动态对比增强超声在髓外骨髓瘤特征描述和监测中的作用：与血清学数据的比较。

Role of dynamic contrast-enhanced sonography for characterization and monitoring of extramedullary myeloma: comparison with serologic data.

机构信息

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

出版信息

J Ultrasound Med. 2013 Oct;32(10):1777-88. doi: 10.7863/ultra.32.10.1777.

DOI:10.7863/ultra.32.10.1777

PMID:24065259

Abstract

OBJECTIVE

To measure blood perfusion in extramedullary myeloma by contrast-enhanced sonography, correlate it with specific hematologic parameters, and determine their utility for local and systemic response monitoring.

METHODS

Twenty-five consecutive patients (14 male and 11 female; median age, 68 years) with extramedullary myeloma were included. After intravenous administration of 2.4 mL of sulfur hexafluoride, extramedullary myeloma masses were examined for 60 seconds. All patients underwent contrast-enhanced sonography at baseline, and 15 were monitored additionally (3 weeks during therapy). Average peak perfusion, regional blood flow (RBF), and regional blood volume (RBV) were calculated. Baseline perfusion parameters were compared with short-term follow-up sonographic data and serologic biomarkers (M gradient). For validation of extramedullary myeloma and systemic myeloma, patients underwent midterm (<3 months) imaging and serologic diagnosis.

RESULTS

Patients with baseline β2-microglobulin (B2M) greater than 3.5 mg/L (n = 17) showed higher perfusion parameters compared with baseline B2M less than 3.5 mg/L (n = 8). At short-term follow-up, patients were classified by serologic criteria as responders (n = 9) and nonresponders (n = 6) and by sonographic criteria as responders (n = 10) and nonresponders (n = 5). In sonographic responders, mean peak, RBV, and RBF dropped from 59.13, 1446.09, and 71.52 (artificial units) at baseline to 29.30, 364.19, and 34.64 at follow-up (P < .05), whereas in nonresponders, perfusion parameters increased from 33.18, 789.82, and 36.92 at baseline to 51.14, 1491.06, and 65.34 at follow-up (P > .05). Prediction of a midterm course of systemic myeloma using serologic data yielded sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.66, 0.77, 0.66, and 0.77, whereas sonographic results (judged by RBV) yielded values of 0.66, 0.55, 0.5, and 0.71. Separate prediction of a local (extramedullary myeloma) response by sonography yielded sensitivity, specificity, PPV, and NPV of 0.8, 1.0, 1.0, and 0.71.

CONCLUSIONS

Contrast-enhanced sonography is a valuable tool for short-term monitoring of the treatment response in extramedullary myeloma.

摘要

目的

通过对比增强超声测量骨髓外骨髓瘤的血流灌注，将其与特定的血液学参数相关联，并确定其在局部和全身反应监测中的效用。

方法

纳入 25 例连续的骨髓外骨髓瘤患者（14 名男性和 11 名女性；中位年龄 68 岁）。静脉注射 2.4 毫升六氟化硫后，对骨髓外骨髓瘤肿块进行 60 秒检查。所有患者均在基线时进行对比增强超声检查，其中 15 例在治疗期间进行了额外监测（3 周）。计算平均峰值灌注、局部血流（RBF）和局部血容量（RBV）。将基线灌注参数与短期随访超声数据和血清学标志物（M 梯度）进行比较。为了验证骨髓外骨髓瘤和全身骨髓瘤，患者在中期（<3 个月）进行影像学和血清学诊断。

结果

基线β2-微球蛋白（B2M）大于 3.5mg/L 的患者（n=17）与基线 B2M 小于 3.5mg/L 的患者（n=8）相比，灌注参数更高。在短期随访中，根据血清学标准将患者分为应答者（n=9）和无应答者（n=6），根据超声标准分为应答者（n=10）和无应答者（n=5）。在超声应答者中，平均峰值、RBV 和 RBF 从基线时的 59.13、1446.09 和 71.52（人工单位）降至随访时的 29.30、364.19 和 34.64（P<.05），而在无应答者中，灌注参数从基线时的 33.18、789.82 和 36.92 增加到随访时的 51.14、1491.06 和 65.34（P>.05）。使用血清学数据预测中期系统性骨髓瘤的发生，其敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 0.66、0.77、0.66 和 0.77，而超声结果（以 RBV 判断）分别为 0.66、0.55、0.5 和 0.71。单独通过超声（根据 RBV 判断）预测局部（骨髓外骨髓瘤）反应的敏感性、特异性、PPV 和 NPV 分别为 0.8、1.0、1.0 和 0.71。