1
|
Hagen F, Grimmer R, Ditt H, Walder L, Wrazidlo R, Karolin B, Hofmann J, Estler A, Horger M. Effects of different virtual monoenergetic CT image data on chest wall post-processing "unfolded ribs" and proposal of an algorithm improvement. Int J Comput Assist Radiol Surg 2023; 18:339-351. [PMID: 35962904 DOI: 10.1007/s11548-022-02721-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/12/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE To find out if the use of different virtual monoenergetic data sets enabled by DECT technology might have a negative impact on post-processing applications, specifically in case of the "unfolded ribs" algorithm. Metal or beam hardening artifacts are suspected to generate image artifacts and thus reduce diagnostic accuracy. This paper tries to find out how the generation of "unfolded rib" CT image reformates is influenced by different virtual monoenergetic CT images and looks for possible improvement of the post-processing tool. MATERIAL AND METHODS Between March 2021 and April 2021, thin-slice dual-energy CT image data of the chest were used creating "unfolded rib" reformates. The same data sets were analyzed in three steps: first the gold standard with the original algorithm on mixed image data sets followed by the original algorithm on different keV levels (40-120 keV) and finally using a modified algorithm which in the first step used segmentation based on mixed image data sets, followed by segmentation based on different keV levels. Image quality (presence of artifacts), lesion and fracture detectability were assessed for all series. RESULTS Both, the original and the modified algorithm resulted in more artifact-free image data sets compared to the gold standard. The modified algorithm resulted in significantly more artifact-free image data sets at the keV-edges (40-120 keV) compared the original algorithm. Especially "black artifacts" and pseudo-lesions, potentially inducing false positive findings, could be reduced in all keV level with the modified algorithm. Detection of focal sclerotic, lytic or mixed (k = 0.990-1.000) lesions was very good for all keV levels. The Fleiss-kappa test for detection of fresh and old rib fractures was ≥ 0.997. CONCLUSION The use of different virtual monoenergetic keVs for the "unfolded rib" algorithm is generating different artifacts. Segmentation-based artifacts could be eliminated by the proposed new algorithm, showing the best results at 70-80 keV.
Collapse
Affiliation(s)
- Florian Hagen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany.
| | | | | | - Lukas Walder
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
| | - Robin Wrazidlo
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
| | - Baumgartner Karolin
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
| | - Johannes Hofmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
| | - Arne Estler
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
| |
Collapse
|
2
|
Park H, Lee SY, Lee J, Pak J, Lee K, Lee SE, Jung JY. Detecting Multiple Myeloma Infiltration of the Bone Marrow on CT Scans in Patients with Osteopenia: Feasibility of Radiomics Analysis. Diagnostics (Basel) 2022; 12:diagnostics12040923. [PMID: 35453971 PMCID: PMC9025143 DOI: 10.3390/diagnostics12040923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 02/04/2023] Open
Abstract
It is difficult to detect multiple myeloma (MM) infiltration of the bone marrow on computed tomography (CT) scans of patients with osteopenia. Our aim is to determine the feasibility of using radiomics analysis to detect MM infiltration of the bone marrow on CT scans of patients with osteopenia. The contrast-enhanced thoracic CT scans of 104 patients with MM and 104 age- and sex-matched controls were retrospectively evaluated. All individuals had decreased bone density on radiography. The study group was divided into development (n = 160) and temporal validation sets (n = 48). The radiomics model was developed using 805 texture features extracted from the bone marrow for a development set, using a Random Forest algorithm. The developed models were applied to evaluate a temporal validation set. For comparison, three radiologists evaluated the CTs for the possibility of MM infiltration in the bone marrow. The diagnostic performances were assessed and compared using an area under the receiver operating characteristic curve (AUC) analysis. The AUC of the radiomics model was not significantly different from those of the radiologists (p = 0.056–0.821). The radiomics analysis results showed potential for detecting MM infiltration in the bone marrow on CT scans of patients with osteopenia.
Collapse
Affiliation(s)
- Hyerim Park
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.P.); (J.L.); (K.L.); (S.-E.L.); (J.-Y.J.)
- Department of Radiology, Soonchunhyang University Cheoan Hospital, Cheonan 31151, Korea;
| | - So-Yeon Lee
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.P.); (J.L.); (K.L.); (S.-E.L.); (J.-Y.J.)
- Correspondence: ; Tel.: +82-2-2258-6743
| | - Jooyeon Lee
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.P.); (J.L.); (K.L.); (S.-E.L.); (J.-Y.J.)
