Accuracy of whole-body low-dose multidetector CT (WBLDCT) versus skeletal survey in the detection of myelomatous lesions, and correlation of disease distribution with whole-body MRI (WBMRI)
Accuracy of whole-body low-dose multidetector CT (WBLDCT) versus skeletal survey in the detection of myelomatous lesions, and correlation of disease distribution with whole-body MRI (WBMRI)
复制标题
DOI：
10.1007/s00256-008-0607-4
复制
发表时间：
2009-03-01
影响因子：
2.1
通讯作者：
Eustace, S. J.
中科院分区：
文献类型：
--
作者：
Gleeson, T. G.;Moriarty, J.;Eustace, S. J.
该研究的目的是评估全身低剂量计算机断层扫描 (WBLDCT) 在多发性骨髓瘤诊断和分期中的可行性，并与骨骼检查 (SS) 进行比较，使用骨髓活检和全身磁共振成像（WBMRI；如果有）作为金标准。在 18 个月的时间内转诊进行疑似多发性骨髓瘤调查或骨髓瘤重新分期的患者被随机分组 使用高 kVp、低 mAs 技术（140 kVp、14 mAs；或 140 kVp、25 mAs）进行两种 WBLDCT 方案之一。对 23 例患者最近进行的 WBMRI 扫描进行了回顾。每种成像方式均由两名放射科医生一致评估，并在 10 个解剖区域进行 0-3 评分（0 = 正常，1 = 1-4 个病变，2 = 5-20 个病变，千分之 3 日元，千分之欧元 20 个病变/弥漫性疾病）。记录疾病的总体分期、图像质量评分和诊断置信度。使用骨髓活检金标准确定骨骼检查和 WBLDCT 的诊断准确性，并将疾病分布与 WBMRI 进行比较。对 39 名患者进行了评估。 WBLDCT 比骨骼检查发现了更多的溶骨性病变，具有更高的诊断置信度，并导致 18 例重新分期（16 例上期，2 例下期）。在最近进行 WBMRI 的患者中，与 SS 相比，WBLDCT 上的疾病分布与 WBMRI 具有更高的相关性。读者对 WBLDCT 阶段的总体印象与 WBMRI 显着相关（kappa = 0.454，p < 0.05）。 WBLDCT 为 WBMRI 提供了补充信息，其中 9 名患者在治疗后有正常骨髓信号，但在 CT 上显示有弥漫性残留皮质异常。WBLDCT 在有效剂量低于以前报道的情况下，在检测溶骨性病变和确定多发性骨髓瘤的总体分期方面优于 SS，并为 WBMRI 提供了补充信息。
The aim of the study is to assess the feasibility of whole-body low-dose computed tomography (WBLDCT) in the diagnosis and staging of multiple myeloma and compare to skeletal survey (SS), using bone marrow biopsy and whole-body magnetic resonance imaging (WBMRI; where available) as gold standard.Patients referred over an 18-month period for investigation of suspected multiple myeloma or restaging of myeloma were randomized to undergo one of two WBLDCT protocols using high kVp, low mAs technique (140 kVp, 14 mAs; or 140 kVp, 25 mAs). Recent WBMRI scans were reviewed in 23 cases. Each imaging modality was assessed by two radiologists in consensus and scored from 0-3 (0 = normal, 1 = 1-4 lesions, 2 = 5-20 lesions, 3 a parts per thousand yenaEuro parts per thousand 20 lesions/diffuse disease) in ten anatomical areas. Overall stage of disease, image quality score, and the degree of confidence of diagnosis were recorded. Diagnostic accuracy of skeletal survey and WBLDCT were determined using a gold standard of bone marrow biopsy and distribution of disease was compared to WBMRI.Thirty-nine patients were evaluated. WBLDCT identified more osteolytic lesions than skeletal survey with a greater degree of diagnostic confidence and led to restaging in 18 instances (16 upstaged, two downstaged). In those with recent WBMRI, distribution of disease on WBLDCT showed superior correlation with WBMRI when compared with SS. Overall reader impression of stage on WBLDCT showed significant correlation with WBMRI (kappa = 0.454, p < 0.05). WBLDCT provided complementary information to WBMRI in nine patients with normal marrow signal following treatment response, but which were shown to have diffuse residual cortical abnormalities on CT.WBLDCT at effective doses lower than previously reported, is superior to SS at detecting osteolytic lesions and at determining overall stage of multiple myeloma, and provides complementary information to WBMRI.