Gleeson T G, Moriarty J, Shortt C P, Gleeson J P, Fitzpatrick P, Byrne B, McHugh J, O'Connell M, O'Gorman P, Eustace S J
Department of Radiology and Diagnostic Imaging, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland.
Skeletal Radiol. 2009 Mar;38(3):225-36. doi: 10.1007/s00256-008-0607-4. Epub 2008 Nov 14.
The aim of the study is to assess the feasibility of whole-body low-dose computed tomography (WBLDCT) in the diagnosis and staging of multiple myeloma and compare to skeletal survey (SS), using bone marrow biopsy and whole-body magnetic resonance imaging (WBMRI; where available) as gold standard.
Patients referred over an 18-month period for investigation of suspected multiple myeloma or restaging of myeloma were randomized to undergo one of two WBLDCT protocols using high kVp, low mAs technique (140 kVp, 14 mAs; or 140 kVp, 25 mAs). Recent WBMRI scans were reviewed in 23 cases. Each imaging modality was assessed by two radiologists in consensus and scored from 0-3 (0 = normal, 1 = 1-4 lesions, 2 = 5-20 lesions, 3 >or= 20 lesions/diffuse disease) in ten anatomical areas. Overall stage of disease, image quality score, and the degree of confidence of diagnosis were recorded. Diagnostic accuracy of skeletal survey and WBLDCT were determined using a gold standard of bone marrow biopsy and distribution of disease was compared to WBMRI.
Thirty-nine patients were evaluated. WBLDCT identified more osteolytic lesions than skeletal survey with a greater degree of diagnostic confidence and led to restaging in 18 instances (16 upstaged, two downstaged). In those with recent WBMRI, distribution of disease on WBLDCT showed superior correlation with WBMRI when compared with SS. Overall reader impression of stage on WBLDCT showed significant correlation with WBMRI (kappa = 0.454, p < 0.05). WBLDCT provided complementary information to WBMRI in nine patients with normal marrow signal following treatment response, but which were shown to have diffuse residual cortical abnormalities on CT.
WBLDCT at effective doses lower than previously reported, is superior to SS at detecting osteolytic lesions and at determining overall stage of multiple myeloma, and provides complementary information to WBMRI.
本研究旨在评估全身低剂量计算机断层扫描（WBLDCT）在多发性骨髓瘤诊断和分期中的可行性，并与骨骼X线检查（SS）进行比较，以骨髓活检和全身磁共振成像（WBMRI，如可用）作为金标准。
在18个月期间转诊来调查疑似多发性骨髓瘤或骨髓瘤再分期的患者被随机分为两组，接受两种使用高千伏、低毫安技术的WBLDCT方案之一（140 kVp，14 mAs；或140 kVp，25 mAs）。回顾了23例近期的WBMRI扫描。两名放射科医生共同对每种成像方式进行评估，并在十个解剖区域从0至3分进行评分（0 = 正常，1 = 1至4个病灶，2 = 5至20个病灶，3≥20个病灶/弥漫性疾病）。记录疾病的总体分期、图像质量评分和诊断的置信度。使用骨髓活检的金标准确定骨骼X线检查和WBLDCT的诊断准确性，并将疾病分布与WBMRI进行比较。
评估了39例患者。WBLDCT比骨骼X线检查发现更多溶骨性病灶，诊断置信度更高，并导致18例分期改变（16例分期上调，2例分期下调）。在近期进行WBMRI检查的患者中，与骨骼X线检查相比，WBLDCT上的疾病分布与WBMRI显示出更好的相关性。WBLDCT上读者对分期的总体印象与WBMRI显示出显著相关性（kappa = 0.454，p < 0.05）。在9例治疗反应后骨髓信号正常但CT显示有弥漫性残留皮质异常的患者中，WBLDCT为WBMRI提供了补充信息。
有效剂量低于先前报道的WBLDCT在检测溶骨性病灶和确定多发性骨髓瘤的总体分期方面优于骨骼X线检查，并为WBMRI提供补充信息。
