文章：

多发性骨髓瘤患者中，通过低剂量全身多排螺旋CT检测到的四肢骨骼骨髓异常的临床意义及预后意义

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

原文发布日期：2015-07-31

DOI: 10.1038/bcj.2015.57

类型: Original Article

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英文摘要：

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.

摘要翻译： 

本研究探讨了多发性骨髓瘤（MM）患者通过低剂量全身多排螺旋计算机断层扫描（MDCT）检测到的四肢骨骼（AS）髓质异常的临床意义。研究共纳入172例患者，包括意义未明的单克隆丙种球蛋白病（MGUS）17例、冒烟型MM47例及症状性MM108例，所有患者均接受低剂量MDCT检查。将四肢骨骼髓质密度CT值（CTv）≥0亨氏单位（HU）定义为异常。MGUS、冒烟型MM和症状性MM患者的髓质异常百分比分别为18%、55%和62%，平均髓质CT值分别为-44.5 HU、-20.3 HU和11.2 HU（P值均<0.001）。多因素分析显示，MM疾病进展与高CT值独立相关。在症状性MM患者中，异常髓质病变的存在与高危细胞遗传学异常发生率升高（34.4% vs 7.7%；P=0.002）及髓外病变发生率增加相关（10.4% vs 0%；P=0.032），同时也是独立的预后不良预测因子（风险比3.546，P=0.04）。本研究表明，MDCT测得的四肢骨骼CT值与MM疾病进展相关，而异常髓质病变的存在是生存预后不良的预测指标。

原文链接：

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