全身低剂量多排 CT 能否排除意义未明的单克隆丙种球蛋白血症（MGUS）患者骨髓瘤骨病的存在？

Can whole-body low-dose multidetector CT exclude the presence of myeloma bone disease in patients with monoclonal gammopathy of undetermined significance (MGUS)?

机构信息

Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.

出版信息

Acad Radiol. 2012 Jan;19(1):89-94. doi: 10.1016/j.acra.2011.09.016.

DOI:10.1016/j.acra.2011.09.016

PMID:22142681

Abstract

RATIONALE AND OBJECTIVES

To determine the benefit of using whole-body low-dose computed tomography (WBLD-CT) in patients with monoclonal gammopathy of undetermined significance (MGUS) for exclusion of multiple myeloma (MM) bone disease.

MATERIALS AND METHODS

Seventy-one consecutive patients with confirmed MGUS (as defined by the latest criteria of the International Myeloma Working Group) who underwent WBLD-CT for diagnosis were identified retrospectively by a search of our institution's electronic medical record database (2002-2009). Patients were classified as low-risk or intermediate/high-risk and followed over a ≥2-year period with additional CT imaging and/or laboratory parameters. Presence of osteolysis, medullary, or extramedullary abnormalities compatible with involvement by MM was recorded. A diffuse or focal increase in medullary density to Hounsfield unit (HU) values >20 HU/>0 HU was considered suspicious for bone marrow infiltration if no other causes identifiable.

RESULTS

The presence of osteolysis was excluded in all 71 patients with MGUS at initial diagnosis and patients were surveilled for ≥2 years. Lytic changes were observed at follow-up in 1/71 patients that progressed to MM and were detectable via WBLD-CT at an early stage (even before a significant rise in M-protein was recorded). In 3/71 patients with MGUS (4%) suspicious bone marrow attenuation values were measured, disclosing disease progression to smoldering myeloma in another patient and false-positive results in 2/71 patients. Bone marrow attenuation assessment resulted in a specificity and negative predictive value of 97%, respectively. No significant difference with respect to bone marrow attenuation was observed in patients with low-risk MGUS versus intermediate- to high-risk MGUS. One of 71 patients showed serologic disease progression to active MM without bone abnormalities detectable.

CONCLUSION

WBLD-CT reliably excludes findings compatible with myeloma in MGUS and thereby complements hematologic laboratory analysis.

摘要

背景和目的

为了明确全身体积低剂量 CT（WBLD-CT）在排除多发性骨髓瘤（MM）骨病变中的应用对意义未明的单克隆丙种球蛋白病（MGUS）患者的获益。

材料和方法

通过检索我们机构的电子病历数据库（2002-2009 年），回顾性地确定了 71 例经证实的 MGUS（根据国际骨髓瘤工作组的最新标准定义）患者，这些患者接受 WBLD-CT 进行诊断。患者分为低危或中高危，并在≥2 年的时间内通过额外的 CT 成像和/或实验室参数进行随访。记录与 MM 受累一致的溶骨性、骨髓内或骨髓外异常。弥漫性或局灶性骨髓密度增加至>20 HU/>0 HU 的 Hounsfield 单位（HU）值被认为是骨髓浸润的可疑表现，如果没有其他可识别的原因。

结果

71 例 MGUS 患者在初始诊断时均排除了溶骨性病变，且患者随访时间≥2 年。在 1/71 例患者中观察到随访时出现溶骨性改变，该患者进展为 MM，并且在早期（甚至在记录到 M 蛋白显著升高之前）即可通过 WBLD-CT 检测到。在 3/71 例 MGUS（4%）患者中测量到可疑的骨髓衰减值，揭示另一位患者进展为冒烟型骨髓瘤，2/71 例患者出现假阳性结果。骨髓衰减评估的特异性和阴性预测值分别为 97%。低危 MGUS 患者与中高危 MGUS 患者的骨髓衰减无显著差异。71 例患者中有 1 例出现血清学疾病进展为活动性 MM，而无骨骼异常可检测。