title: Improved MDCT monitoring of pelvic myeloma bone disease through the use of a novel longitudinal bone subtraction post-processing algorithm.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of a novel CT post-processing software that generates subtraction maps of baseline and follow-up CT examinations in the course of myeloma bone lesions.
  
  
  METHODS
  This study included 61 consecutive myeloma patients who underwent repeated whole-body reduced-dose MDCT at our institution between November 2013 and June 2015. CT subtraction maps classified a progressive disease (PD) vs. stable disease (SD)/remission. Bone subtraction maps (BSMs) only and in combination with 1-mm (BSM+) source images were compared with 5-mm axial/MPR scans.
  
  
  RESULTS
  Haematological response categories at follow-up were: complete remission (n = 9), very good partial remission (n = 2), partial remission (n = 17) and SDh (n = 19) vs. PDh (n = 14). Five-millimetre CT scan yielded PD (n = 14) and SD/remission (n = 47) whereas bone subtraction + 1-mm axial scans (BSM+) reading resulted in PD (n = 18) and SD/remission (n = 43). Sensitivity/ specificity/accuracy for 5-mm/1-mm/BSM(alone)/BSM + in "lesion-by-lesion" reading was 89.4 %/98.9 %/98.3 %/ 99.5 %; 69.1 %/96.9 %/72 %/92.1 % and 83.8 %/98.4 %/92.1 %/98.3 %, respectively. The use of BSM+ resulted in a change of response classification in 9.8 % patients (n = 6) from SD to PD.
  
  
  CONCLUSIONS
  BSM reading is more accurate for monitoring myeloma compared to axial scans whereas BSM+ yields similar results with 1-mm reading (gold standard) but by significantly reduced reading time.
  
  
  CONCLUSIONS
  • CT evaluation of myeloma bone disease using a longitudinal bone subtraction post-processing algorithm. • Bone subtraction post-processing algorithm is more accurate for assessment of therapy. • Bone subtraction allowed improved and more efficient detection of myeloma bone lesions. • Post-processing tool demonstrating a change in response classification in 9.8 % patients (all showing PD). • Reading time could be substantially shortened as compared to regular CT assessment.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str.3, D-72076, Tuebingen, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Horger
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str.3, D-72076, Tuebingen, Germany.
authors.forename: Wolfgang M
authors.initials: WM
authors.lastname: Thaiss
authors.affiliation: Siemens AG Healthcare, Sector Imaging and Interventional Radiology, Siemensstr. 1, D-91301, Forchheim, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Ditt
authors.affiliation: Department of Internal Medicine II, Eberhard-Karls-University Tübingen, D-72076, Tübingen, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Weisel
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medcine, 601 N. Caroline Street, JHOC 3142, Baltimore, MD, 21287, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Fritz
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str.3, D-72076, Tuebingen, Germany.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.affiliation: Siemens Medical Solutions, Malvern, PA, 19355, USA.
authors.forename: Shu
authors.initials: S
authors.lastname: Liao
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str.3, D-72076, Tuebingen, Germany. christopher.kloth@med.uni-tuebingen.de.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kloth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009101:Multiple Myeloma / Q000175:diagnosis*; D009367:Neoplasm Staging / Q000379:methods*; D010384:Pelvic Bones / Q000000981:diagnostic imaging*; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012984:Software; D013382:Subtraction Technique; D051598:Whole Body Imaging
keywords: Bone subtraction maps; CT imaging; Lytic bone lesions; Multiple myeloma; Pelvic bones