The Value Of The Whole-body Low-dose CT In The Distribution Of The Lesion And Proagnosis Assessment Of Multiple Myeloma

Part one:Analyze the assessment value of the whole-body low-dose CT in the distribution of the lesion of multiple myelomaObjective:To analyze the assessment value of the whole-body low-dose computed tomography(WBLDCT)in the lesion distribution of the multiple myeloma(MM)by comparing the imaging of the whole-body diffusion weighted imaging(PET-like).Methods:100 patients collected from June 2016 to May 2018 with definite diagnosed MM all received WBLDCT as part of their diagnostic work-up,in which 48 patients further accepted PET-like examinations.The CT scan was performed on a 64-slice CT scanner(Somatom Definition Flash,Siemens Healthcare,Forchheim,Germany)with tube voltage of 120kV,tube current time product of 80mAs.The range of the CTDIvol(volumetric CT dose index)was 2.81-3.44 mGy.Two experienced radiologists analyzed and graded images subjectively.The two kinds of imaging findings on patients about MM(including positive osteolytic lesions,fracture,and soft tissue)and statistical analysis of the consistency in the distribution of the lesion of MM were obtained commonly.Results:(1)Among the 100 patients received WBLDCT,positive osteolytic lesions were found in 92 cases(92%),fractures in 42 cases(42%)and soft tissue in 25 cases(25%).(2)The positive rate of bone fracture in WBLDCT was significantly higher than that in PET-like(50%vs 31.25%)(P<0.05),while in osteolytic lesions and soft tissue,the positive rate(93.75%vs 95.83%,8.75%vs 16.67%)had no significant differences(P>0.05).(3)There were absolutely consistency about the distribution of the lesion(osteolytic lesions,bone fracture and soft tissue)of MM between the WBLDCT and PET-like examinations(P<0.05).The Kappa value was respectively0.37,0.63,0.37.Conclusion:WBLDCT is an effective alternative for patients with a new diagnosis of multiple myeloma and assessment of complications,which has also high consistency with PET-like in the lesion distribution of MM.Part two:The value of the whole-body low-dose CT in the prognosis assessment of multiple myelomaObjective:To analyze the value of assessment of the WBLDCT in the multiple myeloma.Materials and Methods:An experienced radiologist reviewed all the imaging data retrospectively and divided these patients with MM according to their state of an illness into three CT stages(Ⅰ、Ⅱ、Ⅲ)with reference to Salmon-Durie Plus system.At the same time,clinical laboratory parameters,stages of Durie-Salmon(DS),International Staging System(ISS)and Revised International Staging System(RISS)were also evaluated.To analyze the consistency among stages of CT,ISS and RISS,as well as the pertinence among osteolytic lesions,fractures,soft tissue and clinical classification,stages.All cytogenetic abnormalities of bone marrow myeloma cells were tested by fluorescence in situ hybridization(FISH).Results:(1)There was consistency among the stages of CT,ISS and RISS(P<0.05)and the Kappa value was 0.87 and 0.67 respectively;(2)There was no significant difference in the distribution of clinical classification and the incidence of various types of cytogenetic abnormalities between MM patients with positive and negative osteolytic lesions(P>0.05).Stages of DS,ISS and RISS in the positive osteolytic lesions patients were significantly higher than that in the negative patients(P<0.05);(3)The differences between the patients with positive and negative fractures in the clinical classification,stages,the incidence of the loss of RBI gene(64.3%vs 43.1%)and P53 gene(26.2%vs 6.9%)were statistically significant(P<0.05);(4)There were significant differences between MM patients with positive and negative soft tissues in the distribution of clinical classification,the incidence of the loss of P53 gene(40.0%vs 6.7%)and the distribution of the IGH translocation subtype(P<0.05).Conclusion:WBLDCT scanning had some prediction value in the assessment of the severity of illness for MM patients according to the CT stage.On the other hand,the MM patients with positive bone fracture and soft tissues had higher incidence of cytogenetic abnormalities,which predicted poor prognosis.