文章：

全身计算机断层扫描与传统骨骼检查在多发性骨髓瘤患者中的比较：一项国际骨髓瘤工作组的研究

Whole-body computed tomography versus conventional skeletal survey in patients with multiple myeloma: a study of the International Myeloma Working Group

原文发布日期：2017-08-25

DOI: 10.1038/bcj.2017.78

类型: Original Article

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英文摘要：

For decades, conventional skeletal survey (CSS) has been the standard imaging technique for multiple myeloma (MM). However, recently whole-body computed tomography (WBCT) has been implemented into the diagnostic criteria of MM. This analysis compares sensitivity and prognostic significance of WBCT and CSS in patients with smoldering MM (SMM) and MM. Fifty-four of 212 patients (25.5%) had a negative CSS and a positive WBCT for osteolytic lesions (P<0.0001). Of 66 patients with SMM based on CSS, 12 (22.2%) had osteolytic lesions on WBCT. In comparison, WBCT failed to detect some bone destructions in the appendicular skeleton possibly due to limitations of the field of view. Presence of lytic bone lesions in WBCT was of borderline prognostic significance (P=0.051) for SMM patients, with a median time to progression of 38 versus 82 months for those without bone destructions. In conclusion, WBCT identifies significantly more sites of bone destruction than CSS. More than 20% of patients with SMM according to CSS have in fact active MM detectable with WBCT. On the basis of this and other studies, WBCT (either computed tomography (CT) alone or as part of a positron emission tomography-CT protocol) should be considered the current standard for the detection of osteolytic lesions in MM.

摘要翻译： 

数十年来，常规骨骼检查（CSS）一直是多发性骨髓瘤（MM）的标准影像学技术。然而近年来，全身计算机断层扫描（WBCT）已被纳入MM的诊断标准。本研究比较了WBCT与CSS在冒烟型多发性骨髓瘤（SMM）和MM患者中的敏感性及预后意义。在212例患者中，54例（25.5%）CSS检查结果为阴性而WBCT检测到溶骨性病变（P<0.0001）。在基于CSS诊断的66例SMM患者中，12例（22.2%）通过WBCT检测到溶骨性病变。相比之下，WBCT未能检测到四肢骨骼中的某些骨质破坏，这可能与扫描视野的局限性有关。WBCT检测到的溶骨性病变对SMM患者具有临界预后意义（P=0.051），存在骨质破坏者的中位进展时间为38个月，而无骨质破坏者则为82个月。综上所述，WBCT检测骨质破坏病灶的数量显著多于CSS。根据CSS诊断为SMM的患者中，超过20%实际上通过WBCT可检测到活动性MM。基于本研究及其他证据，WBCT（单独使用CT或作为正电子发射断层扫描-CT方案的组成部分）应被视为当前检测MM溶骨性病变的标准方法。

原文链接：

Whole-body computed tomography versus conventional skeletal survey in patients with multiple myeloma: a study of the International Myeloma Working Group