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Brandelik SC, Skornitzke S, Mokry T, Sauer S, Stiller W, Nattenmüller J, Kauczor HU, Weber TF, Do TD. Quantitative and qualitative assessment of plasma cell dyscrasias in dual-layer spectral CT. Eur Radiol 2021; 31:7664-7673. [PMID: 33783572 PMCID: PMC8452563 DOI: 10.1007/s00330-021-07821-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/19/2021] [Indexed: 01/01/2023]
Abstract
Objectives Virtual non-calcium (VNCa) images could improve assessment of plasma cell dyscrasias by enhancing visibility of bone marrow. Thus, VNCa images from dual-layer spectral CT (DLCT) were evaluated at different calcium suppression (CaSupp) indices, correlating results with apparent diffusion coefficient (ADC) values from MRI. Methods Thirty-two patients with initial clinical diagnosis of a plasma cell dyscrasia before any chemotherapeutic treatment, who had undergone whole-body low-dose DLCT and MRI within 2 months, were retrospectively enrolled. VNCa images with CaSupp indices ranging from 25 to 95 in steps of 10, conventional CT images, and ADC maps were quantitatively analyzed using region-of-interests in the vertebral bodies C7, T12, L1-L5, and the iliac bone. Independent two-sample t-test, Wilcoxon-signed-rank test, Pearson’s correlation, and ROC analysis were performed. Results Eighteen patients had a non-diffuse, 14 a diffuse infiltration in conventional MRI. A significant difference between diffuse and non-diffuse infiltration was shown for VNCa-CT with CaSupp indices from 55 to 95, for conventional CT, and for ADC (each p < 0.0001). Significant quantitative correlation between VNCa-CT and MRI could be found with strongest correlation at CaSupp index 65 for L3 (r = 0.68, p < 0.0001) and averaged L1-L5 (r = 0.66, p < 0.0001). The optimum CT number cut-off point for differentiation between diffuse and non-diffuse infiltration at CaSupp index 65 for averaged L1-L5 was −1.6 HU (sensitivity 78.6%, specificity 75.0%). Conclusion Measurements in VNCa-CT showed the highest correlation with ADC at CaSupp index 65. VNCa technique may prove useful for evaluation of bone marrow infiltration if MRI is not feasible. Key Points • VNCa-CT images can support the evaluation of bone marrow infiltration in plasma cell dyscrasias. • VNCa measurements of vertebral bodies show significant correlation with ADC in MRI. • Averaging L1-L5 at CaSupp index 65 allowed quantitative detection of infiltration comparable to MRI ADC.
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Affiliation(s)
- S C Brandelik
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - S Skornitzke
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - T Mokry
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - S Sauer
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - W Stiller
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - J Nattenmüller
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - H U Kauczor
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - T F Weber
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - T D Do
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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Kintzelé L, Brandelik SC, Wuennemann F, Weber MA, Lehner B, Kauczor HU, Rehnitz C. MRI patterns indicate treatment success and tumor relapse following radiofrequency ablation of osteoblastoma. Int J Hyperthermia 2020; 37:274-282. [PMID: 32188300 DOI: 10.1080/02656736.2020.1739763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Purpose: To explore the typical magnetic resonance imaging (MRI) pattern of osteoblastoma (OB) after radiofrequency ablation (RFA) treatment and to identify signs indicating treatment success or relapse.Materials and methods: Forty-four follow-up MRI examinations of 15 patients with OB who had undergone 19 RFA procedures were analyzed retrospectively. An early follow-up group (1-4 months after RFA) and a late follow-up group (8-131 months after RFA) were established. The groups were further subdivided according to treatment success. Images were analyzed for the presence of central nidus enhancement (CNE), peripheral nidus enhancement (PNE), perifocal bone marrow edema (PBME) and fatty nidus conversion (FNC).Results: The early follow-up MRI image from every patient in the treatment success group exhibited a target-like appearance with negative CNE and positive PNE or PBME. PNE and PBME were observed in 93% and 71% of the early follow-up images, respectively. A target-like appearance was observed in 25% of the late follow-up images, and PNE and PBME were each observed in 20% of these images. FNC was not observed in the early follow-up images, but was seen in 55% of the late follow-up images. All three MRI images of the patients exhibiting clinical recurrence demonstrated strong CNE, PNE and extensive PMBE, which was in contrast to the images of the patients exhibiting treatment success.Conclusion: A target-like appearance of OB in early follow-up MRI examination indicates treatment success. PNE and PBME typically reduce over time and can lead to FNC in successfully treated patients. CNE recurrence, PNE and extensive PBME are signs of relapse.
