OBJECTIVE:To explore the potential value of quantitative parameters derived from dual-energy spectral computed tomography (DESCT) as comparing to the parameters derived from magnetic resonance imaging (MRI) in detecting bone marrow (BM) infiltration and distinguishing different patterns of BM infiltration in patients diagnosed with Multiple myeloma (MM). METHODS:This study involved 35MM patients and 15 healthy control subjects who had undergone spinal DESCT and MRI. Pattern assignment was based on visual assessment of MR images, and the regions of interest were defined on both DESCT and apparent diffusion coefficient maps. Quantitative values of DESCT parameters were measured and compared between infiltrated and healthy bone marrow. Receiver operating characteristic (ROC) analysis was performed to determine potential utility of DESCT parameters in identifying BM infiltration and different patterns defined by MRI. Sensitivity and specificity under the optimal thresholds determined by the Youden Index were also calculated. RSULTS:Statistical differences were observed between the DESCT parameters including Ca(Water), Water(Ca), HAP(Fat), Fat(HAP) and Effective atomic number (Eff-Z) but not for the 70-keV CT value between the infiltrated and healthy BM (all P < 0.001). The 70keV CT value and Ca(Water), HAP(Fat) and Eff-Z values were also found to be statistically different in comparing different infiltration patterns (all P < 0.05). Performance of the model-based parameter Ca/Water was superior in differentiating between infiltrated and healthy BM in which the area under ROC curve, AUC = 0.856 [95% CI, 81.4–89.1%] with sensitivity = 0.841 and specificity = 0.768, as well as between MM patients and control subjects (AUC = 0.910 [95% CI, 79.5–97.3%], sensitivity = 0.829 and specificity = 1.000). CONCLUSIONS:Analysis of DESCT offers potential as a quantitative method to detect infiltrated BM and evaluate infiltration patterns of BM in patients diagnosed with MM.

中文翻译：

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双能谱计算机断层扫描对多发性骨髓瘤患者骨髓浸润的定量评估

目的：探讨双能谱计算机断层扫描 (DESCT) 定量参数与磁共振成像 (MRI) 参数相比在检测骨髓 (BM) 浸润和区分骨髓浸润的不同模式方面的潜在价值。诊断为多发性骨髓瘤 (MM) 的患者。方法：本研究包括 35 名 MM 患者和 15 名接受过脊柱 DESCT 和 MRI 的健康对照受试者。模式分配基于 MR 图像的视觉评估，感兴趣区域在 DESCT 和表观扩散系数图上定义。测量DESCT参数的定量值并在浸润骨髓和健康骨髓之间进行比较。进行接收器操作特征 (ROC) 分析以确定 DESCT 参数在识别 BM 浸润和 MRI 定义的不同模式中的潜在效用。还计算了由约登指数确定的最佳阈值下的敏感性和特异性。结果：在包括 Ca(Water)、Water(Ca)、HAP(Fat)、Fat(HAP) 和有效原子序数 (Eff-Z) 在内的 DESCT 参数之间观察到统计差异，但没有观察到 70-keV CT 值之间的差异。浸润和健康的 BM（所有 P < 0.001）。70keV CT 值和 Ca(Water)、HAP(Fat) 和 Eff-Z 值在比较不同的浸润模式时也有统计学差异（均 P < 0.05）。基于模型的参数 Ca/Water 的性能在区分浸润性和健康 BM 方面表现优异，其中 ROC 曲线下面积 AUC = 0.856 [95% CI, 81.4–89.1%]，灵敏度 = 0.841，特异性 = 0.768，如以及 MM 患者和对照受试者之间（AUC = 0.910 [95% CI, 79.5–97.3%]，敏感性 = 0.829 和特异性 = 1.000）。结论：DESCT 的分析提供了作为检测浸润性 BM 和评估诊断为 MM 患者的 BM 浸润模式的定量方法的潜力。