Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Radiol Med. 2013 Aug;118(5):799-805. doi: 10.1007/s11547-012-0880-0. Epub 2012 Sep 17.
The authors evaluated the role of whole-body 64-slice multidetector computed tomography (WB-MDCT) in treatment planning for multiple myeloma.
This was a prospective study of 28 consecutive patients with multiple myeloma (19 men, nine women; age range, 51-73 years; mean age, 60 years) who underwent WB-MDCT and conventional radiography (CR) of the skeleton. The images were interpreted for the presence of bony lesions, medullary lesions, fractures and extraosseous lesions. We evaluated any changes in treatment planning as a result of WB-MDCT findings.
WB-MDCT was superior to CR for detecting bony lesions (p=0.001), especially of the spine (p=0.001) and thoracic cage (p=0.006). WB-MDCT upstaged 14 patients, with a significant difference in staging (p=0.002) between WB-MDCT and CR. Medullary involvement either focal (n=6) or diffuse (n=3) had a positive correlation with the overall score (r=0.790) and stage (r=0.618) of disease. Spine fractures were better detected at WB-MDCT (n=4) than at CR (n=2). Extraosseous soft tissue lesions (n=7) were detected only at WB-MDCT. Findings detected at the WB-MDCT led to changes in the patient's treatment plan in 39% of cases. Upstaging of seven patients (25%) altered the medical treatment plan, and four of 28 (14%) patients required additional radiotherapy (7%) and vertebroplasty (7%).
We conclude that WB-MDCT has an impact on treatment planning and prognosis in patients with multiple myeloma, as it has high rate of detecting cortical and medullary bone lesions, spinal fracture and extraosseous lesions. This information may alter treatment planning in multiple myeloma due to disease upstaging and detection of spine fracture and extraosseous spinal lesions.
作者评估全身 64 层多层螺旋 CT（WB-MDCT）在多发性骨髓瘤治疗计划中的作用。
这是一项对 28 例连续多发性骨髓瘤患者（19 例男性，9 例女性；年龄 51-73 岁；平均年龄 60 岁）进行的前瞻性研究，这些患者均接受了全身 MDCT 和骨骼常规放射摄影（CR）检查。对骨骼病变、骨髓病变、骨折和骨外病变的存在情况进行了图像解读。我们评估了 WB-MDCT 结果对治疗计划的任何改变。
WB-MDCT 比 CR 更能检测到骨骼病变（p=0.001），尤其是脊柱（p=0.001）和胸壁（p=0.006）。WB-MDCT 将 14 例患者分期上调，WB-MDCT 和 CR 之间的分期差异具有统计学意义（p=0.002）。局灶性（n=6）或弥漫性（n=3）骨髓受累与疾病的总评分（r=0.790）和分期（r=0.618）呈正相关。脊柱骨折在 WB-MDCT 上（n=4）比在 CR 上（n=2）更容易检测到。骨外软组织病变（n=7）仅在 WB-MDCT 上检测到。在 WB-MDCT 上发现的病变导致 39%的患者治疗计划发生改变。7 例患者（25%）分期上调改变了治疗方案，28 例患者中有 4 例（14%）需要额外的放射治疗（7%）和椎体成形术（7%）。
我们得出结论，全身 64 层 MDCT 对多发性骨髓瘤患者的治疗计划和预后有影响，因为它能高度检测皮质和骨髓骨病变、脊柱骨折和骨外病变。由于疾病分期上调以及脊柱骨折和骨外脊柱病变的检测，这些信息可能会改变多发性骨髓瘤的治疗计划。
