Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma

Autores
Borggrefe, J.; Giravent, S.; Campbell, G.; Thomsen, Felix Sebastian Leo; Chang, D.; Franke, M.; Günther, A.; Heller, M.; Wulff, A.
Año de publicación
2015
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Purpose In patients with multiple myeloma (MM), computed tomography is widely used for staging and to detect fractures. Detecting patients at severe fracture risk is of utmost importance. However the criteria for impaired stability of vertebral bodies are not yet clearly defined. We investigated the performance of parameters that can be detected by the radiologist for discrimination of patients with and without fractures. Methods and materials We analyzed 128 whole body low-dose CT of MM patients. In all scans a QCT calibration phantom was integrated into the positioning mat (Image Analysis Phantom®). A QCT-software (Structural Insight) performed the volumetric bone mineral density (vBMD) measurements. Description of fracture risk was provided from the clinical radiological report. Suspected progressive disease (PD) was reported by the referring clinicians. Two radiologists that were blinded to study outcome reported on the following parameters based on predefined criteria: reduced radiodensity in the massa lateralis of the os sacrum (RDS), trabecular thickening and sclerosis of three or more vertebrae (TTS), extraosseous MM manifestations (EOM), visible small osteolytic lesions up to a length of 8 mm (SO) and osteolytic lesions larger than 8 mm (LO). Prevalent vertebral fractures (PVF) were defined by Genant criteria. Age-adjusted standardized odds ratios (sOR) per standard deviation change were derived from logistic regression analysis and area under the curve (AUC) from receiver operating characteristics (ROC) analyses were calculated. ROC curves were compared using the DeLong method. Results 45% of the 128 patients showed PVF (29 of 75 men, 24 of 53 women). Patients with PVF were not significantly older than patients without fractures (64.6 ± 9.2 vs. 63.3 ± 12.3 years: mean ± SD, p = 0.5). The prevalence of each parameter did not differ significantly by sex. Significant fracture discrimination for age adjusted single models was provided by the parameters vBMD (OR 3.5 [1.4-8.8], AUC = 0.64 ± 0.14), SO (sOR 1.6[1.1-2.2], AUC = 0.63 ± 0.05), LO (sOR 2.1[1.1-4.2] AUC = 0.69 ± 0.05) and RDS (sOR 2.6[1.6-4.7], AUC = 0.69 ± 0.05). Multivariate models of these four parameters showed a significantly stronger association with the development of PVF (AUC = 0.80 ± 0.04) than single variables. TTS showed a significant association with PVF in men(sOR 1.5 [0.8-3.0], AUC = 0.63 ± 0.08), but not in women (sOR 2.3[1.4-3.7], AUC = 0.70 ± 0.07). PD was significantly associated with PVF in women (sOR 1.9[1.1-3.6], AUC = 0.67 ± 0.08) but not in men (sOR 1.4[0.9-2.3], AUC = 0.57 ±.07). EOM were not associated with PVF (sOR 1.0[0.4-2.6], AUC = 0.51 ±.05). Conclusion In multiple myeloma, focal skeletal changes in low dose CT scans show a significant association with prevalent vertebral fractures. The combination of large osteolytic lesions and loss in radiodensity as can be detected with simple CT Hounsfield measurements of the os sacrum or BMD measurements showed the strongest association to fractures and may be of value for prospective studies.
