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MULTİPLE MYELOM HASTALARINDA OSTEOLİTİK LEZYON, FRAKTÜR VE OSTEOPOROZ TESPİTİNDE KULLANILAN RADYOLOJİK YÖNTEMLERİN İNCELENMESİ

Year 2023, Volume: 62 Issue: 4, 536 - 541, 18.12.2023
https://doi.org/10.19161/etd.1147765

Abstract

Giriş: Multipl miyelom, klonal plazma hücrelerinin vücutta birikmesiyle oluşan hematolojik bir malignitedir. Osteolitik lezyon varlığı, semptomatik myelom için bir tanı kriteri olarak kabul edilmektedir. Ayrıca, kemik kaybı, patolojik kırıklar ve osteoporoz ile ilişkilidir. Litik lezyon varlığı ve kemik mineral kaybını saptamak için çeşitli görüntüleme yöntemleri ve çift enerjili x-ışını absorpsiyometrisi (DEXA) kullanılır. Bu çalışmada görüntüleme yöntemleri ve DEXA ile osteolitik lezyonların ve kemik mineral kaybının saptanma oranlarının araştırılması amaçlanmıştır.
Gereç ve Yöntem: Bu çalışma 2004-2020 yılları arasında Adnan Menderes Üniversitesi Hastanesi/Türkiye'de gerçekleştirildi. Üç yüz on semptomatik myelom hastası retrospektif olarak incelendi. Osteolitik lezyon, fraktür ve plazmasitomların görüntüleme yöntemleriyle tespit oranı ve ayrıca DEXA ile kemik mineral kaybı oranı kaydedildi. Ayrıca bu bulguların cinsiyet, myelom tipi, litik lezyonlar ve osteoporoz ile ilişkileri araştırıldı.
Bulgular: Litik lezyonlar, direkt grafi ve PET-BT ile hastaların sırasıyla %71,3'ünde ve %81,2'sinde saptadı. PET-BT'nin litik lezyonları saptamada duyarlılığı %96,1 ve özgüllüğü %90,6 idi. MR görüntülemesine, sadece fraktür şüphesi olan hastalarda başvuruldu ve MR çekilen tüm hastalarda fraktür tespit edildi. DEXA çekilen 113 hastada osteoporoz oranı %83,1 idi. Litik lezyon varlığı ile cinsiyet/myelom tipi arasında herhangi bir ilişki saptanmadı.
Sonuç: Çalışmamız, osteolitik lezyonların cinsiyet veya myelom tipi ile korele olmadığını göstermiştir. PET-BT, osteolitik lezyonları saptamak için hassas ve spesifik bir yöntemdir. DEXA, osteoporozu saptamada duyarlı bir yöntem olmasına ragmen; özgüllüğü, litik lezyonları olan hastalarda sınırlı bir değere sahiptir.

