第3代双源双能CT虚拟去钙骨髓成像在多发性骨髓瘤弥漫浸润性病变评价中的应用

Bone Marrow Imaging by Third-generation Dual-source Dual-energy CT Using Virtual Noncalcium Technique for Assessment of Diffuse Infiltrative Lesions of Multiple Myeloma

目的探讨第3代双源双能CT(DSDECT)虚拟去钙(VNCa)骨髓成像在多发性骨髓瘤(MM)弥漫浸润性病变评价中的应用价值。方法以2015年12月至2016年6月在北京协和医院就诊的31例浆细胞病患者为研究对象,行全身第3代DSDECT和全身MRI检查。在VNCa及常规CT图像测定椎体CT值,评价椎体VNCa CT值与MRI信号强度相关性。以MRI为参考标准,评价VNCa对MM弥漫浸润病变的诊断力。结果 MM弥漫浸润椎体组(n=62)VNCa的平均CT值为(-13.27±18.96)HU,明显高于非弥漫浸润椎体组(n=117)的(-63.31±26.75)HU,(Z=-9.731,P=0.000)。椎体VNCa CT值与T1 WI序列椎体和无退变椎间盘信号强度比值呈显著负相关(rs=-0.592,P=0.000)。VNCa诊断MM弥漫浸润病变的受试者工作曲线下面积为0.943;VNCa CT值>-37 HU时的敏感性为90.32%,特异性为87.18%。结论第3代DSDECT VNCa骨髓成像具有诊断MM弥漫浸润病变的能力。

Objective To evaluate the value of bone marrow imaging by third-generation dual-source dual-energy CT（ DSDECT） using virtual noncalcium（ VNCa） technique for the assessment of diffuse infiltrativelesions of multiple myeloma（ MM）. Methods From December 2015 to June 2016,31 patients with plasma disorders at our center were prospectively recruited and received whole-body imaging with third-generation DSDECT and MRI. CT numbers of vertebrae were measured on VNCa images as well as regular CT images. Correlation between VNCa CT numbers and MRI signal intensities of the vertebrae was evaluated. The diagnostic ability of VNCa for MM infiltrative lesions was assessed by ROC analysis, using MRI as the reference standard.Results The mean VNCa CT numbers of vertebrae with MM diffuse infiltration（ n = 62） were（- 13. 27 ±18. 96） HU, which were significantly higher than those of non-infiltrated vertebrae [（- 63. 31 ± 26. 75） HU,（ n = 117） ]（ Z =- 9. 731, P = 0. 000）. VNCa CT numbers of vertebrae were negatively correlated with T1 WI signal intensity normalized by non-degenerative vertebral discs（ rs=- 0. 592, P = 0. 000）. ROC analysis showed the area under the curve of VNCa for the diagnosis of infiltrative lesions was 0. 943. With the cutoff value of- 37 HU, the sensitivity and specificity of VNCa were 90. 32 % and 87. 18 %, respectively. Conclusion Bone marrow imaging by third-generation DSDECT using VNCa technique is a valuable tool for assessing diffuse infiltrative lesions of MM.