Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom.
Department of Radiology, University College Hospital, London, United Kingdom.
PLoS One. 2020 Jan 30;15(1):e0228424. doi: 10.1371/journal.pone.0228424. eCollection 2020.
To identify the whole-body MRI (WB-MRI) image type(s) with the highest value for assessment of multiple myeloma, in order to optimise acquisition protocols and read times.
Thirty patients with clinically-suspected MM underwent WB-MRI at 3 Tesla. Unenhanced Dixon images [fat-only (FO) and water-only (WO)], post contrast Dixon [fat-only plus contrast (FOC) and water-only plus contrast (WOC)] and diffusion weighted images (DWI) of the pelvis from all 30 patients were randomised and read by three experienced readers. For each image type, each reader identified and labelled all visible myeloma lesions. Each identified lesion was compared with a composite reference standard achieved by review of a complete imaging dataset by a further experienced consultant radiologist to determine truly positive lesions. Lesion count, true positives, sensitivity, and positive predictive value were determined. Time to read each scan set was recorded. Confidence for a diagnosis of myeloma was scored using a Likert scale. Conspicuity of focal lesions was assessed in terms of percent contrast and contrast to noise ratio (CNR).
Lesion count, true positives, sensitivity and confidence scores were significantly higher when compared to other image types for DWI (P<0.0001 to 0.003), followed by WOC (significant for sensitivity (P<0.0001 to 0.004), true positives (P = 0.003 to 0.049) and positive predictive value (P< 0.0001 to 0.006)). There was no statistically significant difference in these metrics between FO and FOC. Percent contrast was highest for WOC (P = 0.001 to 0.005) and contrast to noise ratio (CNR) was highest for DWI (P = 0.03 to 0.05). Reading times were fastest for DWI across all observers (P< 0.0001 to 0.014).
Observers detected more myeloma lesions on DWI images and WOC images when compared to other image types. We suggest that these image types should be read preferentially by radiologists to improve diagnostic accuracy and reporting efficiency.
确定全身磁共振成像（WB-MRI）中最适合评估多发性骨髓瘤的图像类型，以优化采集方案和阅读时间。
30 例临床疑似多发性骨髓瘤患者在 3T 磁共振仪上进行 WB-MRI 检查。对所有 30 例患者的未增强 Dixon 图像（仅脂肪[FO]和仅水[WO]）、增强后 Dixon 图像（FO+对比剂和 WO+对比剂）和骨盆扩散加权图像（DWI）进行随机和三位有经验的读者阅读。对于每种图像类型，每位读者均识别并标记所有可见骨髓瘤病灶。将每个识别出的病灶与另一位经验丰富的顾问放射科医师对完整成像数据集的审查结果进行比较，以确定真正的阳性病灶。确定病灶计数、真正的阳性病灶、灵敏度和阳性预测值。记录每个扫描集的阅读时间。使用李克特量表对诊断骨髓瘤的信心进行评分。根据病灶对比度和对比噪声比（CNR）评估局灶性病灶的显影程度。
与其他图像类型相比，DWI 的病灶计数、真正的阳性病灶、灵敏度和置信度评分显著更高（P<0.0001 至 0.003），其次是 WOC（灵敏度（P<0.0001 至 0.004）、真正的阳性病灶（P=0.003 至 0.049）和阳性预测值（P<0.0001 至 0.006）差异有统计学意义）。FO 和 FOC 之间在这些指标上没有统计学差异。WOC 的病灶对比度最高（P=0.001 至 0.005），DWI 的对比噪声比（CNR）最高（P=0.03 至 0.05）。所有观察者的 DWI 阅读时间最快（P<0.0001 至 0.014）。
与其他图像类型相比，观察者在 DWI 图像和 WOC 图像上检测到更多的骨髓瘤病灶。我们建议放射科医生优先阅读这些图像类型，以提高诊断准确性和报告效率。
