胸部CT在多发性骨髓瘤骨病变及临床预后评价中的价值

The value of chest computerized tomography in evaluation of bone disease and clinical prognosis of multiple myeloma

目的探讨胸部CT在多发性骨髓瘤骨病评价中的价值以及在预后判断中的作用。方法回顾性分析北京协和医院2010年6月至2012年8月新诊断的多发性骨髓瘤患者46例临床资料，分析其胸部CT和相应范围X线片检查、临床分期[包括Durie—Salmon（DS）分期和国际分期系统（ISS）]及其荧光原位杂交结果（显示染色体异常）。结果（1）CT和X线片对骨髓瘤骨病骨折的诊断阳性率相近，分别为41．3％（19／46）和30．4％（14／46），差异无统计学意义（P=0．29）。（2）CT较X线片对5—10mm和〉10mm溶骨性病变病例的检出率均显著提高[60．9％（28／46）比13．0％（6／46）；50．0％（23／46）比10．9％（5／46）；P均〈0．001]。（3）各病例中CT检出的溶骨性病变数目显著多于X线片[5—10mm病变：5（0～21）处比0（0～4）处；〉10mm病变：2（0—14）处比0（0～2）处；P均〈0．001]。（4）CT诊断溶骨性病变阳性的患者较阴性患者的RB1基因缺失、D13s319基因缺失和高危细胞遗传学特征发生率更高[46．7％（14／30）和18．8％（3／16）；43．3％（13／30）和18．8％（3／16）；50．0％（15／30）和25．0％（4／16）；P均〈0．001]。结论胸部CT对评价多发性骨髓瘤溶骨病变较X线片敏感，且溶骨性病变与DS分期和RB1基因缺失、D13s319基因缺失及高危细胞遗传学特征相关，对预后判断具有一定临床意义。

Objective To assess the status and severity of bone disease in patients with multiple myeloma （MM） by using chest computerized tomography （CT） and the relationship between clinical prognostic parameters and bone disease. Methods All 46 newly diagnosed MM in-patients received both imaging tests of chest CT and plain X ray. An experienced radiologist reviewed all the imaging data. Clinical laboratory parameters, stages of Durie-Sahnon （DS） and International Staging System （ISS） were evaluated. Five cytogenetic abnormalities of bone marrow myeloma cells were tested by fluorescence in situ hybridization （FISH）. Results The sensitivity of CT and X ray to determine pathological fractures was comparable, the positive rates of which were 41.3% （19/46） and 30. 4% （ 14/46 ） respectively （ P = 0. 29 ）. Nevertheless, the positive rate of osteolytic lesions ascertained by CT was significantly higher than that by X ray （P 〈 0. 001 ）, 60. 9% （28/46） vs 13.0% （6/46） with diameter 5 - 10 mm and 50. 0% （23/46） vs 10. 9% （5/ 46） with diameter more than 10 ram. Osteolytie lesion numbers found by CT were more than those by X ray [5（0-21） vs0（0-4） lesions with diameterS-10 mm （P〈0.001） , 2（0-14） vs0（0-2） lesions with diameter more than 10 mm （P 〈 0. 001 ）, respectively]. Patients with positive osteolytic lesions had higher percentage of RB1 gene deletion[ 46. 7% （14/30） vs 18.8% （3/16）, P 〈0. 001 ], D13s319 deletion [43.3% （13/30） vs 18.8% （3/16） , P 〈0. 001 ] and high risk eytogenctic abnormalities[50. 0% （15/30） vs 25.0% （4/16）, P 〈 0. 001 ]. Conclusions Chest CT is more sensitive than plain X ray in detecting osteolytic myeloma bone disease. Osteolysis determined by CT is relevant to clinical DS stages and riskstratification of cytogenetic abnormalities.