Radiology:双源CT模拟Noncalcium技术在检出多发性骨髓瘤患者脊柱和盆腔骨质浸润诊断准确性

2017-08-23 shaosai MedSci原创

多发性骨髓瘤是恶性浆细胞病中最常见的一种类型,又称骨髓瘤、浆细胞骨髓瘤或Kahler病。虽然早在1844年对此病已有人作出描述,但直到1889年经Kahler详细报告病例后,多发性骨髓瘤才普遍为人们所了解和承认。多发性骨髓瘤的特征是单克隆浆细胞恶性增殖并分泌大量单克隆免疫球蛋白。恶性浆细胞无节制地增生、广泛浸润和大量单克隆免疫球蛋白的出现及沉积,正常多克隆浆细胞增生和多克隆免疫球蛋白分泌受到抑制,

多发性骨髓瘤是恶性浆细胞病中最常见的一种类型,又称骨髓瘤、浆细胞骨髓瘤或Kahler病。多发性骨髓瘤的特征是单克隆浆细胞恶性增殖并分泌大量单克隆免疫球蛋白。恶性浆细胞无节制地增生、广泛浸润和大量单克隆免疫球蛋白的出现及沉积,正常多克隆浆细胞增生和多克隆免疫球蛋白分泌受到抑制,从而引起广泛骨质破坏、反复感染、贫血、高钙血症、高黏滞综合征、肾功能不全等一系列临床表现并导致不良后果。本研究为了验证双源CT利用模拟noncalcium(VNCa)技术在检出多发性骨髓瘤骨髓浸润(BM)的诊断效能,并将结果发表在Radiology上。

本研究共纳入了34例多发性骨髓瘤或属单克隆丙种球蛋白病的患者,并行中轴骨的双源CT和MRI成像。两名观察者独立地评价常规CT和颜色编码的VNCa图像显示BM受累的情况。以MR作为参考标准。在VNCa CT上对BM浸润(n=75)和正常BM(n=170)中勾画感兴趣区(ROI)进行分析并行ROC曲线来计算截断值。

在肉眼观察中,VNCa图像总体的敏感性、特异性、准确率、阳性预测值和阴性预测值分别为91.3% (21 of 23)、90.9% (10 of 11)、 91.2% (31 of 34)、95.5% (21 of 22)、83.3% (10 of 12)。VNCa CT基于ROI的分析浸润和正常骨质间有显着性的差异(P < .001)。ROC分析曲线下面积为0.978。以-44.9 HU为截断值检查BM浸润的敏感性、特异性、准确率、阳性预测值和阴性预测值分别为93.3% (70 of 75)、92.4% (157 of 170)、92.7% (227 of 245)、84.3% (70 of 83)和 96.9% (157 of 162)。

本研究表明,对双源CT VNCa的肉眼观察和基于ROI分析对多发性骨髓瘤患者BM浸润具有良好的诊断效能,准确率堪与MRI相比。

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    2018-05-02 jml2009
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    2017-08-25 Eleven17
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    2017-08-23 圣艮山

    学习了不少事情!

    0

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