<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Background</h3>
<p>The aim of the study was to evaluate whether virtual calcium subtraction (VNCa) image extracted from dual-layer spectral CT could estimate bone marrow (BM) infiltration with MRI as the reference standard and characterize tumor burden in patients with multiple myeloma (MM).</p>
</sec>
<sec><h3>Patients and methods</h3>
<p>Forty-seven patients with newly diagnosed MM were retrospectively enrolled. They had undergone whole-body low-dose dual-layer spectral CT (DLCT) and whole-body MRI within one week. VNCa images with calcium-suppressed (CaSupp) indices ranging from 25 to 95 at an interval of 10 and apparent diffusion coefficient (ADC) maps were quantitatively analyzed on vertebral bodies L1−L5 at the central slice of images. The optimal combination was selected by correlation analysis between CT numbers and ADC values. Then, it was used to characterize tumor burden by correlation analysis and receiver operating characteristic (ROC) curves analysis, including plasma cell infiltration rate (PCIR), high serum-free light chains (SFLC) ratio and the high-risk cytogenetic (HRC) status.</p>
</sec>
<sec><h3>Results</h3>
<p>The most significant quantitative correlation between CT numbers of VNCa images and ADC values could be found at CaSupp index 85 for averaged L1−L5 (r = 0.612, p &lt; 0.001). It allowed quantitative evaluation of PCIR (r = 0.835, p &lt; 0.001). It could also anticipate high SFLC ratio and the HRC status with <italic>area under the curve</italic> (<italic>AUC</italic>) of 0.876 and 0.760, respectively.</p>
</sec>
<sec><h3>Conclusions</h3>
<p>The VNCa measurements of averaged L1−L5 showed the highest correlation with ADC at CaSupp index 85. It could therefore be used as additional imaging biomarker for non-invasive assessment of tumor burden if ADC is not feasible.</p>
</sec>
</abstract>

Background
The aim of the study was to evaluate whether virtual calcium subtraction (VNCa) image extracted from dual-layer spectral CT could estimate bone marrow (BM) infiltration with MRI as the reference standard and characterize tumor burden in patients with multiple myeloma (MM).

Patients and methods
Forty-seven patients with newly diagnosed MM were retrospectively enrolled. They had undergone whole-body low-dose dual-layer spectral CT (DLCT) and whole-body MRI within one week. VNCa images with calcium-suppressed (CaSupp) indices ranging from 25 to 95 at an interval of 10 and apparent diffusion coefficient (ADC) maps were quantitatively analyzed on vertebral bodies L1−L5 at the central slice of images. The optimal combination was selected by correlation analysis between CT numbers and ADC values. Then, it was used to characterize tumor burden by correlation analysis and receiver operating characteristic (ROC) curves analysis, including plasma cell infiltration rate (PCIR), high serum-free light chains (SFLC) ratio and the high-risk cytogenetic (HRC) status.

Results
The most significant quantitative correlation between CT numbers of VNCa images and ADC values could be found at CaSupp index 85 for averaged L1−L5 (r = 0.612, p < 0.001). It allowed quantitative evaluation of PCIR (r = 0.835, p < 0.001). It could also anticipate high SFLC ratio and the HRC status with area under the curve (AUC) of 0.876 and 0.760, respectively.

Conclusions
The VNCa measurements of averaged L1−L5 showed the highest correlation with ADC at CaSupp index 85. It could therefore be used as additional imaging biomarker for non-invasive assessment of tumor burden if ADC is not feasible.

Quantitative assessment of bone marrow infiltration and characterization of tumor burden using dual-layer spectral CT in patients with multiple myeloma

The First Affiliated Hospital of Soochow University

Dushu Lake Hospital Affiliated to Soochow University

Radiology and Oncology

This work is licensed under the Creative Commons Attribution 4.0 International License.

Background
The aim of the study was to evaluate whether virtual calcium subtraction (VNCa) image extracted from dual-layer spectral CT could estimate bone...

Quantitative assessment of bone marrow infiltration and characterization of tumor burden using dual-layer spectral CT in patients with multiple myeloma

Article Category: Research Article

Published Online: Jan 06, 2024

Page range: 43 - 50

Received: Aug 18, 2023

Accepted: Oct 31, 2023

DOI: https://doi.org/10.2478/raon-2024-0003

Keywords
bone marrow, tumor burden, virtual non-calcium, dual energy CT, multiple myeloma

© 2024 Xing Xiong et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Quantitative assessment of bone marrow infiltration and characterization of tumor burden using dual-layer spectral CT in patients with multiple myeloma

Article Category: Research Article

Published Online: Jan 06, 2024

Page range: 43 - 50

Received: Aug 18, 2023

Accepted: Oct 31, 2023

DOI: https://doi.org/10.2478/raon-2024-0003

Keywordsbone marrow, tumor burden, virtual non-calcium, dual energy CT, multiple myeloma

© 2024 Xing Xiong et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Keywords
bone marrow, tumor burden, virtual non-calcium, dual energy CT, multiple myeloma