Fil: Borggrefe, J.. Institut und Poliklinik für Diagnostische Radiologie; Alemania
Fil: Giravent, S.. Universitätsklinikum Schleswig Holstein; Alemania
Fil: Campbell, G.. Universitätsklinikum Schleswig Holstein; Alemania
Fil: Thomsen, Felix Sebastian Leo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional del Sur; Argentina
Fil: Chang, D.. Institut und Poliklinik für Diagnostische Radiologie; Alemania
Fil: Franke, M.. Institut und Poliklinik für Diagnostische Radiologie; Alemania
Fil: Günther, A.. Universitätsklinikum Schleswig Holstein; Alemania
Fil: Heller, M.. Universitätsklinikum Hamburg-Eppendorf; Alemania
Fil: Wulff, A.. Universitätsklinikum Schleswig Holstein; Alemania
Materia
Bone Mineral Density
Bone Structure
Key Words Multiple Myeloma
Osteolytic Lesions
Vertebral Fracture
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/62175

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network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myelomaBorggrefe, J.Giravent, S.Campbell, G.Thomsen, Felix Sebastian LeoChang, D.Franke, M.Günther, A.Heller, M.Wulff, A.Bone Mineral DensityBone StructureKey Words Multiple MyelomaOsteolytic LesionsVertebral Fracturehttps://purl.org/becyt/ford/3.2https://purl.org/becyt/ford/3Purpose In patients with multiple myeloma (MM), computed tomography is widely used for staging and to detect fractures. Detecting patients at severe fracture risk is of utmost importance. However the criteria for impaired stability of vertebral bodies are not yet clearly defined. We investigated the performance of parameters that can be detected by the radiologist for discrimination of patients with and without fractures. Methods and materials We analyzed 128 whole body low-dose CT of MM patients. In all scans a QCT calibration phantom was integrated into the positioning mat (Image Analysis Phantom®). A QCT-software (Structural Insight) performed the volumetric bone mineral density (vBMD) measurements. Description of fracture risk was provided from the clinical radiological report. Suspected progressive disease (PD) was reported by the referring clinicians. Two radiologists that were blinded to study outcome reported on the following parameters based on predefined criteria: reduced radiodensity in the massa lateralis of the os sacrum (RDS), trabecular thickening and sclerosis of three or more vertebrae (TTS), extraosseous MM manifestations (EOM), visible small osteolytic lesions up to a length of 8 mm (SO) and osteolytic lesions larger than 8 mm (LO). Prevalent vertebral fractures (PVF) were defined by Genant criteria. Age-adjusted standardized odds ratios (sOR) per standard deviation change were derived from logistic regression analysis and area under the curve (AUC) from receiver operating characteristics (ROC) analyses were calculated. ROC curves were compared using the DeLong method. Results 45% of the 128 patients showed PVF (29 of 75 men, 24 of 53 women). Patients with PVF were not significantly older than patients without fractures (64.6 ± 9.2 vs. 63.3 ± 12.3 years: mean ± SD, p = 0.5). The prevalence of each parameter did not differ significantly by sex. Significant fracture discrimination for age adjusted single models was provided by the parameters vBMD (OR 3.5 [1.4-8.8], AUC = 0.64 ± 0.14), SO (sOR 1.6[1.1-2.2], AUC = 0.63 ± 0.05), LO (sOR 2.1[1.1-4.2] AUC = 0.69 ± 0.05) and RDS (sOR 2.6[1.6-4.7], AUC = 0.69 ± 0.05). Multivariate models of these four parameters showed a significantly stronger association with the development of PVF (AUC = 0.80 ± 0.04) than single variables. TTS showed a significant association with PVF in men(sOR 1.5 [0.8-3.0], AUC = 0.63 ± 0.08), but not in women (sOR 2.3[1.4-3.7], AUC = 0.70 ± 0.07). PD was significantly associated with PVF in women (sOR 1.9[1.1-3.6], AUC = 0.67 ± 0.08) but not in men (sOR 1.4[0.9-2.3], AUC = 0.57 ±.07). EOM were not associated with PVF (sOR 1.0[0.4-2.6], AUC = 0.51 ±.05). Conclusion In multiple myeloma, focal skeletal changes in low dose CT scans show a significant association with prevalent vertebral fractures. The combination of large osteolytic lesions and loss in radiodensity as can be detected with simple CT Hounsfield measurements of the os sacrum or BMD measurements showed the strongest association to fractures and may be of value for prospective studies.Fil: Borggrefe, J.. Institut und Poliklinik für Diagnostische Radiologie; AlemaniaFil: Giravent, S.. Universitätsklinikum Schleswig Holstein; AlemaniaFil: Campbell, G.. Universitätsklinikum Schleswig Holstein; AlemaniaFil: Thomsen, Felix Sebastian Leo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional del Sur; ArgentinaFil: Chang, D.. Institut und Poliklinik für Diagnostische Radiologie; AlemaniaFil: Franke, M.. Institut und Poliklinik für Diagnostische Radiologie; AlemaniaFil: Günther, A.. Universitätsklinikum Schleswig Holstein; AlemaniaFil: Heller, M.. Universitätsklinikum Hamburg-Eppendorf; AlemaniaFil: Wulff, A.. Universitätsklinikum Schleswig Holstein; AlemaniaElsevier Ireland2015-11info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/62175Borggrefe, J.; Giravent, S.; Campbell, G.; Thomsen, Felix Sebastian Leo; Chang, D.; et al.; Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma; Elsevier Ireland; European Journal Of Radiology; 84; 11; 11-2015; 2269-22740720-048XCONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/doi/10.1016/j.ejrad.2015.07.024info:eu-repo/semantics/altIdentifier/url/https://www.sciencedirect.com/science/article/pii/S0720048X15300644info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-03T09:59:42Zoai:ri.conicet.gov.ar:11336/62175instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-03 09:59:43.099CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma
title Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma
spellingShingle Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma
Borggrefe, J.
