University Hospital of Cologne, Department of Radiology, Kerpener Straße 62, 50937, Cologne, Germany.
University Hospital of Cologne, Department of Radiology, Kerpener Straße 62, 50937, Cologne, Germany.
Eur J Radiol. 2021 Feb;135:109502. doi: 10.1016/j.ejrad.2020.109502. Epub 2020 Dec 25.
Recent studies showed that dual energy CT (DECT) allows for detection of bone marrow infiltration in multiple myeloma (MM) by obtaining virtual non-calcium (VNCa) images. This feasibility study investigated, if VNCa imaging might discriminate metabolically active, focal lesions in MM against avital lesions in MM patients, considering fluorodeoxyglucose positron-emission-tomography CT (FDG PET/CT) as the standard of reference.
The study included 60 osteolytic lesions in 10 consecutive low-dose whole body CT scans of patients with MM, who underwent both FDG PET/CT and DECT at a tertiary care university hospital. Circular ROI measurements were performed in predefined lesions on the monoenergetic CT (MECT) and VNCa images by three blinded radiologists. Each lesion was rated vital or avital by a blinded specialist of nuclear medicine, based on their FDG metabolism.
Each of the three readers could separate FDG PET/CT negative and positive MM lesions when analyzing the VNCa images, while MECT did not show a significant difference. Best results were yielded by high calcium suppression with excellent inter-rater reliability (average sensitivity 0.91, specificity 0.88, cutoff -46.9 HU), followed by medium and low calcium suppression.
In contrast to MECT imaging, VNCa imaging in DECT appears to be feasible to assess metabolic activity of focal MM lesions as defined by the standard of reference, FDG PET/CT. Considering the higher cost and radiation exposure of FDG PET/CT, DECT VNCa imaging might develop to be the modality of choice to assess metabolic activity of focal MM lesions.
最近的研究表明，双能 CT（DECT）通过获得虚拟非钙（VNCa）图像，可以检测多发性骨髓瘤（MM）中的骨髓浸润。本可行性研究探讨了 VNCa 成像是否可以区分 MM 中代谢活跃的局灶性病变与 MM 患者的无活力病变，将氟代脱氧葡萄糖正电子发射断层扫描 CT（FDG PET/CT）作为参考标准。
该研究纳入了 10 例连续低剂量全身 CT 扫描中的 60 个溶骨性病变，这些患者均在三级护理大学医院接受了 FDG PET/CT 和 DECT。三位盲法放射科医生在单能量 CT（MECT）和 VNCa 图像上的预定义病变处进行圆形 ROI 测量。根据 FDG 代谢情况，核医学专家对每个病变进行了活力或无活力的评估。
当分析 VNCa 图像时，三位读者中的每一位都可以区分 FDG PET/CT 阴性和阳性 MM 病变，而 MECT 则没有显示出显著差异。高钙抑制效果最好，具有良好的组内观察者间可靠性（平均敏感度 0.91、特异性 0.88、截断值-46.9 HU），其次是中钙和低钙抑制。
与 MECT 成像相比，DECT 中的 VNCa 成像似乎可以根据 FDG PET/CT 这一参考标准来评估局灶性 MM 病变的代谢活性。考虑到 FDG PET/CT 的成本和辐射暴露较高，DECT VNCa 成像可能会成为评估局灶性 MM 病变代谢活性的首选方法。
