Department of Haematology, VU University Medical Centre, Amsterdam, The Netherlands.
Br J Haematol. 2013 Jul;162(1):50-61. doi: 10.1111/bjh.12346. Epub 2013 Apr 25.
This systematic review of studies compared magnetic resonance imaging (MRI), (18) F-fluorodeoxyglucose positron emission tomography (FDG-PET), FDG-PET with computerized tomography (PET-CT) and CT with whole body X-Ray (WBXR) or (whole body) CT in order to provide evidence-based diagnostic guidelines in multiple myeloma bone disease. A comprehensive search of 3 bibliographic databases was performed; methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria (score 1-14). Data from 32 directly comparative studies were extracted. The mean QUADAS score was 7·1 (3-11), with quality hampered mainly by a poor description of selection and execution criteria. All index tests had a higher detection rate when compared to WBXR, with up to 80% more lesions detected by the newer imaging techniques; MRI (1·12-1·82) CT (1·04-1·33), PET (1·00-1·58) and PET-CT (1·27-1·45). However, the modern imaging techniques detected fewer lesions in the skull and ribs. In a direct comparison CT and MRI performed equally with respect to detection rate and sensitivity. This systematic review supports the International Myeloma Working Group guidelines, which recommend that WBCT can replace WBXR. In our opinion, the equal performance of MRI also indicates that it is a valuable alternative. As lesions of the skull and ribs are underdiagnosed by modern imaging techniques we advise additional X-rays of these regions. The consequences of this approach are discussed.
本系统评价研究比较了磁共振成像（MRI）、（18）F-氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）、FDG-PET 与计算机断层扫描（PET-CT）以及 CT 与全身 X 射线（WBXR）或全身 CT，旨在为多发性骨髓瘤骨病提供基于证据的诊断指南。对 3 个文献数据库进行了全面搜索；使用诊断准确性研究质量评估（QUADAS）标准（评分 1-14）评估方法学质量。提取了 32 项直接比较研究的数据。QUADAS 评分的平均值为 7.1（3-11），主要由于选择和执行标准描述不佳而影响质量。与 WBXR 相比，所有指标检测技术的检出率均较高，较新的成像技术可多检出高达 80%的病变；MRI（1.12-1.82）、CT（1.04-1.33）、PET（1.00-1.58）和 PET-CT（1.27-1.45）。然而，现代成像技术在颅骨和肋骨处的病变检出率较低。在直接比较中，CT 和 MRI 的检出率和敏感度相当。本系统评价支持国际骨髓瘤工作组指南，建议 WBCT 可替代 WBXR。我们认为，MRI 的同等性能也表明其是一种有价值的替代方法。由于现代成像技术对颅骨和肋骨的病变诊断不足，我们建议对这些部位进行额外的 X 射线检查。讨论了这种方法的后果。
