title: Association of QCT Bone Mineral Density and Bone Structure With Vertebral Fractures in Patients With Multiple Myeloma.
abstract: 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 2 study (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. 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. 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). 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.
authors.affiliation: Section for Biomedical Imaging, Department of Radiology and Neuroradiology, University-Clinics Schleswig Holstein, Campus Kiel, Kiel, Germany.|Institute for Diagnostic and Interventional Radiology, University-Clinics Cologne, Cologne, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Borggrefe
authors.affiliation: Section for Biomedical Imaging, Department of Radiology and Neuroradiology, University-Clinics Schleswig Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Giravent
authors.affiliation: Section for Biomedical Imaging, Department of Radiology and Neuroradiology, University-Clinics Schleswig Holstein, Campus Kiel, Kiel, Germany.|Department of Engineering, National University of the South, Bahia Blanca, Argentina.
authors.forename: Felix
authors.initials: F
authors.lastname: Thomsen
authors.affiliation: Section for Biomedical Imaging, Department of Radiology and Neuroradiology, University-Clinics Schleswig Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Jaime
authors.initials: J
authors.lastname: Peña
authors.affiliation: Section for Biomedical Imaging, Department of Radiology and Neuroradiology, University-Clinics Schleswig Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Graeme
authors.initials: G
authors.lastname: Campbell
authors.affiliation: Section for Biomedical Imaging, Department of Radiology and Neuroradiology, University-Clinics Schleswig Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Asmus
authors.initials: A
authors.lastname: Wulff
authors.affiliation: Section for Immun- and Stemcell- Therapy, Department of Inner Medicine, University-Clinics Schleswig Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Günther
authors.affiliation: Section for Biomedical Imaging, Department of Radiology and Neuroradiology, University-Clinics Schleswig Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Heller
authors.affiliation: Section for Biomedical Imaging, Department of Radiology and Neuroradiology, University-Clinics Schleswig Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Claus C
authors.initials: CC
authors.lastname: Glüer
mesh_terms: D019540:Area Under Curve; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000473:pathology*; D016022:Case-Control Studies; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000000981:diagnostic imaging; D016017:Odds Ratio; D016103:Spinal Fractures / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
keywords: BMD; FRACTURE RISK; MULTIPLE MYELOMA; OSTEOPOROSIS; QCT; TRABECULAR SEPARATION; VERTEBRAL FRACTURE