From the Departments of Medical Imaging (F.E.L., D.Z., C.C., P.T., T.K., L.T., N.M.), Hematology (M.C.V.), and Nuclear Medicine (O.G.), Institut de Recherche Expérimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Brussels, Avenue Hippocrate 10, B-1200 Brussels, Belgium; Department of Medical Imaging, Hôpitaux Universitaires de Genève, Geneva, Switzerland (D.L.); GE HealthCare, Diegem, Belgium (G.D.); Department of Medical Imaging, CHU Saint Pierre, Brussels, Belgium (O.C.); and GE HealthCare, Buc, France (J.P.).
Radiology. 2024 Oct;313(1):e231817. doi: 10.1148/radiol.231817.
Background MRI is highly sensitive for assessing bone marrow involvement in multiple myeloma (MM) but does not enable detection of osteolysis. Purpose To assess the diagnostic accuracy, repeatability, and reproducibility of pseudo-CT MRI sequences (zero echo time [ZTE], gradient-echo black bone [BB]) in detecting osteolytic lesions in MM using whole-body CT as the reference standard. Materials and Methods In this prospective study, consecutive patients were enrolled in our academic hospital between June 2021 and December 2022. Inclusion criteria were newly diagnosed MM, monoclonal gammopathy of undetermined significance at high risk for MM, or suspicion of progressive MM. Participants underwent ZTE and BB sequences covering the lumbar spine, pelvis, and proximal femurs as part of 3-T whole-body MRI examinations, as well as clinically indicated fluorine 18 fluorodeoxyglucose PET/CT examination within 1 month that included optimized whole-body CT. Ten bone regions and two scores (categorical score = presence/absence of osteolytic lesion; semiquantitative score = osteolytic lesion count) were assessed by three radiologists (two experienced and one unfamiliar with pseudo-CT reading) on the ZTE, BB, and whole-body CT images. The accuracy, repeatability, and reproducibility of categorical scores (according to Gwet agreement coefficients AC1 and AC2) and differences in semiquantitative scores were assessed at the per-sequence, per-region, and per-patient levels. Results A total of 47 participants (mean age, 67 years ± 11 [SD]; 27 male) were included. In experienced readers, BB and ZTE had the same high accuracy (98%) in the per-patient analysis, while BB accuracy ranged 83%-100% and ZTE accuracy ranged 74%-94% in the per-region analysis. An increase of false-negative (FN) findings in the spine ranging from +17% up to +23%, according to the lumbar vertebra, was observed using ZTE ( < .013). Regardless of the region (except coxal bones), differences in the BB score minus the ZTE score were positively skewed ( < .021). Regardless of the sequence or region, repeatability was very good (AC1 ≥0.87 for all), while reproducibility was at least good (AC2 ≥0.63 for all). Conclusion Both MRI-based ZTE and BB pseudo-CT sequences of the lumbar spine, pelvis, and femurs demonstrated high diagnostic accuracy in detecting osteolytic lesions in MM. Compared with BB, the ZTE sequence yielded more FN findings in the spine. ClinicalTrials.gov Identifier: NCT05381077 Published under a CC BY 4.0 license.
背景 MRI 高度敏感，可用于评估多发性骨髓瘤（MM）骨髓受累情况，但无法检测到溶骨性病变。目的 评估零回波时间（ZTE）和梯度回波黑骨（BB）伪 CT MRI 序列在检测 MM 溶骨性病变方面的诊断准确性、可重复性和可再现性，以全身 CT 作为参考标准。材料与方法 本前瞻性研究纳入了 2021 年 6 月至 2022 年 12 月期间在我院就诊的连续患者。纳入标准为新发 MM、有 MM 高风险的单克隆丙种球蛋白血症或怀疑 MM 进展。患者接受了 ZTE 和 BB 序列检查，范围包括腰椎、骨盆和股骨近端，作为 3-T 全身 MRI 检查的一部分，以及在 1 个月内进行临床指征氟 18 氟脱氧葡萄糖 PET/CT 检查，包括优化的全身 CT。三位放射科医生（两位有经验，一位不熟悉伪 CT 阅读）评估了 ZTE、BB 和全身 CT 图像上的 10 个骨区和两个评分（分类评分=溶骨性病变存在/不存在；半定量评分=溶骨性病变计数）。根据 Gwet 一致性系数 AC1 和 AC2 评估了分类评分（根据 per-sequence、per-region 和 per-patient 水平）和半定量评分差异的准确性、可重复性和可再现性。结果 共纳入 47 名参与者（平均年龄，67 岁±11[标准差]；27 名男性）。在有经验的读者中，BB 和 ZTE 在患者水平上具有相同的高准确性（98%），而 BB 的准确性范围为 83%-100%，ZTE 的准确性范围为 74%-94%。使用 ZTE 观察到脊柱 FN 发现的假阴性（FN）增加，范围从+17%到+23%，根据腰椎（<0.013）。无论区域如何（除了骨盆骨），BB 评分减去 ZTE 评分的差异呈正偏态分布（<0.021）。无论序列或区域如何，可重复性均非常好（所有序列的 AC1≥0.87），而再现性至少良好（所有序列的 AC2≥0.63）。结论 腰椎、骨盆和股骨的基于 MRI 的 ZTE 和 BB 伪 CT 序列均在检测 MM 溶骨性病变方面具有较高的诊断准确性。与 BB 相比，ZTE 序列在脊柱中产生了更多的 FN 发现。ClinicalTrials.gov 标识符：NCT05381077 发布于 CC BY 4.0 许可下。
