Abstract
Background and objectives: In order to increase the accuracy of lytic lesion detection in multiple myeloma, a dedicated second-opinion interpretation of medical images performed by subspecialty musculoskeletal radiologists could increase accuracy. Therefore, the purpose of this study is to evaluate the added value (increased accuracy) of subspecialty second-opinion (SSO) consultations for Computed Tomography (CT) examinations in Multiple Myeloma (MM) patients undergoing stem cell transplantation on standard computed tomography with a focus on focal lesion detection. Materials and Methods: Approval from the institutional review board was obtained. This retrospective study included 70 MM consecutive patients (mean age, 62 years ± 11.3 (standard deviation); range, 35–88 years) admitted in the last six years. Pre-transplant total-body CT (reported by general radiologists) was the only inclusion criteria. Each of these CT examinations had a second-opinion interpretation by two experienced subspecialty musculoskeletal (MSK) radiologists (13 years of experience and 6 years of experience, mean: 9.5 years), experts in musculoskeletal radiology and bone image interpretation with a focus on lytic lesions. Results: Per lesion intra- and inter-observer agreement between the two radiologists was calculated with K statistics and the results were good (K = 0.67: Confidence Inteval (CI) 95%: 0.61–0.78). When the initial CT reports were compared with the re-interpretation reports, 46 (65%) of the 70 cases (95% CI: 37–75%) had no discrepancy. There was a discrepancy in detecting a clinically unimportant abnormality in 10/70 (14%) patients (95% CI: 7–25%) unlikely to alter patient care or irrelevant to further clinical management. A discrepancy in interpreting a clinically important abnormality was registered in 14/70 (21%) patients for focal lesions. The mean diameter of focal lesions was: 23 mm (95% CI: 5–57 mm). The mean number of focal lesions per patient was 3.4 (95% CI). Conclusions: subspecialty second-opinion consultations in multiple myeloma CT is more accurate to identify lesions, especially lytic lesions, amenable to influence patients’ care.
Highlights
Multiple myeloma (MM) is a hematologic disorder characterized by an excessive production of the immunoglobulin M component of plasma cells
Pre-transplant total-body Computed Tomography (CT) with minimal technical standard (Table 1) available in the Hospital Picture Archiving and Communication System (PACS) or available in DICOM format from CT acquired outside the hospital were the only inclusion criteria—the initial CT reading was done by general radiologists with no known formal (ESSR Diploma, track record in MSK radiological activities) or informal specialized experience in MSK radiology
(1) Per lesion intra- and Inter-observer agreement between the two radiologists was calculated with K statistics. p values below 0.05 were considered statistically significant
Summary
Multiple myeloma (MM) is a hematologic disorder characterized by an excessive production of the immunoglobulin M component of plasma cells. The detection of lytic bone lesions on imaging separates asymptomatic from symptomatic MM patients, even if no clinical symptoms are present [1,2,3,4]. Imaging is used to detect bone lesions, to predict the risk of early progression from smoldering MM (sMM) to active MM, to identify extra-medullary disease and to identify the sites of possible pathologic fractures or neurologic complications [3]. In order to increase the accuracy of lytic lesion detection in multiple myeloma, a dedicated second-opinion interpretation of medical images performed by subspecialty musculoskeletal radiologists could increase accuracy. The purpose of this study is to evaluate the added value (increased accuracy) of subspecialty second-opinion (SSO) consultations for Computed Tomography (CT) examinations in Multiple Myeloma (MM) patients undergoing stem cell transplantation on standard computed tomography with a focus on focal lesion detection
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