Bone Mineral Density
Bone Structure
Key Words Multiple Myeloma
Osteolytic Lesions
Vertebral Fracture
title_short Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma
title_full Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma
title_fullStr Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma
title_full_unstemmed Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma
title_sort Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma
dc.creator.none.fl_str_mv Borggrefe, J.
Giravent, S.
Campbell, G.
Thomsen, Felix Sebastian Leo
Chang, D.
Franke, M.
Günther, A.
Heller, M.
Wulff, A.
author Borggrefe, J.
author_facet Borggrefe, J.
Giravent, S.
Campbell, G.
Thomsen, Felix Sebastian Leo
Chang, D.
Franke, M.
Günther, A.
Heller, M.
Wulff, A.
author_role author
author2 Giravent, S.
Campbell, G.
Thomsen, Felix Sebastian Leo
Chang, D.
Franke, M.
Günther, A.
Heller, M.
Wulff, A.
author2_role author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Bone Mineral Density
Bone Structure
Key Words Multiple Myeloma
Osteolytic Lesions
Vertebral Fracture
topic Bone Mineral Density
Bone Structure
Key Words Multiple Myeloma
Osteolytic Lesions
Vertebral Fracture
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.2
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv Purpose In patients with multiple myeloma (MM), computed tomography is widely used for staging and to detect fractures. Detecting patients at severe fracture risk is of utmost importance. However the criteria for impaired stability of vertebral bodies are not yet clearly defined. We investigated the performance of parameters that can be detected by the radiologist for discrimination of patients with and without fractures. Methods and materials We analyzed 128 whole body low-dose CT of MM patients. In all scans a QCT calibration phantom was integrated into the positioning mat (Image Analysis Phantom®). A QCT-software (Structural Insight) performed the volumetric bone mineral density (vBMD) measurements. Description of fracture risk was provided from the clinical radiological report. Suspected progressive disease (PD) was reported by the referring clinicians. Two radiologists that were blinded to study outcome reported on the following parameters based on predefined criteria: reduced radiodensity in the massa lateralis of the os sacrum (RDS), trabecular thickening and sclerosis of three or more vertebrae (TTS), extraosseous MM manifestations (EOM), visible small osteolytic lesions up to a length of 8 mm (SO) and osteolytic lesions larger than 8 mm (LO). Prevalent vertebral fractures (PVF) were defined by Genant criteria. Age-adjusted standardized odds ratios (sOR) per standard deviation change were derived from logistic regression analysis and area under the curve (AUC) from receiver operating characteristics (ROC) analyses were calculated. ROC curves were compared using the DeLong method. Results 45% of the 128 patients showed PVF (29 of 75 men, 24 of 53 women). Patients with PVF were not significantly older than patients without fractures (64.6 ± 9.2 vs. 63.3 ± 12.3 years: mean ± SD, p = 0.5). The prevalence of each parameter did not differ significantly by sex. Significant fracture discrimination for age adjusted single models was provided by the parameters vBMD (OR 3.5 [1.4-8.8], AUC = 0.64 ± 0.14), SO (sOR 1.6[1.1-2.2], AUC = 0.63 ± 0.05), LO (sOR 2.1[1.1-4.2] AUC = 0.69 ± 0.05) and RDS (sOR 2.6[1.6-4.7], AUC = 0.69 ± 0.05). Multivariate models of these four parameters showed a significantly stronger association with the development of PVF (AUC = 0.80 ± 0.04) than single variables. TTS showed a significant association with PVF in men(sOR 1.5 [0.8-3.0], AUC = 0.63 ± 0.08), but not in women (sOR 2.3[1.4-3.7], AUC = 0.70 ± 0.07). PD was significantly associated with PVF in women (sOR 1.9[1.1-3.6], AUC = 0.67 ± 0.08) but not in men (sOR 1.4[0.9-2.3], AUC = 0.57 ±.07). EOM were not associated with PVF (sOR 1.0[0.4-2.6], AUC = 0.51 ±.05). Conclusion In multiple myeloma, focal skeletal changes in low dose CT scans show a significant association with prevalent vertebral fractures. The combination of large osteolytic lesions and loss in radiodensity as can be detected with simple CT Hounsfield measurements of the os sacrum or BMD measurements showed the strongest association to fractures and may be of value for prospective studies.
