Abstract
ObjectiveTo identify textural features on dual-energy CT (DECT)–based bone marrow images in myeloma which correlate with serum markers of myeloma activity and the degree of medullary involvement.MethodsA total of 110 patients (63.0 ± 11.0 years, 51 female) who underwent unenhanced whole-body DECT between September 2015 and February 2019 were retrospectively included, which was approved by our institutional ethics committee with a waiver of the informed consent requirement. All patients had current hematologic laboratory tests. Using DECT post-processing, non-calcium bone marrow images were reconstructed. The vertebral bodies T10–L5 were segmented for quantification of textural features, which were compared with serologic parameters and myeloma stages by the Mann-Whitney U test. In a subgroup of 56/110 patients with current bone marrow biopsies, textural features were correlated with the degree of bone marrow infiltration.ResultsFirst-order features were higher in patients with advanced stage of myeloma (p < .02), whereas the 2nd-order “gray-level co-occurrence matrix (GLCM) cluster prominence” was lower (p < .04). In patients with elevated serum-free light chains (SFLC) or kappa/lambda SFLC ratio above 1.56, the “entropy” and 2nd-order GLCM features were lower (p < .03). The degree of bone marrow infiltration correlated with 1st-order features (e.g., “uniformity”; rP = 0.49; p < .0001), whereas “entropy” and 2nd-order GLCM features were negatively correlated (e.g., “difference entropy”; rP = − 0.54; p < .0001).ConclusionsCT textural features applied on non-calcium bone marrow images correlate well with myeloma-related serologic parameters and histology showing a more uniform tissue structure and higher attenuation with increasing medullary infiltration and could therefore be used as additional imaging biomarkers for non-invasive assessment of medullary involvement.Key Points• Texture analysis applied on dual-energy reconstructed non-calcium bone marrow images provides information about marrow structure and attenuation.• Myeloma-related serologic parameters and the degree of myeloma cell infiltration correlate with 1st- and 2nd-order features which could be useful as additional imaging biomarkers for non-invasive assessment of medullary involvement.
Highlights
Multiple myeloma (MM) is a malignant hematologic disease of the mature B cells which primarily involve the bone marrow [1]
Our results show that there is a strong correlation between textural features quantified on virtual non-contrast unenhanced dual-energy CT images and the degree of myeloma cell infiltration of the bone marrow
We found that the magnitude of 1st, 2nd, and higher order bone marrow textural features significantly differs in multiple myeloma patients depending on the disease stage as assigned according to the Salmon and Durie classification [23]
Summary
Multiple myeloma (MM) is a malignant hematologic disease of the mature B cells (plasma cells) which primarily involve the bone marrow [1]. By comparison with other hematological diseases, MM is in most cases going along with secretion of paraproteins (e.g., IgG, IgA, light chains), which can be quantified in serum and urine known as the M-gradient and are considered to correlate with the tumor burden [2] The presence of these tumor markers in most myeloma patients makes their monitoring before, during, and after treatment more reliable compared with other hematologic malignancies. The first two imaging modalities have been mainly used for indirect assessment of medullary involvement based on visualization of secondary bone destruction, so-called myeloma bone disease (MBD). In this respect, MR imaging is more sensitive. MR-based assessment of the extent and pattern of MM mainly operates by evaluation of ancillary T1-
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