- Department of Applied Statistics, Hanyang University, Seoul 04763, Korea
| | - Juyoung Pak
- Department of Radiology, Soonchunhyang University Cheoan Hospital, Cheonan 31151, Korea;
| | - Koeun Lee
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.P.); (J.L.); (K.L.); (S.-E.L.); (J.-Y.J.)
| | - Seung-Eun Lee
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.P.); (J.L.); (K.L.); (S.-E.L.); (J.-Y.J.)
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.P.); (J.L.); (K.L.); (S.-E.L.); (J.-Y.J.)
| |
Collapse
|
3
|
Sieren MM, Brenne F, Hering A, Kienapfel H, Gebauer N, Oechtering TH, Fürschke A, Wegner F, Stahlberg E, Heldmann S, Barkhausen J, Frydrychowicz A. Rapid study assessment in follow-up whole-body computed tomography in patients with multiple myeloma using a dedicated bone subtraction software. Eur Radiol 2020; 30:3198-3209. [DOI: 10.1007/s00330-019-06631-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/20/2019] [Accepted: 12/13/2019] [Indexed: 11/28/2022]
|
4
|
Kiliç K, Akyüz M, Cindil E, Erdoğan N, Erbaş G, Araç M. Evaluation of a two-image technique consisting of an axial and a coronal image generated by using the rib-flattening application: effect on reading time and diagnostic validity. Turk J Med Sci 2020; 50:59-65. [PMID: 31731329 PMCID: PMC7080368 DOI: 10.3906/sag-1908-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/03/2019] [Indexed: 12/05/2022] Open
Abstract
Background/aim When reading a chest CT, a radiologist needs to evaluate each rib one by one due to complex curvy shape, which makes reporting a tiresome and time-consuming task. A new curved planar reformat application that flattens ribs on a single plane may find a place in the radiology reporting room. This study aimed to evaluate the effect of a two-image set created by using the rib-flattening application on the performance of a radiologist in detecting sclerotic rib lesions in cancer patients. Materials and methods The local Institutional Review Board approved this retrospective study. Two radiologists with different experience levels reviewed chest CT examinations of 106 patients (76 men, 30 women). We divided the patients into group A (n = 54), reviewed by a standard method, and group B (n = 52), reviewed by a standard method and the two-image set created on the rib-flattening application. Reading times, validity indices, and agreement levels with reference data were evaluated for both readers. Results The median reading time of the junior examiner significantly decreased with the rib-flattening method (160.5 s vs. 70.0 s; P < 0.001). Diagnostic indices of the senior reader were improved significantly at per patient level (group A, AUC: 0.867; group B, AUC: 0.982; P = 0.046). The new method showed better agreement levels (kappa: 0.69 to 0.96) than the general method (kappa: 0.53 to 0.91). Conclusion Based on improved agreement levels, reading times, and diagnostic validity indices we conclude that a two-image set consisting of an axial and a coronal flattened-rib image may be used in conjunction with an ordinary exam.
Collapse
Affiliation(s)
- Koray Kiliç
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Melih Akyüz
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Emetullah Cindil
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Nesrin Erdoğan
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Gonca Erbaş
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Araç
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| |
Collapse
|
5
|
Improved Detection of Benign and Malignant Rib Lesions in the Routine Computed Tomography Workup of Oncological Patients Using Automated Unfolded Rib Image Postprocessing. Invest Radiol 2020; 55:84-90. [DOI: 10.1097/rli.0000000000000599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
6
|
Automatic rib cage unfolding with CT cylindrical projection reformat in polytraumatized patients for rib fracture detection and characterization: Feasibility and clinical application. Eur J Radiol 2019; 110:121-127. [DOI: 10.1016/j.ejrad.2018.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 11/23/2022]
|
7
|
Chantry A, Kazmi M, Barrington S, Goh V, Mulholland N, Streetly M, Lai M, Pratt G. Guidelines for the use of imaging in the management of patients with myeloma. Br J Haematol 2017; 178:380-393. [PMID: 28677897 DOI: 10.1111/bjh.14827] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The role of imaging in myeloma has gained increasing importance over the past few years. The recently revised definition of myeloma from the International Myeloma Working Group (IMWG) includes cross sectional imaging as a method to define bone disease and also incorporates its use in the disease definition for patients with suspected smouldering myeloma. The National Institute for Health and Care Excellence myeloma guidelines also recommend cross sectional imaging for patients with suspected myeloma. There is also increasing use of imaging in disease assessments and the International Myeloma Working Group has recently incorporated imaging in defining new response categories of minimal residual disease negativity, with or without imaging-based evidence of disease. Plain X-rays have previously been the standard imaging modality included in a myeloma work up at presentation but evidence is mounting for use of cross-sectional modalities such as computed tomography (CT), magnetic resonance imaging (MRI) and 18 fluoro-deoxyglucose (18 F-FDG) positron emission tomography (PET)/CT. Funding and therefore availability of newer imaging techniques remains a barrier. Here, we propose an evidence-based approach to the use and technical application of the latest imaging modalities at diagnosis and in the follow-up of patients with myeloma and plasmacytoma.
