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Clinical and prognostic significance of bone marrow abnormalities in the appendicular skeleton detected by low-dose whole-body multidetector computed tomography in patients with multiple myeloma.

Nishida Y, Matsue Y, Suehara Y, Fukumoto K, Fujisawa M, Takeuchi M, Ouchi E, Matsue K - Blood Cancer J (2015)

Bottom Line: Disease progression of MM was independently associated with high CTv on multivariate analysis.In symptomatic MM, the presence of abnormal medullary lesions was associated with increased incidence of high-risk cytogenetic abnormalities (34.4% vs 7.7%; P=0.002) and extramedullary disease (10.4% vs 0%; P=0.032).This study showed that CTv of AS by MDCT is correlated with disease progression of MM, and the presence of abnormal medullary lesions is a predictor for poor survival.

View Article: PubMed Central - PubMed

Affiliation: 1] Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa, Japan [2] Department of Hematology, Respiratory Medicine and Oncology, Division of Internal Medicine, Saga University, Saga, Japan.

ABSTRACT
Clinical significance of medullary abnormalities in the appendicular skeleton (AS) detected by low-dose whole-body multidetector computed tomography (MDCT) in patients with multiple myeloma (MM) was investigated. A total of 172 patients with monoclonal gammopathy of undetermined significance (MGUS) (n=17), smoldering MM (n=47) and symptomatic MM (n=108) underwent low-dose MDCT. CT values (CTv) of medullary density of AS⩾0 Hounsfield unit (HU) was considered as abnormal. Percentage of medullary abnormalities and the mean CTv of AS in patients with MGUS, smoldering MM and symptomatic MM were 18, 55 and 62% and -44.5 , -20.3 and 11.2 HU, respectively (P<0.001 and P<0.001). Disease progression of MM was independently associated with high CTv on multivariate analysis. In symptomatic MM, the presence of abnormal medullary lesions was associated with increased incidence of high-risk cytogenetic abnormalities (34.4% vs 7.7%; P=0.002) and extramedullary disease (10.4% vs 0%; P=0.032). It was also an independent poor prognostic predictor (hazard ratio 3.546, P=0.04). This study showed that CTv of AS by MDCT is correlated with disease progression of MM, and the presence of abnormal medullary lesions is a predictor for poor survival.

No MeSH data available.


Related in: MedlinePlus

Representative presentation of normal right humeral bone marrow (a), abnormal medullary lesions in a patient with MM with diffuse (b) and focal pattern (c). CTv of the abnormal medullary lesion was measured using a circular region of interest (ROI) and expressed in Hounsfield units.
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fig1: Representative presentation of normal right humeral bone marrow (a), abnormal medullary lesions in a patient with MM with diffuse (b) and focal pattern (c). CTv of the abnormal medullary lesion was measured using a circular region of interest (ROI) and expressed in Hounsfield units.

Mentions: As the bone marrow of AS is usually replaced by adipose tissue in normal adults and is expected to exhibit lower CT values (CTv) than the density of water (=0 Hounsfield Unit (HU)), bone marrow infiltration with densities in the positive range were considered to indicate myelomatous infiltration. Therefore, medullary lesions in AS with CTv⩾0 HU were considered as abnormal.3 Mean CTv of visualized high-density lesions in bony canals of AS were measured using a circular regions of interest. The highest mean CTv of the regions of interest among the bony canals was used as the CTv of the patient. The size of the regions of interest was determined according the size of the respective high-density area. Infiltration of the humeral and femoral bony canals was classified as focal or diffuse according to the pattern of the dense area. The diffuse pattern was defined as homogenous opacity of >90% of the bony canal of any AS, and the focal pattern was defined as the presence of any circumscribed focal high-density area recognized visually. Figure 1 shows representative illustrations of normal right humeral bone marrow and abnormal medullary lesions in a patient with MM with diffuse and focal patterns.


Clinical and prognostic significance of bone marrow abnormalities in the appendicular skeleton detected by low-dose whole-body multidetector computed tomography in patients with multiple myeloma.

Nishida Y, Matsue Y, Suehara Y, Fukumoto K, Fujisawa M, Takeuchi M, Ouchi E, Matsue K - Blood Cancer J (2015)

Representative presentation of normal right humeral bone marrow (a), abnormal medullary lesions in a patient with MM with diffuse (b) and focal pattern (c). CTv of the abnormal medullary lesion was measured using a circular region of interest (ROI) and expressed in Hounsfield units.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526783&req=5

fig1: Representative presentation of normal right humeral bone marrow (a), abnormal medullary lesions in a patient with MM with diffuse (b) and focal pattern (c). CTv of the abnormal medullary lesion was measured using a circular region of interest (ROI) and expressed in Hounsfield units.
Mentions: As the bone marrow of AS is usually replaced by adipose tissue in normal adults and is expected to exhibit lower CT values (CTv) than the density of water (=0 Hounsfield Unit (HU)), bone marrow infiltration with densities in the positive range were considered to indicate myelomatous infiltration. Therefore, medullary lesions in AS with CTv⩾0 HU were considered as abnormal.3 Mean CTv of visualized high-density lesions in bony canals of AS were measured using a circular regions of interest. The highest mean CTv of the regions of interest among the bony canals was used as the CTv of the patient. The size of the regions of interest was determined according the size of the respective high-density area. Infiltration of the humeral and femoral bony canals was classified as focal or diffuse according to the pattern of the dense area. The diffuse pattern was defined as homogenous opacity of >90% of the bony canal of any AS, and the focal pattern was defined as the presence of any circumscribed focal high-density area recognized visually. Figure 1 shows representative illustrations of normal right humeral bone marrow and abnormal medullary lesions in a patient with MM with diffuse and focal patterns.

Bottom Line: Disease progression of MM was independently associated with high CTv on multivariate analysis.In symptomatic MM, the presence of abnormal medullary lesions was associated with increased incidence of high-risk cytogenetic abnormalities (34.4% vs 7.7%; P=0.002) and extramedullary disease (10.4% vs 0%; P=0.032).This study showed that CTv of AS by MDCT is correlated with disease progression of MM, and the presence of abnormal medullary lesions is a predictor for poor survival.

View Article: PubMed Central - PubMed

Affiliation: 1] Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa, Japan [2] Department of Hematology, Respiratory Medicine and Oncology, Division of Internal Medicine, Saga University, Saga, Japan.

ABSTRACT
Clinical significance of medullary abnormalities in the appendicular skeleton (AS) detected by low-dose whole-body multidetector computed tomography (MDCT) in patients with multiple myeloma (MM) was investigated. A total of 172 patients with monoclonal gammopathy of undetermined significance (MGUS) (n=17), smoldering MM (n=47) and symptomatic MM (n=108) underwent low-dose MDCT. CT values (CTv) of medullary density of AS⩾0 Hounsfield unit (HU) was considered as abnormal. Percentage of medullary abnormalities and the mean CTv of AS in patients with MGUS, smoldering MM and symptomatic MM were 18, 55 and 62% and -44.5 , -20.3 and 11.2 HU, respectively (P<0.001 and P<0.001). Disease progression of MM was independently associated with high CTv on multivariate analysis. In symptomatic MM, the presence of abnormal medullary lesions was associated with increased incidence of high-risk cytogenetic abnormalities (34.4% vs 7.7%; P=0.002) and extramedullary disease (10.4% vs 0%; P=0.032). It was also an independent poor prognostic predictor (hazard ratio 3.546, P=0.04). This study showed that CTv of AS by MDCT is correlated with disease progression of MM, and the presence of abnormal medullary lesions is a predictor for poor survival.

No MeSH data available.


Related in: MedlinePlus