■常规计算机断层扫描(CT)对非溶骨性多发性骨髓瘤(NOL-MM)中骨髓浸润的诊断敏感性较低。这项研究旨在比较光谱CT的两种材料分解技术的性能,并去除钙(Ca)的X射线吸收成分与羟基磷灰石(HAP)的X射线吸收成分,以诊断NOL-MM。
■2022年10月至2023年3月,前瞻性纳入福建医科大学附属协和医院41例接受胸部能谱CT和胸椎磁共振成像(MRI)检查的无局灶性骨病变MM患者;选择另一组41例年龄和性别匹配的健康连续参与者作为对照组.根据MRI检查结果,MM患者分为弥漫性浸润型MM(DP-MM)或正常型MM(NP-MM).在椎骨上手动绘制感兴趣区域(ROI)。存储了ROI中70keV图像的CT值和基本材料密度。基本的两材料对包括Ca相关对(Ca-X)和HAP相关对(HAP-X),X指的是脂肪,水,或肌肉。材料密度值DCa(X),DX(Ca),DHAP(X),和DX(HAP)分别用于诊断MM,受试者工作特征曲线下面积(AUC)用于评估诊断性能。
■41例NOL-MM患者包括30例DP-MM和11例NP-MM。CT值,DCa(X),和DHAP(X)在NOL-MM之间具有可比性,DP-MM,NP-MM,和比较组。DX(HAP)在区分NOL-MM组与对照组方面优于DX(Ca){AUC[95%置信区间(CI)],0.874(0.800,0.949)vs.0.737(0.630,0.844);P=0.02},比较组的DP-MM组[AUC(95%CI),0.933(0.878,0.989)vs.0.785(0.677,0.894);P=0.01],比较组的NP-MM组[AUC(95%CI),0.714(0.540,0.888)与0.605(0.429,0.782);P=0.03],和NP-MM组的DP-MM组[AUC(95%CI),0.809(0.654,0.964)与0.736(0.566,0.907);P=0.049]。DX(HAP)和DX(Ca)的诊断性能仅受到去除材料的影响,而X材料没有影响。
■去除HAPX射线吸收成分的能谱CT双材料分解技术对于NOL-MM的诊断很有用,无论配对的材料。
UNASSIGNED: Conventional computed tomography (CT) has low sensitivity for the diagnosis of bone marrow infiltration in nonosteolytic multiple myeloma (NOL-MM). This study aimed to compare the performance of the two-material decomposition technique of spectral CT with the removal of X-ray absorption components of calcium (Ca) versus that of hydroxyapatite (HAP) for diagnosis of NOL-MM.
UNASSIGNED: From October 2022 to March 2023, a total of 41 consecutive patients with MM without focal bone lesions undergoing chest spectral CT and thoracic spine magnetic resonance imaging (MRI) in Fujian Medical University Union Hospital were prospectively enrolled; meanwhile, another set of 41 age- and sex-matched healthy consecutive participants were selected as a comparison group. Based on MRI findings, patients with MM were classified with a diffuse infiltration pattern MM (DP-MM) or a normal pattern MM (NP-MM). Regions of interest (ROIs) were manually drawn on vertebrae. CT values of 70-keV images and basic material density within the ROIs were stored. The basic two-material pairs included a Ca-related pair (Ca-X) and an HAP-related pair (HAP-X), with X referring to fat, water, or muscle. Material density values DCa(X), DX(Ca), DHAP(X), and DX(HAP) were each used to diagnose MM, and the area under the receiver operating characteristic curve (AUC) was used to assess diagnostic performance.
UNASSIGNED: The 41 patients with NOL-MM included 30 with DP-MM and 11 with NP-MM. CT value, DCa(X), and DHAP(X) were comparable between the NOL-MM, DP-MM, NP-MM, and comparison groups. DX(HAP) was better than DX(Ca) for distinguishing the NOL-MM group from the comparison group {AUC [95% confidence interval (CI)], 0.874 (0.800, 0.949) vs. 0.737 (0.630, 0.844); P=0.02}, the DP-MM group from the comparison group [AUC (95% CI), 0.933 (0.878, 0.989) vs. 0.785 (0.677, 0.894); P=0.01], the NP-MM group from the comparison group [AUC (95% CI), 0.714 (0.540, 0.888) vs. 0.605 (0.429, 0.782); P=0.03], and the DP-MM group from the NP-MM group [AUC (95% CI), 0.809 (0.654, 0.964) vs. 0.736 (0.566, 0.907); P=0.049]. The diagnostic performance of DX(HAP) and DX(Ca) was influenced only by the removed material, while the X material had no influence.
UNASSIGNED: The spectral CT two-material decomposition technique with removal of X-ray absorption components of HAP is useful for diagnosis of NOL-MM, irrespective of the paired material.