论文部分内容阅读
目的比较全身MR成像(WBMRI)和血液学指标对干细胞移植术后多发骨髓瘤病人的持续性或复发性疾病的诊断效能。方法将33例经干细胞移植术治疗后的多发骨髓瘤病人在2个时间点进行66次WBMRI采集,将病人2个时间点间疾病的严重度和髓内外骨髓瘤病变的影像动态变化以统一的疗效标准进行比较(kappa统计),包括血液学指标。结果33例病人采集的66次WBMRI结果,10例病人(30.3%)被归为疾病进展,23例被认为疾病缓解。10例疾病进展病例中的8例(80%)出现髓外病灶。WBMRI和实验室检查结果在33例样本中有26例(78.8%)结果相一致。结果发现在WBMRI和血液学指标比较中存在51.2%的一致性,95%CI为19.8%～82.6%。WBMRI的敏感度为63.6%,特异度为86.4%,阳性预测值(PPV)70.0%,阴性预测值(NPV)82.6%以及对疾病缓解检测的精确度为78.8%。结论 WBMRI可以检测经干细胞移植术后多发骨髓瘤病人的髓内外病灶并进行精确定位,但是对于确定疾病缓解与常规实验室检查结果仅表现出中度的一致性。要点①WBMRI在肿瘤学应用中越来越发挥其优势。②WBMRI继SCT之后能对髓内、髓外骨髓瘤病变进行定位。③WBMRI和血清学分析在评价疗效时没有充分的一致性。④对于确定疾病缓解,WBMRI可在实验室检查以外提供有限额外的诊断价值。
Objective To compare the diagnostic efficacy of whole body MR imaging (WBMRI) and hematologic parameters for persistent or recurrent disease in patients with multiple myeloma after stem cell transplantation. Methods Thirty-three patients with multiple myeloma treated by stem cell transplantation were screened for WBMRI 66 times at two time points. The severity of the disease and the changes of the intramedullary and extramedullary myeloma lesions at two time points were unified Efficacy criteria were compared (kappa statistics), including hematologic indicators. Results Sixty-three WBMRI results were collected in 33 patients, 10 patients (30.3%) were classified as disease progression, and 23 patients were considered disease remission. Eight cases (80%) of the 10 cases of disease progression showed extramedullary lesions. WBMRI and laboratory findings in 33 cases of 26 cases (78.8%) the results are consistent. The results showed that there was 51.2% consistency between WBMRI and hematological indexes, 95% CI 19.8% ~ 82.6%. WBMRI had a sensitivity of 63.6%, a specificity of 86.4%, a positive predictive value (PPV) of 70.0%, a negative predictive value (NPV) of 82.6%, and a resolution of 78.8% for disease remission detection. Conclusions WBMRI can detect and accurately locate intramedullary and extramedullary lesions in patients with multiple myeloma after stem cell transplantation, but show only modest agreement with routine laboratory findings in determining disease response. Points ① WBMRI is playing an increasingly important role in oncology applications. ② WBMRI following SCT can be intramedullary, extramedullary myeloma lesions were located. ③ WBMRI and serological analysis in the evaluation of efficacy is not fully consistent. ④ WBMRI provides a limited additional diagnostic value beyond laboratory tests for determining disease response.