摘要
目的 探讨全身低剂量CT骨扫描联合MRI在多发性骨髓瘤诊断、分期及分型中的价值.方法 回顾性选择2020年1月至2023年11月来亳州市人民医院诊治的72例多发性骨髓瘤患者病例资料,根据患者自身的疾病特点及相关部位行全身低剂量CT骨扫描、MRI检查.对比全身低剂量CT骨扫描、MRI及二者联合对多发性骨髓瘤、不同部位骨损害病灶的检出率,分析全身低剂量CT骨扫描、MRI与多发性骨髓瘤临床ISS分期的一致性、全身低剂量CT骨扫描、MRI对临床ISS分期的诊断效能,全身低剂量CT骨扫描、MRI与多发性骨髓瘤临床分型的一致性,全身低剂量CT骨扫描、MRI对多发性骨髓瘤临床分型的诊断效能.结果 全身低剂量CT骨扫描联合MRI对多发性骨髓瘤的检出率明显较单一检查检出率高,差异有统计学意义(P＜0.05).二者联合对多发性骨髓瘤脊柱骨损害检出率明显较单一检查检出率高,差异有统计学意义(P＜0.05);二者联合对颈椎、盆骨、腰椎、四肢及胸椎骨损害的检出率较单一检查高,但组间比较差异无统计意义(P＞0.05).全身低剂量CT与临床ISS分期的Kappa值为0.773(P=0.000),MRI与临床ISS分期的Kappa值为0.719(P=0.000),二者联合与临床ISS分期的Kappa值为0.971(P=0.000),二者联合与ISS分期一致性良好,全身低剂量CT骨扫描、MRI与ISS分期一致性较好.全身低剂量CT骨扫描联合MRI对临床ISS分期Ⅰ期、Ⅱ期的诊断特异度、对Ⅲ期的诊断敏感度明显较单一检查高,差异均有统计学意义(P＜0.05);二者联合对Ⅰ期、Ⅱ期的诊断敏感度、对Ⅲ期的诊断特异度较单一诊断高,但组间比较差异无统计学意义(P＞0.05).全身低剂量CT骨扫描与临床分型的Kappa值为0.841,MRI检查与临床分型的Kappa值为0.801,二者联合与临床分型的Kappa值为0.980,CT、MRI及二者联合与临床分型的一致性良好(均P=0.000).全身低剂量CT骨扫描联合MRI对多发性骨髓瘤临床分型IgG、IgD型、其他分型的诊断特异度、对IgA型的诊断敏感度明显较单一检查高,差异均有统计学意义(P＜0.05);二者联合对IgG型、IgD型、其他分型的诊断敏感度、对IgA型的诊断特异度较单一诊断高,但组间比较差异无统计学意义(P＞0.05).结论 全身低剂量CT骨扫描联合MRI对多发性骨髓瘤诊断准确率较单一检查高,对临床分期、分型的诊断一致性较好,二者联合可在一定程度上评估多发性骨髓瘤的诊断、分期及分型.
Abstract
Objective To investigate the value of whole body low-dose CT combined with MRI in the diagnosis,staging and classifica-tion of multiple myeloma.Methods The data of 72 patients with multiple myeloma diagnosed and treated in Bozhou People's Hospital from Janu-ary 2020 to November 2023 were retrospectively selected,and low-dose CT and MRI examinations of the whole body were performed according to their own disease characteristics and relative sites.The detection rates of systemic low-dose CT,MRI and their combination for multiple myeloma and bone lesions in different parts were compared,the consistency of systemic low-dose CT,MRI and clinical ISS staging of multiple myeloma were analyzed,and the diagnostic efficacy of systemic low-dose CT and MRI for clinical ISS staging were analyzed.Consistency of whole body low-dose CT and MRI with clinical classification of multiple myeloma,diagnostic efficacy of whole body low-dose CT and MRI in clinical classifica-tion of multiple myeloma.Results The detection rate of whole body low-dose CT combined with MRI for multiple myeloma was significantly higher than that of single examination,the difference was statistically significant(P＜0.05).The detection rate of spinal bone damage in multi-ple myeloma was significantly higher than that of single examination,the difference was statistically significant(P＜0.05);the detection rate of cervical,pelvic,lumbar,limb and thoracic vertebrae was higher than that of single examination,but the difference between groups was not statisti-cally significant(P＞0.05).The detection rate of spinal bone damage in multiple myeloma was significantly higher than that of single examina-tion,the difference was statistically significant(P＜0.05).The detection rate of bone damage of skull,pelvis,ribs and extremities was higher than that of single examination,but there was no statistically significant difference between groups(P＞0.05).Kappa value of whole body low-dose CT and clinical ISS stage was 0.773(P=0.000),Kappa value of MRI and clinical ISS stage was 0.719(P=0.000),and Kappa val-ue of combined MRI and clinical ISS stage was 0.971(P=0.000).The combination of the two had good consistency with ISS staging,and the whole body low-dose CT and MRI had good consistency with ISS staging.The diagnostic specificity of whole body low-dose CT combined with MRI for ISS stage Ⅰ and Ⅱ and the diagnostic sensitivity for ISS stage Ⅲ were significantly higher than that of single examination,the differences were statistically significant(P＜0.05).The diagnostic sensitivity and specificity of the two combined methods for stage Ⅰ and Ⅱ were higher than that for single diagnosis,but there were no statistically significant differences between groups(P＞0.05).The Kappa value of whole body low-dose CT and clinical type was 0.841,that of MRI and clinical type was 0.801,and that of the combination of the two was 0.980.The con-sistency between CT,MRI and the combination of the two and clinical type was good(P=0.000).Overall low dose CT combined with MRI showed higher diagnostic specificity for IgG,IgD and other types of multiple myeloma than single examination,the differences were statistically sig-nificant(P＜0.05).The diagnostic sensitivity of the combination of the two groups for IgG type,IgD type and other types and the diagnostic spe-cificity of IgA type were higher than that of single diagnosis,but there was no statistically significant difference between groups(P＞0.05).Con-clusion Overall low-dose CT combined with MRI has higher diagnostic accuracy in multiple myeloma than single examination,and has better di-agnostic consistency in clinical staging and classification.The combination can evaluate the diagnosis,staging and classification of multiple myelo-ma to a certain extent.
基金项目
中国红十字基金会医学赋能-领航菁英科研项目(XM-HRYXFN-2021-05-24)
维普
万方数据