Abstract
Background
Multiple myeloma (MM) is the second most common hemato-oncological malignancy, characterized
by the clonal proliferation of malignant plasma cells and bone marrow infiltration.
The degree of bone marrow infiltration, which is crucial for diagnosis and treatment
initiation, is determined through biopsy. While MRI and CT are considered standard
imaging methods for detecting focal lesions and osteolytic changes, CT has limitations,
particularly in detecting diffuse infiltration patterns without osteolysis. Spectral
CT techniques offer a promising alternative for assessing bone marrow infiltration
through material decomposition.
Method
A systematic literature search was conducted in the PubMed database for relevant keywords
in articles published between 01/2010 and 12/2024. Original studies evaluating spectral
CT techniques for the assessment of MM bone marrow infiltration were included. Articles
with a different focus, such as fracture detection, were excluded. A qualitative synthesis
of the study results was performed.
Results and Conclusion
Spectral CT techniques improve the differentiation between healthy and infiltrated
bone marrow. Particularly, the commonly applied virtual calcium suppression showed
good sensitivity and specificity compared to histology, serology, or MRI. Spectral
CT also shows potential for distinguishing different bone marrow infiltration patterns,
assessing disease activity, and evaluating treatment response. Limitations included
reduced sensitivity for detecting moderate infiltration within red bone marrow and
small cohort sizes. Multicenter analyses are required to compare different device
manufacturers, evaluate the utility of spectral CT biomarkers, the potential of currently
less intensively studied material density maps and radiomics features, as well as,
of photon-counting CT.
Key Points
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Spectral CT techniques can detect bone marrow infiltration in MM and allow for differentiation
of infiltration patterns in CT imaging.
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Spectral CT parameters appear to have potential as biomarkers for tumor activity and
treatment response.
Citation Format
Keywords
myeloma - bones - marrow - spine