Collapse
Affiliation(s)
- Andrew Chantry
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Majid Kazmi
- Department of Haematology, Guys and St Thomas's NHS Foundation Trust, London, UK
| | - Sally Barrington
- Division of Imaging Sciences & Biomedical Engineering, King's College London Department of Cancer Imaging, London, UK
- The PET Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vicky Goh
- Division of Imaging Sciences & Biomedical Engineering, King's College London Department of Cancer Imaging, London, UK
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicola Mulholland
- Department of Radiology, Kings College Hospital NHS Foundation Trust, London, UK
| | - Matthew Streetly
- Department of Haematology, Guys and St Thomas's NHS Foundation Trust, London, UK
| | | | - Guy Pratt
- Department of Haematology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
8
|
Horger M, Ditt H, Liao S, Weisel K, Fritz J, Thaiss WM, Kaufmann S, Nikolaou K, Kloth C. Automated "Bone Subtraction" Image Analysis Software Package for Improved and Faster CT Monitoring of Longitudinal Spine Involvement in Patients with Multiple Myeloma. Acad Radiol 2017; 24:623-632. [PMID: 28256439 DOI: 10.1016/j.acra.2016.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/18/2016] [Indexed: 01/16/2023]
Abstract
RATIONALE AND OBJECTIVES The study aimed to assess the diagnostic benefit of a novel computed tomography (CT) post-processing software generating subtraction maps of longitudinal non-enhanced CT examinations for monitoring the course of myeloma bone disease in the spine. MATERIALS AND METHODS The local institutional review board approved the retrospective data evaluation. Included were 82 consecutive myeloma patients (46 male; mean age, 65.08 ± 9.76) who underwent 188 repeated whole-body reduced-dose Multislice Detector Computed Tomography (MDCT) at our institution between December 2013 and January 2016. Lytic bone lesions were categorized as new or enlarging versus stable. Bone subtraction maps were read in combination with corresponding 1-mm source images comparing results to those of standard image reading of 5-mm axial and 2-mm multiplanar reformat reconstructions (MPR) scans and hematologic markers, and classified as either progressive disease (PD) or stable disease (SD or remission). The standard of reference was 1-mm axial CT image reading + hematologic response both confirmed at follow-up. For statistical purposes, we subgrouped the hematologic response categories similarly to those applied for CT imaging (progression vs stable/response). RESULTS According to the standard of reference, 16 patients experienced PD and 66 SD at follow-up. Th sensitivity, specificity, and accuracy for axial 5 mm + 2 mm MPR image versus bone subtraction maps in a "lesion-by-lesion" reading were 97.6%, 92.3%, and 97.2% versus 97.8%, 96.7%, and 97.7%, respectively. The use of bone subtraction maps resulted in a change of response classification in 9.7% of the patients (n = 8) versus 5 mm + 2 mm MPR image reading from SD to PD. Bone sclerosis lesions were detected in 52 out of 82 patients (63.4%). The reading time was significantly lower with the software bone subtraction compared to standard reading (P < 0.01) and 1-mm image reading (P < 0.001). CONCLUSION Accuracy of bone subtraction maps reading for monitoring multiple myeloma is slightly increased over that of conventional axial + MPR image reading and significantly speeds up the reading time.
