Wang Tiantian, Peng Xin, Qiao Wenli, Xing Yan, Yang Jiqin, Zhao Jinhua
Department of Nuclear Medicine, Shanghai General Hospital of Nanjing Medical University, Shanghai 200080, P.R. China.
Department of Radiology, Tengzhou Central People's Hospital, Tengzhou, Shandong 277500, P.R. China.
Mol Clin Oncol. 2020 Jul;13(1):13-18. doi: 10.3892/mco.2020.2039. Epub 2020 Apr 30.
PET/CT has been identified as one of the routine methods for the assessment of multiple myeloma (MM) bone marrow infiltration. In the routine method of performing PET/CT, the 18F-Fludeoxyglucose (F-FDG) uptake in this disease is often used in the assessment of this condition, however CT diagnosis is not currently commonly used. The aim of the present study was to investigate the importance of CT in PET/CT for assessing diffuse infiltration (DI) of bone marrow in MM. MRI was used as a control in the present study, which is the gold standard for assessing DI of bone marrow and is divided into 3 levels: Mild, moderate and severe DI. Subsequently, a total of four combinations of PET and CT results were listed using the enumeration method for the evaluation of DI in the bone marrow. These combinations were respectively compared with the three levels of MR imaging to screen the most consistent method. The concordances of the new method and routine F-FDG PET/CT for the assessment of DI with MR imaging were compared using the McNemar test, respectively. The results of the DI assessment from the two methods were verified by performing Durie-Salmon (D-S) PLUS staging. Compared with MR imaging, the results were as follows: PET and CT exhibited negative results, suggesting mild DI; one of them was positive, suggesting moderate DI; and two were positive, suggesting severe DI. The results of concordance between two methods (new and routine) and MR imaging are indicated as follows: For the new method, McNemar test, P=0.513 and Kappa=0.745; for the routine F-FDG PET/CT method, McNemar test, P=0.03 and Kappa=0.547. Re-performance of D-S PLUS staging presented the following results: New method, McNemar test, P=0.317 and Kappa=0.93; for the routine method, McNemar test, P=0.223 and Kappa=0.811. These findings indicated that the CT component of PET/CT could improve the concordance with MRI results in the assessment of DI, and the same results were obtained when D-S PLUS staging was performed. The CT in PET/CT can enhance diagnostic accuracy in the assessment of DI by reducing the false negatives when compared with the routine F-FDG method.
正电子发射断层显像/计算机断层扫描（PET/CT）已被确定为评估多发性骨髓瘤（MM）骨髓浸润的常规方法之一。在进行PET/CT的常规方法中，该疾病中18F-氟脱氧葡萄糖（F-FDG）摄取情况常用于评估病情，然而目前CT诊断并不常用。本研究的目的是探讨PET/CT中的CT在评估MM骨髓弥漫性浸润（DI）方面的重要性。本研究中使用磁共振成像（MRI）作为对照，MRI是评估骨髓DI的金标准，分为轻度、中度和重度DI三个等级。随后，采用枚举法列出PET和CT结果的四种组合，用于评估骨髓DI。将这些组合分别与MRI的三个等级进行比较，以筛选出最一致的方法。分别使用McNemar检验比较新方法和常规F-FDG PET/CT评估DI与MRI成像的一致性。通过进行Durie-Salmon（D-S）PLUS分期来验证两种方法DI评估的结果。与MRI成像相比，结果如下：PET和CT均为阴性结果，提示轻度DI；其中之一为阳性，提示中度DI；两者均为阳性，提示重度DI。两种方法（新方法和常规方法）与MRI成像的一致性结果如下：对于新方法，McNemar检验，P = 0.513，Kappa = 0.745；对于常规F-FDG PET/CT方法，McNemar检验，P = 0.03，Kappa = 0.547。再次进行D-S PLUS分期得出以下结果：新方法，McNemar检验，P = 0.317，Kappa = 0.93；对于常规方法，McNemar检验，P = 0.223，Kappa = 0.811。这些发现表明，PET/CT中的CT成分在评估DI时可提高与MRI结果的一致性，并且在进行D-S PLUS分期时也得到了相同的结果。与常规F-FDG方法相比，PET/CT中的CT通过减少假阴性结果可提高DI评估的诊断准确性。
