0.0001), confirmed by WBLDCT. CR underestimated the disease stage in 16% and overestimated it in 8% of the patients (P=0.0077). WBLDCT detected more rib fractures compared with CR (188 vs. 47; P<0.0001), vertebral compressions (93 vs. 67; P=0.010) and extraskeletal findings (194 vs. 52; P<0.0001). There was no correlation observed between lesion size (≥5 mm) and its attenuation (r=-0.006; P=0.93). The inter-observer agreement for the presence of osteolytic lesions was κ=0.76 for WBLDCT, and κ=0.55 for CR. The present study concluded that WBLDCT with hybrid iterative reconstruction technique demonstrates superiority to CR with an identical radiation dose in the detection of bone lesions, skeletal fractures, vertebral compressions and extraskeletal findings, which results in up- or downstaging in 24% patients according to the IMWG criteria. The attenuation of osteolytic lesions can be measured with the avoidance of the partial volume effect.

Department of Hematology 1st Faculty of Medicine Charles University and General University Hospital Prague 128 08 Prague Czech Republic

Department of Imaging Methods St Anne's University Hospital in Brno 656 91 Brno Czech Republic

Department of Radiology 1st Faculty of Medicine Charles University and General University Hospital Prague 128 08 Prague Czech Republic

Institute of Nuclear Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague 128 08 Prague Czech Republic

Radiology Unit IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori 1 47014 Meldola Italy

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