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. 2024 Oct 17;16(4):624-635.
doi: 10.3390/hematolrep16040061.

Trabecular Attenuation of L1 in Adult Patients with Multiple Myeloma: An Observational Study on Low-Dose CT Images

Carlo Augusto Mallio  1   2 , Valeria Tomarchio  1   3 , Francesco Pulcini  1   2 , Edoardo Verducci  1   2 , Caterina Bernetti  1   2 , Maria Antonietta Tafuri  1   3 , Federico Greco  2   4 , Luigi Rigacci  1   3 , Bruno Beomonte Zobel  1   2 , Ombretta Annibali  1   3
Affiliations

Trabecular Attenuation of L1 in Adult Patients with Multiple Myeloma: An Observational Study on Low-Dose CT Images

Carlo Augusto Mallio et al. Hematol Rep. .

Abstract

Background: The aim of this study was to evaluate the impact of trabecular attenuation of the L1 vertebral body in low-dose CT in adult patients with multiple myeloma (MM), smoldering multiple myeloma (SMM), and monoclonal gammopathy of undetermined significance (MGUS).

Materials and methods: The study population consisted of 22 patients with MGUS and 51 consecutive patients with newly diagnosed MM (SMM, n = 21; symptomatic MM, n = 36). CT scans were conducted using a 128-slice CT scanner (Somatom go.Top, Siemens, Munich, Germany). Low-dose whole-body CT scans were performed at a single time point for each patient. Trabecular bone density values were obtained by defining regions of interest on non-contrast images at the level of L1 vertebra. A threshold of p = 0.05 was applied to determine statistical significance.

Results: The median Hounsfield unit (HU) value in patients with MGUS, SMM, and MM was 148 HU (range 81-190), 130 HU (range 93-193), and 92 HU (range 26-190), respectively, with a statistically significant difference between the groups (p = 0.0015). Patients with HU values ≤ 92 had lower progression-free survival with statistically significant differences compared to the group with HU values > 92 (p < 0.0499).

Conclusions: This is the earliest evidence of the importance of evaluating L1 attenuation values in low-dose CT images in patients with MGUS, SMM, and MM. Further prospective studies could contribute to reinforcing these results and exploring the clinical applicability and generalization of L1 attenuation values in low-dose whole-body CT scans in routine clinical practice.

Keywords: CT; MGUS; low-dose; multiple myeloma; spine.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Axial CT image showing ROI placement at the level of the trabecular bone of the L1 vertebra. Purple and orange lines are for anatomical reference of correct positioning.
Figure 2
Figure 2
Box plot of HU value in patients with MGUS, smoldering MM, and symptomatic MM. ANOVA, analysis of variance.
Figure 3
Figure 3
Kaplan–Meier curves showing the survival analysis of MM patients divided according to HU values.
Figure 4
Figure 4
Axial low-dose CT images at the level of L1, showing the progressive reduction in bone density across the three groups: monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), and multiple myeloma (MM).
See this image and copyright information in PMC

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