References

  • (1)-Rajkumar SV. Multiple myeloma: 2020 update on diagnosis, risk-stratification and management. Am J Hematol 2020 May;95(5):548-567. doi: 10.1002/ajh.25791.
  • (2)- Terpos E, Ntanasis-Stathopoulos I , Gavriatopoulou M, Dimopoulos MA. Pathogenesis of bone disease in multiple myeloma: from bench to bedside. Blood Cancer J 2018 Jan 12;8(1):7. doi: 10.1038/s41408-017-0037-4.
  • (3)- Zamagni E, Cavo M, Fakhri B, Vij R, Roodman D. Bones in Multiple Myeloma: Imaging and Therapy. Am Soc Clin Oncol Educ Book 2018 May 23;38:638-646. doi: 10.1200 / EDBK_205583.
  • (4)- Gaudio A, Xourafa A, Rapisarda R, Zanoli L, Signorelli SS, Castellino P. Hematological Diseases and Osteoporosis. Int J Mol Sci 2020 May 16;21(10):3538. doi: 10.3390/ijms21103538.
  • (5)- Rajkumar SV. Updated Diagnostic Criteria and Staging System for Multiple Myeloma. Am SocClinOncolEduc Book. 2016;35: e418-23. doi: 10.1200/EDBK_159009.
  • (6)- Rosen HN and Drezner MK. Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women. Available at : https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-evaluation-of-osteoporosis-in-postmenopausal-women.Last access date: 23 July 2022.
  • (7)- Durie BG, Salmon SE. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer. 1975;36(3):842.
  • (8)- Drake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc 2008 Sep;83(9):1032-45.doi: 10.4065/83.9.1032.
  • (9)- Bouvard B, Royer M, Chappard D, Audran M, Hoppé E, Legrand E. Monoclonal gammopathy of undetermined significance, multiple myeloma, and osteoporosis. Joint Bone Spine 2010 Mar;77(2):120-4. doi: 10.1016/j.jbspin.2009.12.002.
  • (10)- Derlin T and Bannas P. Imaging of multiple myeloma: Current concepts. World J Orthop. 2014 Jul 18; 5(3): 272–282. doi: 10.5312/wjo.v5.i3.272
  • (11)- Dimopoulos M, Terpos E, Comenzo RL, Tosi P, Beksac M, Sezer O et al. International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple myeloma. Leukemia. 2009 ;23:1545–1556. DOI: 10.1038/leu.2009.89
  • (12)-Collins CD. Multiple myeloma. Cancer Imaging 2010 Feb 11;10(1):20-31. doi: 10.1102 /1470 -7330.2010.0013.
  • (13)- Mosebach J, Thierjung H, Schlemmer HP, Delorme S. Multiple Myeloma Guidelines and Their Recent Updates: Implications for Imaging. Rofo 2019 Nov;191(11):998-1009. doi: 10.1055/a-0897-3966.
  • (14)- Kumar SK, Rajkumar V, Kyle RA, Duin MV, Sonneveld P, et al. Multiple myeloma. Nat Rev Dis Primers 2017 Jul 20;3:17046. doi: 10.1038/nrdp.2017.46.
  • (15)- Filho AGO, Carneiro BC, Pastore D, Silva IP, Yamashita SR, Consolo FD, et al. Whole-Body Imaging of Multiple Myeloma: Diagnostic Criteria. Radiographics Jul-Aug 2019;39(4):1077-1097. doi: 10.1148/rg.2019180096.
  • (16)-Laubach JP. Multiple myeloma: Clinical features, laboratory manifestations, and diagnosis. Available at: https://www.uptodate.com/contents/multiple-myeloma-clinical-features-laboratory-manifestations-and-diagnosis.Last access date: 23 July 2022.
  • (17)- Kyle R, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003 Jan;78(1):21-33. doi: 10.4065/78.1.21.
  • (18)- Hess T, Egerer G, Kasper B, Rasul KI, Goldschmidt H, Kauffmann GW. Atypical manifestations of multiple myeloma: radiological appearance. Eur J Radiol 2006 May;58(2):280-5.doi: 10.1016/j.ejrad.2005.11.015.
  • (19)-Touzaeu C and Moreau P. How I treat extramedullary myeloma. Blood 2016 Feb 25;127(8):971-6. doi: 10.1182/blood-2015-07-635383.
  • (20)- Seckinger A, Hose D. Interaction between myeloma cells and bone tissue. Radiologe 2014 Jun;54(6):545-50. doi: 10.1007/s00117-013-2626-y.
  • (21)-Karaguzel G and Holick MF. Diagnosis and treatment of osteopenia. Rev Endocr Metab Disord 2010 Dec;11(4):237-51.doi: 10.1007/s11154-010-9154-0.
  • (22)- Cengiz A, Arda HÜ, Döğer F, Yavaşoğlu İ, Yürekli Y, Bolaman AZ. Correlation Between Baseline 18F-FDG PET/CT Findings and CD38- and CD138-Expressing Myeloma Cells in Bone Marrow and Clinical Parameters in Patients with Multiple Myeloma. Turk J Haematol. 2018 Sep; 35(3): 175–180. doi: 10.4274/tjh.2017.0372
  • (23)- Kosmala A, Bley T, Petritsch B. Imaging of Multiple Myeloma. Rofo 2019 Sep;191(9):805-816. doi: 10.1055/a-0864-2084 . (24)- Cavo M, Terpos E, Nanni C, Moreau P, Lentzsch S, Zweegman S, et al. Role of 18 F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol 2017 Apr;18(4):e206-e217. doi: 10.1016/S1470-2045(17)30189-4.
  • (25)- Moreau P, Attal M, Karlin L, Garderet L, Facon T, Macro M et al. Prospective evaluation of MRI and PET-CT at diagnosis and before maintenance therapy in symptomatic patients with multiple myeloma included in the IFM/DFCI 2009 trial. Blood. 2015;126(23):395. doi: 10.1200/JCO.2017.72.2975.

