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- Title
Calcium-Based Imaging of the Spine at Dual-Layer CT and Evaluation of Vertebral Fractures in Multiple Myeloma.
- Authors
Brandelik, Simone C.; Rahn, Stefanie; Merz, Maximilian; Stiller, Wolfram; Skornitzke, Stephan; Melzig, Claudius; Kauczor, Hans-Ulrich; Weber, Tim F.; Do, Thuy D.
- Abstract
Simple Summary: The purpose of the study is to evaluate the prediction of vertebral fractures in patients with plasma cell dyscrasias using dual-layer CT. The study retrospectively enrolled 81 patients diagnosed with plasma cell dyscrasia who underwent whole-body DLCT at diagnosis and follow-up. In the baseline CT, conventional CT image data (CI), calcium-suppressed image data (CaSupp25 and CaSupp100), and virtual calcium-only (VCa) image data were quantitatively analyzed in the lumbar vertebral bodies and in fractured vertebral bodies. New vertebral fractures occurred in 24 patients during follow-up. Lower CT numbers in CI and VCa, and higher CT numbers in CaSupp25, at baseline were significantly associated with a higher risk of new fractures. Logistic regression analysis revealed that CT numbers in CaSupp25 and VCa might be better predictors of fractures than CI. Cut-off values were suggested: CI at 103 HU and VCa at 129 HU. In conclusion, quantitative assessment with CaSupp and calculation of VCa can predict vertebral fracture risk in multiple myeloma patients, indicating that DLCT may be useful in detecting imminent fractures. Purpose: To evaluate the prediction of vertebral fractures in plasma cell dyscrasias using dual-layer CT (DLCT) with quantitative assessment of conventional CT image data (CI), calcium suppressed image data (CaSupp), and calculation of virtual calcium-only (VCa) image data. Material and Methods: Patients (n = 81) with the diagnosis of a plasma cell dyscrasia and whole-body DLCT at the time of diagnosis and follow-up were retrospectively enrolled. CI, CaSupp25, and CaSupp100 were quantitatively analyzed using regions of interest in the lumbar vertebral bodies and fractured vertebral bodies on baseline or follow-up imaging. VCa were calculated by subtraction (CaSupp100-CaSupp25), delineating bone only. Logistic regression analyses were performed to assess the possibility of imminent spine fractures. Results: In 24 patients, new vertebral fractures were observed in the follow-up imaging. The possibility of new vertebral fractures was significant for baseline assessment of CT numbers in CI, CaSupp25, and VCa (p = 0.01, respectively), with a higher risk for new fractures in the case of lower CT numbers in CI (Odds ratio = [0.969; 0.994]) and VCa (Odds ratio = [0.978; 0.995]) and in the case of higher CT numbers in CaSupp 25 (Odds ratio 1.015 [1.006; 1.026]). Direct model comparisons implied that CT numbers in CaSupp 25 and VCa might show better fracture prediction than those in CI (R2 = 0.18 both vs. 0.15; AICc = 91.95, 91.79 vs. 93.62), suggesting cut-off values for CI at 103 HU (sensitivity: 54.2%; specificity: 82.5; AUC: 0.69), for VCa at 129 HU (sensitivity: 41.7%; specificity: 94.7; AUC: 0.72). Conclusions: Quantitative assessment with CaSupp and calculation of VCa is feasible to predict the vertebral fracture risk in MM patients. DLCT may prove useful in detecting imminent fractures.
- Subjects
MULTIPLE myeloma; RISK assessment; PARAPROTEINEMIA; COMPUTED tomography; LOGISTIC regression analysis; VERTEBRAL fractures; RETROSPECTIVE studies; DESCRIPTIVE statistics; CALCIUM; ODDS ratio; CONFIDENCE intervals; PATIENT aftercare; SENSITIVITY &; specificity (Statistics); DISEASE risk factors; DISEASE complications
- Publication
Cancers, 2024, Vol 16, Issue 15, p2688
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16152688