Purpose: To evaluate the prediction of vertebral fractures in plasma cell dyscrasias using dual-layer CT (DLCT) with quantitative assessment of conventional CT image data (CI), calcium suppressed image data (CaSupp), and calculation of virtual calcium-only (VCa) image data. Material and Methods: Patients (n= 81) with the diagnosis of a plasma cell dyscrasia and whole-body DLCT at the time of diagnosis and follow-up were retrospectively enrolled. CI, CaSupp25, and CaSupp100 were quantitatively analyzed using regions of interest in the lumbar vertebral bodies and fractured vertebral bodies on baseline or follow-up imaging. VCa were calculated by subtraction (CaSupp100-CaSupp25), delineating bone only. Logistic regression analyses were performed to assess the possibility of imminent spine fractures. Results: In 24 patients, new vertebral fractures were observed in the follow-up imaging. The possibility of new vertebral fractures was significant for baseline assessment of CT numbers in CI, CaSupp25, and VCa (p= 0.01, respectively), with a higher risk for new fractures in the case of lower CT numbers in CI (Odds ratio = [0.969; 0.994]) and VCa (Odds ratio = [0.978; 0.995]) and in the case of higher CT numbers in CaSupp 25 (Odds ratio 1.015 [1.006; 1.026]). Direct model comparisons implied that CT numbers in CaSupp 25 and VCa might show better fracture prediction than those in CI (R2= 0.18 both vs. 0.15; AICc = 91.95, 91.79 vs. 93.62), suggesting cut-off values for CI at 103 HU (sensitivity: 54.2%; specificity: 82.5; AUC: 0.69), for VCa at 129 HU (sensitivity: 41.7%; specificity: 94.7; AUC: 0.72). Conclusions: Quantitative assessment with CaSupp and calculation of VCa is feasible to predict the vertebral fracture risk in MM patients. DLCT may prove useful in detecting imminent fractures.
目的：评估采用双层CT（DLCT）结合常规CT图像数据（CI）、钙抑制图像数据（CaSupp）的定量分析及虚拟纯钙图像数据（VCa）计算对浆细胞疾病患者椎体骨折的预测价值。材料与方法：回顾性纳入81例确诊浆细胞疾病并在诊断及随访期间接受全身DLCT检查的患者。在基线或随访影像中，通过感兴趣区定量分析腰椎椎体及骨折椎体的CI、CaSupp25和CaSupp100数据。通过减影法（CaSupp100减CaSupp25）计算仅显示骨结构的VCa图像。采用逻辑回归分析评估近期发生脊柱骨折的可能性。结果：24例患者在随访影像中出现新发椎体骨折。基线CI、CaSupp25和VCa的CT值对新发椎体骨折具有显著预测意义（p值均为0.01）：CI（比值比=[0.969; 0.994]）和VCa（比值比=[0.978; 0.995]）的CT值越低，或CaSupp25（比值比=1.015 [1.006; 1.026]）的CT值越高，新发骨折风险越大。直接模型比较显示，CaSupp25与VCa的CT值可能较CI具有更好的骨折预测能力（R2均为0.18 vs. 0.15；AICc=91.95、91.79 vs. 93.62），建议CI的截断值为103 HU（敏感性54.2%，特异性82.5%，AUC 0.69），VCa的截断值为129 HU（敏感性41.7%，特异性94.7%，AUC 0.72）。结论：通过CaSupp定量评估与VCa计算可有效预测多发性骨髓瘤患者的椎体骨折风险，DLCT技术在识别即将发生的骨折方面具有应用潜力。
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