INVESTIGATION OF THE RADIOLOGICAL TECHNIQUES TO DETECT OSTEOLYTIC LESIONS, FRACTURES, AND OSTEOPOROSIS IN MULTIPLE MYELOMA PATIENTS

Year 2023, Volume: 62 Issue: 4, 536 - 541, 18.12.2023
https://doi.org/10.19161/etd.1147765

Abstract

Aim: Multiple myeloma is a malignancy of clonal plasmacytes. Osteolytic lesions represent a criterion for symptomatic myeloma and are associated with bone loss, pathological fractures, and osteoporosis. Skeletal surveys with other sophisticated techniques and dual-energy x-ray absorptiometry (DEXA) are used to screen lytic lesions, and bone mineral loss, respectively. Here, we aimed to investigate the rates of detection regarding osteolytic lesions and bone mineral loss by several imaging techniques.
Materials and Methods: The study was carried out in Adnan Menderes University Hospital/Turkey, between the years 2004- 2020. Three-hundred and ten symptomatic myeloma patients were screened retrospectively. The results of radiological techniques were recorded. The detection rate of osteolytic lesions, fractures, and plasmacytomas by imaging techniques, as well as bone mineral loss with DEXA was recorded. Also, associations with gender, myeloma type, lytic lesions, and osteoporosis were investigated.
Results: Skeletal survey and PET-CT detected lytic lesions in 71.3% and 81.2% of patients, respectively. PET-CT had a sensitivity of 96.1% and specificity of 90.6% to detect lytic lesions. MRI was only used for patients with suspicious fractures and detected them for all patients who underwent MRI. The osteoporosis rate was 83.1% for 113 patients who underwent DEXA. Any association between lytic lesions and gender/myeloma type was not detected.
Conclusion: Our study demonstrated that osteolytic lesions are not correlated with gender or myeloma type. PET-CT is a sensitive and specific method for detecting osteolytic lesions. Although DEXA is sensitive, its specificity is limited to detect osteoporosis in patients with lytic lesions.

