通过双能计算机断层扫描（CT）诊断新发生的、在传统CT扫描上未检测到骨病的多发性骨髓瘤。
Diagnosis of newly developed multiple myeloma without bone disease detectable on conventional computed tomography (CT) scan by using dual-energy CT.
作者信息
Jiang Nan, Xia Yu, Luo Mingcong, Chen Jianhua, Qiu Zongjian, Liu Jianfang
机构信息
Department of Radiology, Fujian Medical University Union Hospital, 29 Xin Quan Road, Gulou District, Fuzhou, Fujian 350001, China.
Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China.
出版信息
J Bone Oncol. 2024 Sep 24;48:100636. doi: 10.1016/j.jbo.2024.100636. eCollection 2024 Oct.
OBJECTIVE
To evaluate the diagnostic utility of fat (hydroxyapatite) density [D] on dual-energy computed tomography (DECT) for identifying clinical diagnosed multiple myeloma without bone disease (MNBD) that is not visible on conventional CT scans.
MATERIAL AND METHODS
In this age-gender-examination sites matched case control prospective study, Chest and/or abdominal images on Revolution CT of MNBDs and control subjects were consecutive enrolled in a 1:2 ratio from October 2022 to November 2023. Multiple myeloma was clinical diagnosed according to criteria of the International Myeloma Working Group. Regions of interest (ROIs) were drawn separately for all thoracolumbar vertebrae in the scanning range by two radiologists. Additionally, a radiologist specializing in musculoskeletal imaging supervised the process. D was extracted from each ROI. The spine was divided into upper thoracic (UPT), middle and lower thoracic (MLT), thoracolumbar (TL), and middle and lower lumbar (MLL) vertebrae. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the diagnostic performance of D in diagnosing multiple myeloma, and the sensitivity, specificity, and accuracy under the optimal cut-off were determined by Youden index (sensitivity + specificity -1).
RESULTS
A total of 32 and MNBD patients and 64 control patients were included. The total number of ROIs outlined included MNBD group (n = 493) and control group (n = 986). For all vertebrae, D got average performance in the diagnosis of MNBD (AUC = 0.733, < 0.001) with a cut-off value of 958 (mg/cm); the sensitivity, specificity, and accuracy were 58.8 %, 77.8 %, and 71.7 %, respectively. Regarding segment analysis, the diagnostic performance was good for all (AUC, 0.803-0.837; < 0.001) but the UPT segment (AUC = 0.692, = 0.002). The optimal diagnostic cut-off values for the MLT, TL, and MLL vertebrae were 955 mg/cm, 947 mg/cm, and 947 mg/cm, respectively; the sensitivity, specificity, and accuracy were 80.0 %-87.5 %, 71.9 %-82.6 %, and 77.1 %-81.6 %, respectively.
CONCLUSION
DECT was effective for detecting MNBD, and better diagnostic results can be obtained by grouping different spine segments.
目的
评估双能计算机断层扫描（DECT）上的脂肪（羟基磷灰石）密度[D]对识别临床诊断的无骨病多发性骨髓瘤（MNBD）的诊断效用，而这些病例在传统CT扫描上不可见。
材料与方法
在这项年龄、性别、检查部位匹配的病例对照前瞻性研究中，2022年10月至2023年11月，以1:2的比例连续纳入MNBD患者和对照者的胸部和/或腹部Revolution CT图像。根据国际骨髓瘤工作组的标准对多发性骨髓瘤进行临床诊断。两名放射科医生在扫描范围内为所有胸腰椎分别绘制感兴趣区域（ROI）。此外，一名专门从事肌肉骨骼成像的放射科医生监督该过程。从每个ROI中提取D值。脊柱分为上胸椎（UPT）、中胸椎和下胸椎（MLT）、胸腰椎（TL）以及中腰椎和下腰椎（MLL）椎体。计算受试者操作特征曲线（AUC）下的面积以评估D在诊断多发性骨髓瘤中的诊断性能，并通过约登指数（敏感性+特异性-1）确定最佳截断值下的敏感性、特异性和准确性。
结果
共纳入32例MNBD患者和64例对照患者。勾勒出的ROI总数包括MNBD组（n = 493）和对照组（n = 986）。对于所有椎体，D在MNBD诊断中表现中等（AUC = 0.733，<0.001），截断值为958（mg/cm）；敏感性、特异性和准确性分别为58.8%、77.8%和71.7%。关于节段分析，除UPT节段（AUC = 0.692，=0.002）外，所有节段的诊断性能均良好（AUC，0.803 - 0.837；<0.001）。MLT、TL和MLL椎体的最佳诊断截断值分别为955 mg/cm、947 mg/cm和947 mg/cm；敏感性、特异性和准确性分别为80.0% - 87.5%、71.9% - 82.6%和77.1% - 81.6%。
结论
DECT对检测MNBD有效，通过对不同脊柱节段进行分组可获得更好的诊断结果。
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