Association of QCT Bone Mineral Density and Bone Structure With Vertebral Fractures in Patients With Multiple Myeloma

Authors
Borggrefe, Jan; Giravent, Sarah; Thomsen, Felix Sebastian Leo; Peña, Jaime; Campbell, Graeme; Wulff, A.; Günther, A.; Heller, Martin; Glüer, Claus C.
Publication Year
2015
Language
English
Format
article
Status
Published version
Description
Purpose: Computed tomography (CT) is used for staging osteolytic lesions and detecting fractures in patients with multiple myeloma (MM). In the OsteoLysis of Metastases and Plasmacell-infiltration Computed Tomography (OLyMP-CT) study we investigated whether patients with and without vertebral fractures show differences in bone mineral density (BMD) or microstructure that could be used to identify patients at risk for fracture. Methods and Materials: We evaluated whole-body CT scans in a group of 104 MM patients without visible osteolytic lesions using an underlying lightweight calibration phantom (Image Analysis Inc., Columbia, KY, USA). QCT software (StructuralInsight) was used for the assessment of BMD and bone structure of the T11 or T12 vertebral body. Age-adjusted standardized odds ratios (sORs) per SD change were derived from logistic regression analyses, and areas under the receiver operating characteristics (ROC) curve (AUCs) analyses were calculated. Results: Forty-six of the 104 patients had prevalent vertebral fractures (24/60 men, 22/44 women). Patients with fractures were not significantly older than patients without fractures (mean ± SD, 64 ± 9.2 versus 62 ± 12.3 years; p = 0.4). Trabecular BMD in patients with fractures versus without fractures was 169 ± 41 versus 192 ± 51 mg/cc (AUC = 0.62 ± 0.06, sOR = 1.6 [1.1 to 2.5], p = 0.02). Microstructural variables achieved optimal discriminatory power at bone thresholds of 150 mg/cc. Best fracture discrimination for single microstructural variables was observed for trabecular separation (Tb.Sp) (AUC = 0.72 ± 0.05, sOR = 2.4 (1.5 to 3.9), p < 0.0001). In multivariate models AUCs improved to 0.77 ± 0.05 for BMD and Tb.Sp, and 0.79 ± 0.05 for Tb.Sp and trabecular thickness (Tb.Th). Compared to BMD values, these improvements of AUC values were statistically significant (p < 0.0001). Conclusion: In MM patients, QCT-based analyses of bone structure derived from routine CT scans permit discrimination of patients with and without vertebral fractures. Rarefaction of the trabecular network due to plasma cell infiltration and osteoporosis can be measured. Deterioration of microstructural measures appear to be of value for vertebral fracture risk assessment and may indicate early stages of osteolytic processes not yet visible.
Fil: Borggrefe, Jan . Universitätsklinikum Schleswig Holstein. Klinik für Radiologie und Neuroradiologie. Sektion für Biomedizinische Bildgebung; Alemania. Uniklinik Köln. Institut und Poliklinik für Diagnostische Radiologie; Alemania
Fil: Giravent, Sarah . Universitätsklinikum Schleswig Holstein. Klinik für Radiologie und Neuroradiologie. Sektion für Biomedizinische Bildgebung; Alemania
Fil: Thomsen, Felix Sebastian Leo. Universitätsklinikum Schleswig Holstein. Klinik für Radiologie und Neuroradiologie. Sektion für Biomedizinische Bildgebung; Alemania. Universidad Nacional del Sur; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Bahia Blanca; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Bahía Blanca. Instituto de Investigación en Ingeniería Eléctrica; Argentina
Fil: Peña, Jaime . Universitätsklinikum Schleswig Holstein. Klinik für Radiologie und Neuroradiologie. Sektion für Biomedizinische Bildgebung; Alemania
Fil: Campbell, Graeme . Universitätsklinikum Schleswig Holstein. Klinik für Radiologie und Neuroradiologie. Sektion für Biomedizinische Bildgebung; Alemania
Fil: Wulff, A.. Universitätsklinikum Schleswig Holstein. Klinik für Radiologie und Neuroradiologie. Sektion für Biomedizinische Bildgebung; Alemania
Fil: Günther, A.. Universitätsklinikum Schleswig Holstein. Klinik für Innere Medizin. Sektion für Immun- und Stammzelltransplantation; Alemania
Fil: Heller, Martin . Universitätsklinikum Schleswig Holstein. Klinik für Radiologie und Neuroradiologie. Sektion für Biomedizinische Bildgebung; Alemania
Fil: Glüer, Claus C.. Universitätsklinikum Schleswig Holstein. Klinik für Radiologie und Neuroradiologie. Sektion für Biomedizinische Bildgebung; Alemania
Subject
Multiple Myeloma
Osteoporosis
Vertebral fracture
QCT
Fracture risk
Trabecular separation
BMD
Radiología, Medicina Nuclear y Diagnóstico por Imágenes
Medicina Clínica
CIENCIAS MÉDICAS Y DE LA SALUD
Access level
Restricted access
License
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repository
CONICET Digital (CONICET)
Institution
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identifier
oai:ri.conicet.gov.ar:11336/11745