Fil: Borggrefe, J.. Institut und Poliklinik für Diagnostische Radiologie; Alemania
Fil: Giravent, S.. Universitätsklinikum Schleswig Holstein; Alemania
Fil: Campbell, G.. Universitätsklinikum Schleswig Holstein; Alemania
Fil: Thomsen, Felix Sebastian Leo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional del Sur; Argentina
Fil: Chang, D.. Institut und Poliklinik für Diagnostische Radiologie; Alemania
Fil: Franke, M.. Institut und Poliklinik für Diagnostische Radiologie; Alemania
Fil: Günther, A.. Universitätsklinikum Schleswig Holstein; Alemania
Fil: Heller, M.. Universitätsklinikum Hamburg-Eppendorf; Alemania
Fil: Wulff, A.. Universitätsklinikum Schleswig Holstein; Alemania
description Purpose In patients with multiple myeloma (MM), computed tomography is widely used for staging and to detect fractures. Detecting patients at severe fracture risk is of utmost importance. However the criteria for impaired stability of vertebral bodies are not yet clearly defined. We investigated the performance of parameters that can be detected by the radiologist for discrimination of patients with and without fractures. Methods and materials We analyzed 128 whole body low-dose CT of MM patients. In all scans a QCT calibration phantom was integrated into the positioning mat (Image Analysis Phantom®). A QCT-software (Structural Insight) performed the volumetric bone mineral density (vBMD) measurements. Description of fracture risk was provided from the clinical radiological report. Suspected progressive disease (PD) was reported by the referring clinicians. Two radiologists that were blinded to study outcome reported on the following parameters based on predefined criteria: reduced radiodensity in the massa lateralis of the os sacrum (RDS), trabecular thickening and sclerosis of three or more vertebrae (TTS), extraosseous MM manifestations (EOM), visible small osteolytic lesions up to a length of 8 mm (SO) and osteolytic lesions larger than 8 mm (LO). Prevalent vertebral fractures (PVF) were defined by Genant criteria. Age-adjusted standardized odds ratios (sOR) per standard deviation change were derived from logistic regression analysis and area under the curve (AUC) from receiver operating characteristics (ROC) analyses were calculated. ROC curves were compared using the DeLong method. Results 45% of the 128 patients showed PVF (29 of 75 men, 24 of 53 women). Patients with PVF were not significantly older than patients without fractures (64.6 ± 9.2 vs. 63.3 ± 12.3 years: mean ± SD, p = 0.5). The prevalence of each parameter did not differ significantly by sex. Significant fracture discrimination for age adjusted single models was provided by the parameters vBMD (OR 3.5 [1.4-8.8], AUC = 0.64 ± 0.14), SO (sOR 1.6[1.1-2.2], AUC = 0.63 ± 0.05), LO (sOR 2.1[1.1-4.2] AUC = 0.69 ± 0.05) and RDS (sOR 2.6[1.6-4.7], AUC = 0.69 ± 0.05). Multivariate models of these four parameters showed a significantly stronger association with the development of PVF (AUC = 0.80 ± 0.04) than single variables. TTS showed a significant association with PVF in men(sOR 1.5 [0.8-3.0], AUC = 0.63 ± 0.08), but not in women (sOR 2.3[1.4-3.7], AUC = 0.70 ± 0.07). PD was significantly associated with PVF in women (sOR 1.9[1.1-3.6], AUC = 0.67 ± 0.08) but not in men (sOR 1.4[0.9-2.3], AUC = 0.57 ±.07). EOM were not associated with PVF (sOR 1.0[0.4-2.6], AUC = 0.51 ±.05). Conclusion In multiple myeloma, focal skeletal changes in low dose CT scans show a significant association with prevalent vertebral fractures. The combination of large osteolytic lesions and loss in radiodensity as can be detected with simple CT Hounsfield measurements of the os sacrum or BMD measurements showed the strongest association to fractures and may be of value for prospective studies.
publishDate 2015
dc.date.none.fl_str_mv 2015-11
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/62175
Borggrefe, J.; Giravent, S.; Campbell, G.; Thomsen, Felix Sebastian Leo; Chang, D.; et al.; Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma; Elsevier Ireland; European Journal Of Radiology; 84; 11; 11-2015; 2269-2274
0720-048X
CONICET Digital
CONICET
url http://hdl.handle.net/11336/62175
identifier_str_mv Borggrefe, J.; Giravent, S.; Campbell, G.; Thomsen, Felix Sebastian Leo; Chang, D.; et al.; Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma; Elsevier Ireland; European Journal Of Radiology; 84; 11; 11-2015; 2269-2274
0720-048X
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/doi/10.1016/j.ejrad.2015.07.024
info:eu-repo/semantics/altIdentifier/url/https://www.sciencedirect.com/science/article/pii/S0720048X15300644
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
eu_rights_str_mv openAccess
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dc.publisher.none.fl_str_mv Elsevier Ireland
publisher.none.fl_str_mv Elsevier Ireland
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
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