Recommendations for acquisition, interpretation and reporting of whole body low dose CT in patients with multiple myeloma and other plasma cell disorders: a report of the IMWG Bone Working Group

Moulopoulos, Lia A.; Koutoulidis, Vassilis; Hillengaß, Jens; Zamagni, Elena; Aquerreta, Jesús Dámaso; Roche, Charles; Lentzsch, Suzanne; Moreau, Philippe; Cavo, Michèle; Miguel, Jesús F. San; Dimopoulos, Meletios A.; Rajkumar, S. Vincent; Durie, Brian G.M.; Terpos, Evangelos; Delorme, Stefan

doi:10.1038/s41408-018-0124-1

Cited by 64 publications

(70 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The widespread availability of multi-detector CT scanners has contributed to the increased use of WBLDCT for the diagnosis and follow-up of MM. The total effective dose of the WBLDCT in our study is comparable to those reported in recent literature [24][25][26][27]. Moreover, our measured organ specific dose is comparable to the organ dose described by Kröpil DLP dose length product, CTDI vol volume computed tomography dose index, NA not applicable/available et al [28].…”

Section: Discussionsupporting

confidence: 88%

Organ dose and total effective dose of whole-body CT in multiple myeloma patients

et al. 2019

View full text Add to dashboard Cite

Objective To evaluate organ dose and total effective dose of whole-body low-dose CT (WBLDCT) performed on different CTscanner models in patients with multiple myeloma (MM) and to compare it to the effective dose of radiographic skeletal survey and representative diagnostic CTs. Material and methods We retrospectively analyzed data from 228 patients (47.4% females, mean age 67.9 ± 10.4 years, mean weight 81.8 ± 22.4 kg) who underwent WBLDCT for the work-up or surveillance of MM. Patients were scanned using one of six multi-detector CT-scanners. Organ doses and total effective doses per scan were calculated using a commercially available dosemanagement platform (Radimetrics, Bayer Healthcare, Leverkusen, Germany). The median effective dose was compared to radiographic skeletal survey and representative diagnostic CTs. Results The mean effective dose of our WBLDCT-protocol was 4.82 mSv. A significantly higher effective dose was observed in females compared to males (4.95 vs. 4.70 mSv, P = 0.002). Mean organ dose ranged from 3.72 mSv (esophagus) to 13.09 mSv (skeleton). Mean effective dose varied amongst different CT-scanners (range 4.34-8.37 mSv). The median effective dose of WBLDCT was more than twice the dose of a skeletal survey (4.82 vs. 2.04 mSv), 23% higher than a diagnostic contrast-enhanced chest CT (3.9 mSv), 46% lower than a diagnostic contrast-enhanced abdomen/pelvis CT (9.0 mSv), and 45% lower than a lumbar spine CT (8.7 mSv). Conclusions WBLDCT in MM has a higher effective dose than a radiographic skeletal survey, but a lower effective dose than diagnostic CTs of lumbar spine, abdomen and pelvis. This underlines the broad applicability of WBLDCT in the management of MM patients.

show abstract

Section: Discussionsupporting

confidence: 88%

Organ dose and total effective dose of whole-body CT in multiple myeloma patients

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In line with this concern, neither in IMWG [ 9 ] nor the recently published ESMO guidelines [ 18 ] took into account the inner density of lesion detected by WB-LDCT. In addition, recently published recommendations from IMWG on interpretation of WB-LDCT suggest that the presence of fat-containing foci excludes the diagnosis of osteolysis, provided that the patient has not been previously treated [ 19 ]. Concordance between WB-LDCT and PET is reported to be higher than 85% [ 20 ] while concordance between WB-LDCT and MRI is roughly 70% [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Whole-body low-dose CT recognizes two distinct patterns of lytic lesions in multiple myeloma patients with different disease metabolism at PET/MRI

