Diagnostic value of whole-body ultra-low dose computed tomography in comparison with spinal magnetic resonance imaging in the assessment of disease in multiple myeloma

Abstract

This study compared the diagnostic value of Whole-Body Ultra Low-Dose computed tomography (WBULDCT) with that of Spinal Magnetic Resonance Imaging (SMRI) in identification of spinal bone marrow involvement in patients with Multiple Myeloma (MM). Thirty-five patients with histologically proven MM underwent WBULDCT and dedicated SMRI. Unenhanced WBULDCT was performed on a 256-slice scanner, with 120 kV and 40 mAs. SMRI was performed on a 1·5T magnet, with T1-turbo spin echo and T2-short tau inversion recovery sequences on sagittal plane. WBULDCT was compared with SMRI in terms of lesion detection, pattern and bone marrow involvement. The overall concordance between WBULDCT and SMRI in lesion detection was 76·7%, detecting (25/35) or excluding (8/35) involvement of the axial skeleton, while in 2/35 patients WBULDCT and SMRI were discordant in terms of axial skeleton involvement. The concordance in spinal distribution of lesions was 61·6% on cervical, 71·5% on dorsal, 86·4% on lumbar and 94·4% on sacral, while for the pattern of disease, it was 56·1% for the focal and 88·7% for the combined pattern. Cohen's kappa index was 0·85 (P < 0·001) assessing an excellent agreement. WBULDCT represents a useful diagnostic tool in the detection of spinal involvement of MM patients, offering detailed information about extra-axial involvement, which could be potentially missed with dedicated SMRI.

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

“…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].…”

Whole‐body ultra‐low dose computed tomography in comparison with spinal magnetic resonance imaging in the assessment of disease in multiple myeloma; Methodological issues on Diagnostic value

“…The concordance in spinal distribution of lesions was 61Á6% on cervical, 71Á5% on dorsal, 86Á4% on lumbar and 94Á4% on sacral, while for the pattern of disease, it was 56Á1% for the focal and 88Á7% for the combined pattern. Cohen's kappa index was 0Á85 (P < 0Á001), assessing an excellent agreement (Ippolito et al, 2017). I should like to raise 3-4 methodological and statistical points regarding diagnostic value.…”

“…One more important thing is our approach to assess validity is global average; however, an individual based approach should be considered to correctly assess reliability. Ippolito et al (2017) concluded that WBULDCT represents a useful diagnostic tool in the detection of spinal involvement of MM patients, offering detailed information about extra-axial involvement, which could be potentially missed with dedicated SMRI. Here, I have discussed the limitations of their approach and the lack of evidence for such a …”

“…I was interested to read the recent paper by Ippolito et al (2017), published in this journal. The purpose of the authors was to compare the diagnostic value of whole-body ultra low-dose computed tomography (WBULDCT) with that of Spinal Magnetic Resonance Imaging (SMRI) for the identification of spinal bone marrow involvement in patients with Multiple Myeloma (MM) (Ippolito et al, 2017).…”

“…The purpose of the authors was to compare the diagnostic value of whole-body ultra low-dose computed tomography (WBULDCT) with that of Spinal Magnetic Resonance Imaging (SMRI) for the identification of spinal bone marrow involvement in patients with Multiple Myeloma (MM) (Ippolito et al, 2017). Based on their results, the overall concordance between WBULDCT and SMRI in lesion detection was 76Á7%, detecting or excluding involvement of the axial skeleton in 25 and 35 out of the 35 cases studied, while in 2/35 patients WBULDCT and SMRI were discordant in terms of axial skeleton involvement.…”