Prospective comparison of 18-FDG PET/CT and whole-body diffusion-weighted MRI in the assessment of multiple myeloma
Prospective comparison of 18-FDG PET/CT and whole-body diffusion-weighted MRI in the assessment of multiple myeloma
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DOI：
10.1007/s00277-020-04265-2
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发表时间：
2020-09-19
影响因子：
3.5
通讯作者：
Marit, Gerald
中科院分区：
文献类型：
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作者：
Mesguich, Charles;Hulin, Cyrille;Marit, Gerald
磁共振成像（MRI）和（18）F-氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（（18）FDG 18F-FDG PET-CT）是多发性骨髓瘤（MM）分期的标准程序。应用于全身MRI（WB-DWI）的弥散加权序列提高了其灵敏度。我们比较了（18）F-FDG PET-CT和WB-DWI检测到的MM骨局灶性病变（FL）的数量，并评价了（18）F-FDG PET-CT对弥漫性浸润的诊断性能。30例新诊断的MM患者前瞻性接受了18F-FDG PET-CT和WB-DWI。骨骼区域阳性的标准是>= 1个局灶性骨病变（FL）和/或弥漫性疾病。MRI以MY-RADS标准作为诊断弥漫性浸润的参考标准，F-18-FDG PET-CT和WB-DWI均为阳性者28/30例，两种方法的一致性为1.00（95%CI 0.77-1.00）。18 F-FDG PET-CT检出的FL平均数为16.7个，WB-DWI检出的FL平均数为23.9个（P= 0.028）。WB-DWI在颅骨（P= 0.001）和脊柱（P= 0.006）中检测到更多FL。使用患病率和偏倚校正Kappa指数评估的一致性对于脊柱、胸骨-肋骨和上肢为中等（0.40-0.60），对于骨盆和下肢为显著（0.60-0.80）。18F-FDGPET-CT诊断弥漫性骨髓浸润的敏感性、特异性和准确性分别为0.75、0.79和0.77。尽管WB-DWI比18 F-FDG PET-CT检测到更多的FL，但在每个患者的骨病检测方面没有差异。
Magnetic resonance imaging (MRI) and(18)F-fluorodeoxyglucose positron emission tomography-computed tomography ((18)FDG 18F-FDG PET-CT) are standard procedures for staging multiple myeloma (MM). Diffusion-weighted sequences applied to whole-body MRI (WB-DWI) improve its sensitivity. We compared the number of MM bone focal lesions (FLs) detected by(18)F-FDG PET-CT and WB-DWI and evaluated the diagnostic performance of(18)F-FDG PET-CT for diffuse infiltration. Thirty newly diagnosed MM patients prospectively underwent 18F-FDG PET-CT and WB-DWI. The criteria for skeletal region positivity were >= 1 focal bone lesions (FLs) and/or diffuse disease. MRI with the MY-RADS criteria was used as a reference standard for the diagnosis of diffuse infiltration.F-18-FDG PET-CT and WB-DWI were both interpreted as positive in 28/30 patients with an agreement of 1.00 (95% CI 0.77-1.00) between the two methods. The mean numbers of FLs were 16.7 detected by(18)F-FDG PET-CT and 23.9 detected by WB-DWI (P= 0.028). WB-DWI detected more FLs in the skull (P= 0.001) and spine (P= 0.006). Agreement assessed using the prevalence and bias-corrected kappa index was moderate (0.40-0.60) for the spine, sternum-ribs and upper limbs and substantial (0.60-0.80) for the pelvis and lower limbs. As regards the diagnosis of diffuse bone marrow infiltration, the sensitivity, specificity and accuracy of(18)F-FDG PET-CT were 0.75, 0.79 and 0.77, respectively. Although WB-DWI detected more FLs than did(18)F-FDG PET-CT, there was no difference in the detection of bone disease on a per-patient basis.F-18-FDG PET-CT showed high performance, including for evaluation of diffuse infiltration.