References

  • (1)-Rajkumar SV. Multiple myeloma: 2020 update on diagnosis, risk-stratification and management. Am J Hematol 2020 May;95(5):548-567. doi: 10.1002/ajh.25791.
  • (2)- Terpos E, Ntanasis-Stathopoulos I , Gavriatopoulou M, Dimopoulos MA. Pathogenesis of bone disease in multiple myeloma: from bench to bedside. Blood Cancer J 2018 Jan 12;8(1):7. doi: 10.1038/s41408-017-0037-4.
  • (3)- Zamagni E, Cavo M, Fakhri B, Vij R, Roodman D. Bones in Multiple Myeloma: Imaging and Therapy. Am Soc Clin Oncol Educ Book 2018 May 23;38:638-646. doi: 10.1200 / EDBK_205583.
  • (4)- Gaudio A, Xourafa A, Rapisarda R, Zanoli L, Signorelli SS, Castellino P. Hematological Diseases and Osteoporosis. Int J Mol Sci 2020 May 16;21(10):3538. doi: 10.3390/ijms21103538.
  • (5)- Rajkumar SV. Updated Diagnostic Criteria and Staging System for Multiple Myeloma. Am SocClinOncolEduc Book. 2016;35: e418-23. doi: 10.1200/EDBK_159009.
  • (6)- Rosen HN and Drezner MK. Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women. Available at : https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-evaluation-of-osteoporosis-in-postmenopausal-women.Last access date: 23 July 2022.
  • (7)- Durie BG, Salmon SE. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer. 1975;36(3):842.
  • (8)- Drake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc 2008 Sep;83(9):1032-45.doi: 10.4065/83.9.1032.
  • (9)- Bouvard B, Royer M, Chappard D, Audran M, Hoppé E, Legrand E. Monoclonal gammopathy of undetermined significance, multiple myeloma, and osteoporosis. Joint Bone Spine 2010 Mar;77(2):120-4. doi: 10.1016/j.jbspin.2009.12.002.
  • (10)- Derlin T and Bannas P. Imaging of multiple myeloma: Current concepts. World J Orthop. 2014 Jul 18; 5(3): 272–282. doi: 10.5312/wjo.v5.i3.272
  • (11)- Dimopoulos M, Terpos E, Comenzo RL, Tosi P, Beksac M, Sezer O et al. International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple myeloma. Leukemia. 2009 ;23:1545–1556. DOI: 10.1038/leu.2009.89
  • (12)-Collins CD. Multiple myeloma. Cancer Imaging 2010 Feb 11;10(1):20-31. doi: 10.1102 /1470 -7330.2010.0013.
  • (13)- Mosebach J, Thierjung H, Schlemmer HP, Delorme S. Multiple Myeloma Guidelines and Their Recent Updates: Implications for Imaging. Rofo 2019 Nov;191(11):998-1009. doi: 10.1055/a-0897-3966.
  • (14)- Kumar SK, Rajkumar V, Kyle RA, Duin MV, Sonneveld P, et al. Multiple myeloma. Nat Rev Dis Primers 2017 Jul 20;3:17046. doi: 10.1038/nrdp.2017.46.
  • (15)- Filho AGO, Carneiro BC, Pastore D, Silva IP, Yamashita SR, Consolo FD, et al. Whole-Body Imaging of Multiple Myeloma: Diagnostic Criteria. Radiographics Jul-Aug 2019;39(4):1077-1097. doi: 10.1148/rg.2019180096.
  • (16)-Laubach JP. Multiple myeloma: Clinical features, laboratory manifestations, and diagnosis. Available at: https://www.uptodate.com/contents/multiple-myeloma-clinical-features-laboratory-manifestations-and-diagnosis.Last access date: 23 July 2022.
  • (17)- Kyle R, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003 Jan;78(1):21-33. doi: 10.4065/78.1.21.
  • (18)- Hess T, Egerer G, Kasper B, Rasul KI, Goldschmidt H, Kauffmann GW. Atypical manifestations of multiple myeloma: radiological appearance. Eur J Radiol 2006 May;58(2):280-5.doi: 10.1016/j.ejrad.2005.11.015.
  • (19)-Touzaeu C and Moreau P. How I treat extramedullary myeloma. Blood 2016 Feb 25;127(8):971-6. doi: 10.1182/blood-2015-07-635383.
  • (20)- Seckinger A, Hose D. Interaction between myeloma cells and bone tissue. Radiologe 2014 Jun;54(6):545-50. doi: 10.1007/s00117-013-2626-y.
  • (21)-Karaguzel G and Holick MF. Diagnosis and treatment of osteopenia. Rev Endocr Metab Disord 2010 Dec;11(4):237-51.doi: 10.1007/s11154-010-9154-0.
  • (22)- Cengiz A, Arda HÜ, Döğer F, Yavaşoğlu İ, Yürekli Y, Bolaman AZ. Correlation Between Baseline 18F-FDG PET/CT Findings and CD38- and CD138-Expressing Myeloma Cells in Bone Marrow and Clinical Parameters in Patients with Multiple Myeloma. Turk J Haematol. 2018 Sep; 35(3): 175–180. doi: 10.4274/tjh.2017.0372
  • (23)- Kosmala A, Bley T, Petritsch B. Imaging of Multiple Myeloma. Rofo 2019 Sep;191(9):805-816. doi: 10.1055/a-0864-2084 . (24)- Cavo M, Terpos E, Nanni C, Moreau P, Lentzsch S, Zweegman S, et al. Role of 18 F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol 2017 Apr;18(4):e206-e217. doi: 10.1016/S1470-2045(17)30189-4.
  • (25)- Moreau P, Attal M, Karlin L, Garderet L, Facon T, Macro M et al. Prospective evaluation of MRI and PET-CT at diagnosis and before maintenance therapy in symptomatic patients with multiple myeloma included in the IFM/DFCI 2009 trial. Blood. 2015;126(23):395. doi: 10.1200/JCO.2017.72.2975.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Articles
Authors

Atakan TURGUTKAYA 0000-0001-8428-4730

İrfan YAVAŞ 0000-0003-1703-2175

Tuğba ŞAHİN 0000-0002-4032-1189

Gokhan SARGIN 0000-0002-3778-8351

Gürhan KADIKÖYLÜ 0000-0001-9979-7475

Ali BOLAMAN 0000-0003-0651-5462

Publication Date December 18, 2023
Submission Date July 25, 2022
Published in Issue Year 2023Volume: 62 Issue: 4

Cite

Vancouver TURGUTKAYA A, YAVAŞ İ, ŞAHİN T, SARGIN G, KADIKÖYLÜ G, BOLAMAN A. INVESTIGATION OF THE RADIOLOGICAL TECHNIQUES TO DETECT OSTEOLYTIC LESIONS, FRACTURES, AND OSTEOPOROSIS IN MULTIPLE MYELOMA PATIENTS. EJM. 2023;62(4):536-41.