et al. 2018

View full text Add to dashboard Cite

We evaluated differences in density and 18 F-FDG PET/MRI features of lytic bone lesions (LBLs) identified by whole-body low-dose CT (WB-LDCT) in patients affected by newly diagnosed multiple myeloma (MM). In 18 MM patients, 135 unequivocal LBLs identified by WB-LDCT were characterized for inner density (negative or positive Hounsfield unit (HU)), where negative density (HU < 0) characterizes normal yellow marrow whereas positive HU correlates with tissue-like infiltrative pattern. The same LBLs were analyzed by 18 F-FDG PET/DWI-MRI, registering DWI signal with ADC and SUV max values. According to HU, 35 lesions had a negative density (− 56.94 ± 31.87 HU) while 100 lesions presented positive density (44.87 ± 23.89 HU). In seven patients, only positive HU LBLs were demonstrated whereas in eight patients, both positive and negative HU LBLs were detected. Intriguingly, in three patients (16%), only negative HU LBLs were shown. At 18 F-FDG PET/DWI-MRI analysis, negative HU LBLs presented low ADC values (360.69 ± 154.38 × 10 −6 mm 2 /s) and low SUV max values (1.69 ± 0.56), consistent with fatty marrow, whereas positive HU LBLs showed an infiltrative pattern, characterized by higher ADC (mean 868.46 ± 207.67 × 10 −6 mm 2 /s) and SUV max (mean 5.04 ± 1.94) values. Surprisingly, histology of negative HU LBLs documented infiltration by neoplastic plasma cells scattered among adipocytes. In conclusion, two different patterns of LBLs were detected by WB-LDCT in MM patients. Both types of lesions were indicative for active disease, although only positive HU LBL were captured by 18 F-FDG PET/DWI-MRI imaging, indicating that WB-LDCT adds specific information. Electronic supplementary material The online version of this article (10.1007/s00277-018-3555-7) contains supplementary material, which is available to authorized users.

show abstract

“…In MM, the bone lesions of myeloma are determined by the proliferation of cells from a single clone. Then, osteoclasts are activated and destroy the bone [1]. MM, known with the abbreviation CRAB (hyperCalcemia, Renal failure, Anaemia, and lytic Bone lesions) is a cytogenetically heterogenous disorder of clonal plasma cells [1].…”

Section: Introductionmentioning

confidence: 99%

“…Then, osteoclasts are activated and destroy the bone [1]. MM, known with the abbreviation CRAB (hyperCalcemia, Renal failure, Anaemia, and lytic Bone lesions) is a cytogenetically heterogenous disorder of clonal plasma cells [1]. The extent of the bone disease negatively influences patients' quality of life, increasing both morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Subspecialty Second-Opinion in Multiple Myeloma CT: Emphasis on Clinically Significant Lytic Lesions

et al. 2020

View full text Add to dashboard Cite

Background and objectives: In order to increase the accuracy of lytic lesion detection in multiple myeloma, a dedicated second-opinion interpretation of medical images performed by subspecialty musculoskeletal radiologists could increase accuracy. Therefore, the purpose of this study is to evaluate the added value (increased accuracy) of subspecialty second-opinion (SSO) consultations for Computed Tomography (CT) examinations in Multiple Myeloma (MM) patients undergoing stem cell transplantation on standard computed tomography with a focus on focal lesion detection. Materials and Methods: Approval from the institutional review board was obtained. This retrospective study included 70 MM consecutive patients (mean age, 62 years ± 11.3 (standard deviation); range, 35–88 years) admitted in the last six years. Pre-transplant total-body CT (reported by general radiologists) was the only inclusion criteria. Each of these CT examinations had a second-opinion interpretation by two experienced subspecialty musculoskeletal (MSK) radiologists (13 years of experience and 6 years of experience, mean: 9.5 years), experts in musculoskeletal radiology and bone image interpretation with a focus on lytic lesions. Results: Per lesion intra- and inter-observer agreement between the two radiologists was calculated with K statistics and the results were good (K = 0.67: Confidence Inteval (CI) 95%: 0.61–0.78). When the initial CT reports were compared with the re-interpretation reports, 46 (65%) of the 70 cases (95% CI: 37–75%) had no discrepancy. There was a discrepancy in detecting a clinically unimportant abnormality in 10/70 (14%) patients (95% CI: 7–25%) unlikely to alter patient care or irrelevant to further clinical management. A discrepancy in interpreting a clinically important abnormality was registered in 14/70 (21%) patients for focal lesions. The mean diameter of focal lesions was: 23 mm (95% CI: 5–57 mm). The mean number of focal lesions per patient was 3.4 (95% CI). Conclusions: subspecialty second-opinion consultations in multiple myeloma CT is more accurate to identify lesions, especially lytic lesions, amenable to influence patients’ care.

show abstract

Recommendations for acquisition, interpretation and reporting of whole body low dose CT in patients with multiple myeloma and other plasma cell disorders: a report of the IMWG Bone Working Group

Cited by 64 publications

References 33 publications

Organ dose and total effective dose of whole-body CT in multiple myeloma patients

Organ dose and total effective dose of whole-body CT in multiple myeloma patients

Whole-body low-dose CT recognizes two distinct patterns of lytic lesions in multiple myeloma patients with different disease metabolism at PET/MRI

Subspecialty Second-Opinion in Multiple Myeloma CT: Emphasis on Clinically Significant Lytic Lesions

Contact Info

Product

Resources

About