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

Abstract

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.

Quantitative Imaging and Radiomics in Multiple Myeloma: opportunity or hype?

“…By instance, it is not always possible to obtain WBLDCT in every patient and often patients with MM receive standard total body CT including thorax and abdominal evaluation. However, after standard reporting of thorax and abdominal findings, in patients affected by MM the focus should be given to small lytic lesion [3][4][5]18]. Further, the largest number of CT examinations of patients affected by MM is performed in the elderly, which implies that multiple degenerative bone changes are likely to influence the radiological report reducing the agreement among readers in CT image interpretation to detect even clinically significant small lytic lesions [6,8,10,11].…”

“…This hematological malignant disease is characterized by the autonomous monoclonal proliferation of plasma cells in the bone marrow [2]. More specifically, MM is a cytogenetically heterogeneous disorder of clonal plasma cells in which an excessive production of either monoclonal intact immunoglobulin molecules or immunoglobulin free light chains kappa or lambda is crucial for development of clinical features [3][4][5][6][7]. Many risk factors for MM are known, including male sex, radiation exposure and monoclonal gammopathy of undetermined significance (MGUS) [1, 6,8].…”

“…Yet, the diagnostic and prognostic capabilities of medical imaging in MM are still under investigation and development. In fact, significant variability in image-based prognostic scores is present among different centres and in clinical practice [5,11,13,15]. Further, although the updated version of the IMWG criteria accepts the use of CT, WBLDCT and PET/CT to diagnose lytic bone disease in MM, there is still a lack of reliable computational tools for increasing the prognostic value of these modern imaging modalities.…”

“…However, in some cases, lesion could be numerous, well circumscribed and could punch out lucencies, raindrop skull, endosteal scalloping and sometimes generalized osteopenia [25,26]. In these cases, it is likely that a sub-speciality with experience in reading CT and MRI data will enhance the role of CT and MRI for MM [27,28]. In many centers, consultation and second-opinion interpretation of medical images by subspecialty radiologists are routinely performed [5,[29][30][31][32][33].…”

“…In these cases, it is likely that a sub-speciality with experience in reading CT and MRI data will enhance the role of CT and MRI for MM [27,28]. In many centers, consultation and second-opinion interpretation of medical images by subspecialty radiologists are routinely performed [5,[29][30][31][32][33]. A recent study was done with the aimto improve the radiological detection and characterization of clinically significant lytic lesions using standard CT (Figure 2).…”