Werner Sebastian, Krauss Bernhard, Horger Marius
Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany.
Siemens Healthcare GmbH, Diagnostic Imaging, Forchheim, Germany.
Quant Imaging Med Surg. 2022 Mar;12(3):1871-1881. doi: 10.21037/qims-21-545.
Systemic lung cancer treatment-induced changes in bone marrow attenuation assessed via dual-energy CT-based virtual non-calcium (VNCa) imaging of the axial skeleton and their relationship to hematological laboratory have not yet been investigated.
VNCa bone marrow images of the axial skeleton derived from 93 unenhanced reduced dose dual-energy CTs of the thorax and abdomen of 31 patients were retrospectively analyzed. Each patient had received one pre-therapy baseline exam and two consecutive follow-up exams (FU1 and FU2) at a mean of 7.7 and 11.7 weeks after start of therapy. Concurrent hematologic laboratory data were available for every exam. Seven regions of interest were placed in the spine and pelvis and mean VNCa bone marrow attenuation was measured. Twenty-two Patients receiving highly myelotoxic treatment (Group A) were compared to 9 patients receiving less toxic substances (Group B).
Median bone marrow attenuation in Group A/Group B was -31.8 HU (IQR 12.7)/40.6 HU (IQR, 12.2) at baseline, -46.5 HU (IQR, 12.5)/-43.8 HU (15.7) at FU1 and -46.9 HU (IQR, 22.0)/-38.5 HU (IQR, 18.5) at FU2. In both subgroups the reduction of the mean attenuation between baseline and FU1 was statistically significant although in Group A it was more pronounced; no significant difference was found between FU1 and FU2. The differences between Groups were not statistically significant. Leukopenia rates at FU1 and FU 2 were 50% and 54.5% in Group A and 0% and 22% in Group B. Anemia rates rose from 31.8% at baseline to 90% at FU1 and 86.4% at FU2 in Group A and fell from 77.8% at baseline to 66.7% at FU1 and further to 55.6% at FU2 in Group B.
Both highly myelotoxic as well as-to a smaller degree-less myelotoxic systemic therapy led to a significant drop in bone marrow attenuation with no significant tendency towards subsequent elevation irrespective of the treatment's degree of toxicity or the presence of myelosuppression and not even under hematological supportive therapy. The results suggest that in this clinical setting an increase in bone marrow attenuation should be regarded as suspicious for tumor infiltration.
尚未研究通过基于双能CT的轴位骨骼虚拟非钙（VNCa）成像评估的系统性肺癌治疗引起的骨髓衰减变化及其与血液学实验室指标的关系。
回顾性分析了31例患者的93例胸部和腹部未增强低剂量双能CT获得的轴位骨骼VNCa骨髓图像。每位患者在治疗开始后平均7.7周和11.7周分别接受一次治疗前基线检查和两次连续的随访检查（FU1和FU2）。每次检查均有同时期的血液学实验室数据。在脊柱和骨盆放置7个感兴趣区，测量平均VNCa骨髓衰减。将22例接受高骨髓毒性治疗的患者（A组）与9例接受低毒性物质治疗的患者（B组）进行比较。
A组/B组基线时骨髓衰减中位数为-31.8 HU（四分位间距12.7）/40.6 HU（四分位间距12.2），FU1时为-46.5 HU（四分位间距12.5）/-43.8 HU（15.7），FU2时为-46.9 HU（四分位间距22.0）/-38.5 HU（四分位间距18.5）。在两个亚组中，基线和FU1之间平均衰减的降低均具有统计学意义，尽管A组更为明显；FU1和FU2之间未发现显著差异。两组之间的差异无统计学意义。A组FU1和FU2时的白细胞减少率分别为50%和54.5%，B组为0%和22%。A组贫血率从基线时的31.8%升至FU1时的90%和FU2时的86.4%，B组从基线时的77.8%降至FU1时的66.7%，进一步降至FU2时的55.6%。
高骨髓毒性以及程度较轻的低骨髓毒性全身治疗均导致骨髓衰减显著下降，无论治疗的毒性程度或骨髓抑制情况如何，甚至在血液学支持治疗下，均无随后升高的明显趋势。结果表明，在这种临床情况下，骨髓衰减增加应被视为肿瘤浸润可疑。