Collapse
|
9
|
Ha JY, Jeon KN, Bae K, Choi BH. Effect of Bone Reading CT software on radiologist performance in detecting bone metastases from breast cancer. Br J Radiol 2017; 90:20160809. [PMID: 28256905 DOI: 10.1259/bjr.20160809] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate the effect of CT software that generates rib unfolding images and automatically numbers ribs and thoracic spines on radiologist performance in detecting thoracic bone metastases from breast cancer. METHODS A total of 126 patients with breast cancer who underwent chest CT and fludeoxyglucose (FDG)-positron emission tomography (PET)/CT and/or bone scans were retrospectively reviewed. One board-certified radiologist (R1) and one radiology resident (R2) independently assessed the original chest CT and rib unfolding images using a commercially available post-processing software (Bone Reading) application to evaluate metastasis in the ribs and thoracic spines. Results were compared with reference standard based on CT, FDG-PET/CT and/or bone scan with follow-up. RESULTS Based on reference standard, 78 metastatic bone lesions in 26 patients were identified. On per-patient-based analysis, Bone Reading assessed by R1/R2 had a sensitivity of 84.6%/80.8% and a specificity of 94.0%/94.0% with an accuracy of 92.1%/91.3%. The original CT reading yielded a sensitivity of 73.1%/57.7% and a specificity of 95.0%/94.0% with an accuracy of 90.5%/86.5%. The sensitivity and accuracy of Bone Reading were significantly higher than those of CT reading, as assessed by R2 (both p = 0.031). On per-lesion-based analysis, Bone Reading assessed by R1/R2 yielded a sensitivity of 84.6%/82.1% and a specificity of 99.7%/99.6% with an accuracy of 99.4%/99.3%, while the original CT reading yielded a sensitivity of 71.8%/62.8% and a specificity of 99.6%/99.5% with an accuracy of 99.2%/98.9%. The sensitivity and accuracy with Bone Reading application were significantly higher than those with CT reading by both readers (R1, p = 0.006 and p = 0.036, respectively; R2, both p < 0.001). The mean reading time needed for Bone Reading application was significantly shorter than that for original chest CT reading (p < 0.001). Bone Reading application helped readers find small and sclerotic lesions missed in original CT reading. CONCLUSION In patients with breast cancer, the use of Bone Reading application improved radiologist performance in bone metastasis detection compared with original chest CT reading with reduced reading time. This software will be more helpful to inexperienced radiologists for improving the reading performance. Advances in knowledge: Small and sclerotic lesions can be easily missed in original CT reading. Using Bone Reading CT software can enhance the performance of radiologists in detecting bone metastasis in breast cancer. False-negative rates can be significantly reduced in both inexperienced and experienced readers.
Collapse
Affiliation(s)
- Ji Y Ha
- 1 Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Kyung N Jeon
- 1 Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Kyungsoo Bae
- 1 Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Bong H Choi
- 1 Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,3 Department of Nuclear Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| |
Collapse
|
10
|
Horger M, Thaiss WM, Ditt H, Weisel K, Fritz J, Nikolaou K, Liao S, Kloth C. Improved MDCT monitoring of pelvic myeloma bone disease through the use of a novel longitudinal bone subtraction post-processing algorithm. Eur Radiol 2016; 27:2969-2977. [PMID: 27882427 DOI: 10.1007/s00330-016-4642-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 09/16/2016] [Accepted: 10/10/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of a novel CT post-processing software that generates subtraction maps of baseline and follow-up CT examinations in the course of myeloma bone lesions. MATERIALS AND METHODS This study included 61 consecutive myeloma patients who underwent repeated whole-body reduced-dose MDCT at our institution between November 2013 and June 2015. CT subtraction maps classified a progressive disease (PD) vs. stable disease (SD)/remission. Bone subtraction maps (BSMs) only and in combination with 1-mm (BSM+) source images were compared with 5-mm axial/MPR scans. RESULTS Haematological response categories at follow-up were: complete remission (n = 9), very good partial remission (n = 2), partial remission (n = 17) and SDh (n = 19) vs. PDh (n = 14). Five-millimetre CT scan yielded PD (n = 14) and SD/remission (n = 47) whereas bone subtraction + 1-mm axial scans (BSM+) reading resulted in PD (n = 18) and SD/remission (n = 43). Sensitivity/ specificity/accuracy for 5-mm/1-mm/BSM(alone)/BSM + in "lesion-by-lesion" reading was 89.4 %/98.9 %/98.3 %/ 99.5 %; 69.1 %/96.9 %/72 %/92.1 % and 83.8 %/98.4 %/92.1 %/98.3 %, respectively. The use of BSM+ resulted in a change of response classification in 9.8 % patients (n = 6) from SD to PD. CONCLUSION BSM reading is more accurate for monitoring myeloma compared to axial scans whereas BSM+ yields similar results with 1-mm reading (gold standard) but by significantly reduced reading time. KEY POINTS • CT evaluation of myeloma bone disease using a longitudinal bone subtraction post-processing algorithm. • Bone subtraction post-processing algorithm is more accurate for assessment of therapy. • Bone subtraction allowed improved and more efficient detection of myeloma bone lesions. • Post-processing tool demonstrating a change in response classification in 9.8 % patients (all showing PD). • Reading time could be substantially shortened as compared to regular CT assessment.