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Affiliation(s)
- Laurent Kintzelé
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Felix Wuennemann
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Burkhard Lehner
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Rehnitz
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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Brandelik SC, Heussel CP, Kauczor HU, Röcken C, Huber L, Basset M, Kimmich C, Schönland SO, Hegenbart U, Nattenmüller J. CT features in amyloidosis of the respiratory system - Comprehensive analysis in a tertiary referral center cohort. Eur J Radiol 2020; 129:109123. [PMID: 32590259 DOI: 10.1016/j.ejrad.2020.109123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE Amyloidosis of the respiratory system is rare and challenging since imaging findings have several more prevalent alternative diagnoses. We analyze and quantify chest CT findings in a large tertiary referral center patient cohort with confirmed amyloidosis of the respiratory system. METHODS 67 patients with histology-proven amyloidosis of the respiratory system and with available chest CT scans were retrospectively enrolled (years 2002-2018): 41 patients with local pulmonary parenchymal, 20 with local tracheobronchial, and 6 with systemic amyloidosis. CT was scored for findings like mass lesions, nodules, cysts, lymphadenopathy, calcifications and pleural, interstitial and tracheobronchial manifestations. Clinical data and imaging findings' frequencies among patients with local pulmonary parenchymal and tracheobronchial amyloidosis were compared. RESULTS Patients with local pulmonary parenchymal amyloidosis were older (67 vs. 56 years; P = 0.013) and less frequently symptomatic for cough (24% vs. 70%; P = 0.018) and bronchopulmonal infections (7% vs. 55%; P < 0.001) than patients with tracheobronchial amyloidosis. Local pulmonary parenchymal amyloidosis showed higher frequency of mass-like lesions (41% vs. 0%; P = 0.002) and nodules (95% vs. 20%; P < 0.001, with 10 or more nodules in 56% vs. 0%; P < 0.001 and predominantly pleura-associated in 32% vs. 0%; P = 0.02). Tracheobronchial amyloidosis leads to wall thickening of the bronchi (100% vs. 5%; P < 0.001) and the trachea (70% vs. 2%; P < 0.001). Systemic amyloidosis went along with a predominant alveolar septal pattern in 4 out of 6 patients. CONCLUSION Patients with local pulmonary parenchymal amyloidosis differ significantly from patients with tracheobronchial amyloidosis regarding clinical data and CT findings' frequencies. Being familiar with radiological manifestations of all three respiratory amyloidosis distribution patterns is essential to accelerate the diagnosis.
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Affiliation(s)
- Simone Christine Brandelik
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Röntgenstrasse 1, 69126 Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Röntgenstrasse 1, 69126 Heidelberg, Germany
| | - Christoph Röcken
- Department of Pathology, Christian-Albrechts-University Kiel, Arnold-Heller-Str.3/14, 24105 Kiel, Germany
| | - Laura Huber
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Marco Basset
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Christoph Kimmich
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Stefan Olaf Schönland
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Ute Hegenbart
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Johanna Nattenmüller
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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Brandelik SC, Krzykalla J, Hielscher T, Hillengass J, Kloth JK, Kauczor HU, Weber MA. [Focal lesions in whole-body MRI in multiple myeloma : Quantification of tumor mass and correlation with disease-related parameters and prognosis]. Radiologe 2017; 58:72-78. [PMID: 28905085 DOI: 10.1007/s00117-017-0299-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES In this study, we evaluated methods of quantification of tumor mass in whole-body MRI (wb-MRI) in multiple myeloma and correlated these with disease-related parameters in serum and bone marrow. MATERIALS AND METHODS We retrospectively evaluated wb-MRIs of 52 patients with focal infiltration pattern and a total of 700 focal lesions (subsequently called lesions). We determined the longest diameter (LD), the segmented volume (SV), and the morphology (spherical or non-spherical). We correlated total number/volume of the lesions with clinical parameters and prognosis and furthermore LD with SV. After that we analyzed the agreement of SV and estimated volume (EV) using the volume formula of a sphere based on LD. RESULTS Results showed no significant correlations of total number/volume with prognosis or clinical parameters. The latter were situated predominantly in the normal range. Furthermore, 10% of lesions were spherical. SV and LD correlated significantly in single lesions and on patient level. SV was in lesions <6 cm3 systematically larger and in lesions ≥6 cm3 smaller than EV. In 95%, we found in small lesions a deviation of EV versus SV from +0.9 cm3 to -4.6 cm3 and in large lesions from +160 cm3 to -111 cm3 (EV-SV). CONCLUSIONS Quantification of tumor mass in the focal infiltration pattern is performed more accurately by volumetry than LD due to the predominant existence of non-spherical lesions. The patient cohort with clinical parameters predominantly in the normal range is distributed to ISS stage I and partly pretreated, a fact that makes interpretation of absent correlations more difficult. Consider also a variation in activitiy of lesions and a diffuse infiltration not detectable by MRI.
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Affiliation(s)
- S C Brandelik
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - J Krzykalla
- Biostatistik, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - T Hielscher
- Biostatistik, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - J Hillengass
- Hämatologie und Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - J K Kloth
- Radiologie Löbau, Löbau, Deutschland
| | - H U Kauczor
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - M A Weber
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
- Diagnostische und Interventionelle Radiologie, Universitätsmedizin Rostock, Rostock, Deutschland
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