Collapse
Affiliation(s)
- Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str.3, D-72076, Tuebingen, Germany
| | - Wolfgang M Thaiss
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str.3, D-72076, Tuebingen, Germany
| | - Hendrik Ditt
- Siemens AG Healthcare, Sector Imaging and Interventional Radiology, Siemensstr. 1, D-91301, Forchheim, Germany
| | - Katja Weisel
- Department of Internal Medicine II, Eberhard-Karls-University Tübingen, D-72076, Tübingen, Germany
| | - Jan Fritz
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medcine, 601 N. Caroline Street, JHOC 3142, Baltimore, MD, 21287, USA
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str.3, D-72076, Tuebingen, Germany
| | - Shu Liao
- Siemens Medical Solutions, Malvern, PA, 19355, USA
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str.3, D-72076, Tuebingen, Germany.
| |
Collapse
|
11
|
Simplified response monitoring criteria for multiple myeloma in patients undergoing therapy with novel agents using computed tomography. Eur J Radiol 2016; 85:2195-2199. [PMID: 27842666 DOI: 10.1016/j.ejrad.2016.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/24/2016] [Accepted: 10/14/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Multiple myeloma is a malignant hematological disorder of the mature B-cell lymphocytes originating in the bone marrow. While therapy monitoring is still mainly based on laboratory biomarkers, the additional use of imaging has been advocated due to inaccuracies of serological biomarkers or in a-secretory myelomas. Non-enhanced CT and MRI have similar sensitivities for lesions in yellow marrow-rich bone marrow cavities with a favourable risk and cost-effectiveness profile of CT. Nevertheless, these methods are still limited by frequently high numbers of medullary lesions and its time consumption for proper evaluation. OBJECTIVE To establish simplified response criteria by correlating size and CT attenuation changes of medullary multiple myeloma lesions in the appendicular skeleton with the course of lytic bone lesions in the entire skeleton. Furthermore to evaluate these criteria with respect to established hematological myeloma-specific parameters for the prediction of treatment response to bortezomib or lenalidomide. MATERIALS AND METHODS Non-enhanced reduced-dose whole-body CT examinations of 78 consecutive patients (43 male, 35 female, mean age 63.69±9.2years) with stage III multiple myeloma were retrospectively re-evaluated. On per patient basis, size and mean CT attenuation of 2-4 representative lesions in the limbs were measured at baseline and at a follow-up after a mean of 8 months. Results were compared with the course of lytical bone lesions as well with that of specific hematological biomarkers. Myeloma response was assessed according to the International Myeloma Working Group (IMWG) uniform response criteria. Testing for correlation between response of medullary lesions (Respmed) and response of all myeloma manifestations including osteolyses (Resptotal) was performed using the corrected contingency coefficient (Ccorr). RESULTS The correlation between Respmed based on length diameter and transverse diameter and Resptotal was perfect (Ccorr=1.0; p<0.0001) whereas the correlation based on density was moderate (Ccorr=0.54; p<0.0001). The evaluation of simplified response criteria with a measurement of only 2 medullary lesions yielded the best sensitivity and specificity valued for treatment-induced changes for the length diameter evaluation with 94.4%/95.7% for prediction of progressive disease and 78.6%/93.3% for prediction of therapy response. There were no significant differences between patients treated with bortezomib and lenalidomide (p>0.05). CONCLUSION Measurements of size of a minimum of two medullary lesions is sufficient for response assessment and correlates very well with the course of lytic bone lesions and that of hematologic parameters.
Collapse
|
12
|
Glemser PA, Pfleiderer M, Heger A, Tremper J, Krauskopf A, Schlemmer HP, Yen K, Simons D. New bone post-processing tools in forensic imaging: a multi-reader feasibility study to evaluate detection time and diagnostic accuracy in rib fracture assessment. Int J Legal Med 2016; 131:489-496. [DOI: 10.1007/s00414-016-1412-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 06/29/2016] [Indexed: 11/27/2022]
|
13
|
Improved Follow-Up and Response Monitoring of Thoracic Cage Involvement in Multiple Myeloma Using a Novel CT Postprocessing Software: The Lessons We Learned. AJR Am J Roentgenol 2016; 206:57-63. [DOI: 10.2214/ajr.15.15089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|