{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:09:32Z","timestamp":1792037372832,"version":"4.4.0"},"reference-count":33,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2024,1,6]],"date-time":"2024-01-06T00:00:00Z","timestamp":1704499200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The aim of the study was to evaluate whether virtual calcium subtraction (VNCa) image extracted from dual-layer spectral CT could estimate bone marrow (BM) infiltration with MRI as the reference standard and characterize tumor burden in patients with multiple myeloma (MM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>Forty-seven patients with newly diagnosed MM were retrospectively enrolled. They had undergone whole-body low-dose dual-layer spectral CT (DLCT) and whole-body MRI within one week. VNCa images with calcium-suppressed (CaSupp) indices ranging from 25 to 95 at an interval of 10 and apparent diffusion coefficient (ADC) maps were quantitatively analyzed on vertebral bodies L1\u2212L5 at the central slice of images. The optimal combination was selected by correlation analysis between CT numbers and ADC values. Then, it was used to characterize tumor burden by correlation analysis and receiver operating characteristic (ROC) curves analysis, including plasma cell infiltration rate (PCIR), high serum-free light chains (SFLC) ratio and the high-risk cytogenetic (HRC) status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The most significant quantitative correlation between CT numbers of VNCa images and ADC values could be found at CaSupp index 85 for averaged L1\u2212L5 (r = 0.612, p &lt; 0.001). It allowed quantitative evaluation of PCIR (r = 0.835, p &lt; 0.001). It could also anticipate high SFLC ratio and the HRC status with\n                      <jats:italic>area under the curve<\/jats:italic>\n                      (\n                      <jats:italic>AUC<\/jats:italic>\n                      ) of 0.876 and 0.760, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The VNCa measurements of averaged L1\u2212L5 showed the highest correlation with ADC at CaSupp index 85. It could therefore be used as additional imaging biomarker for non-invasive assessment of tumor burden if ADC is not feasible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2478\/raon-2024-0003","type":"journal-article","created":{"date-parts":[[2024,1,6]],"date-time":"2024-01-06T07:12:49Z","timestamp":1704525169000},"page":"43-50","source":"Crossref","is-referenced-by-count":8,"title":["Quantitative assessment of bone marrow infiltration and characterization of tumor burden using dual-layer spectral CT in patients with multiple myeloma"],"prefix":"10.2478","volume":"58","author":[{"given":"Xing","family":"Xiong","sequence":"first","affiliation":[{"name":"Department of Radiology , The First Affiliated Hospital of Soochow University , Suzhou , Jiangsu , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Radiology , The First Affiliated Hospital of Soochow University , Suzhou , Jiangsu , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Radiology , The First Affiliated Hospital of Soochow University , Suzhou , Jiangsu , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengmei","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Radiology , The First Affiliated Hospital of Soochow University , Suzhou , Jiangsu , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Clinical Science , Philips Healthcare Greater China , Shanghai , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiology , Dushu Lake Hospital Affiliated to Soochow University , Suzhou , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunhong","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Radiology , The First Affiliated Hospital of Soochow University , Suzhou , Jiangsu , China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2024,1,6]]},"reference":[{"key":"2026071211371431280_j_raon-2024-0003_ref_001","doi-asserted-by":"crossref","unstructured":"Kazandjian D. Multiple myeloma epidemiology and survival: a unique malignancy. Semin Oncol 2016; 43: 676\u201381. doi: 10.1053\/j.seminoncol.2016.11.004","DOI":"10.1053\/j.seminoncol.2016.11.004"},{"key":"2026071211371431280_j_raon-2024-0003_ref_002","doi-asserted-by":"crossref","unstructured":"Panaroni C, Yee AJ, Raje NS. Myeloma and bone disease. Curr Osteoporos Rep 2017; 15: 483\u201398. doi: 10.1007\/s11914-017-0397-5","DOI":"10.1007\/s11914-017-0397-5"},{"key":"2026071211371431280_j_raon-2024-0003_ref_003","unstructured":"O\u2019Donnell EK, Raje NS. Myeloma bone disease: pathogenesis and treatment. Clin Adv Hematol Oncol 2017; 15: 285\u201395. PMID: 28591104"},{"key":"2026071211371431280_j_raon-2024-0003_ref_004","doi-asserted-by":"crossref","unstructured":"Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014; 15: e538\u201348. doi: 10.1016\/S1470-2045(14)70442-5","DOI":"10.1016\/S1470-2045(14)70442-5"},{"key":"2026071211371431280_j_raon-2024-0003_ref_005","doi-asserted-by":"crossref","unstructured":"Duvauferrier R, Valence M, Patrat-Delon S, Brillet E, Niederberger E, Marchand A, et al. Current role of CT and whole body MRI in multiple myeloma. Diagn Interv Imaging 2013; 94: 169\u201383. doi: 10.1016\/j.diii.2012.12.001","DOI":"10.1016\/j.diii.2012.12.001"},{"key":"2026071211371431280_j_raon-2024-0003_ref_006","doi-asserted-by":"crossref","unstructured":"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\u201356. doi: 10.1038\/leu.2009.89","DOI":"10.1038\/leu.2009.89"},{"key":"2026071211371431280_j_raon-2024-0003_ref_007","doi-asserted-by":"crossref","unstructured":"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: 842\u201354. doi: 10.1002\/1097-0142(197509)36:3<842::aid-cncr2820360303>3.0.co;2-u","DOI":"10.1002\/1097-0142(197509)36:3<842::AID-CNCR2820360303>3.0.CO;2-U"},{"key":"2026071211371431280_j_raon-2024-0003_ref_008","doi-asserted-by":"crossref","unstructured":"Portet M, Owens E, Howlett D. The use of whole-body MRI in multiple myeloma. Clin Med 2019; 19: 355\u20136. doi: 10.7861\/clinmedicine.19-4-355","DOI":"10.7861\/clinmedicine.19-4-355"},{"key":"2026071211371431280_j_raon-2024-0003_ref_009","doi-asserted-by":"crossref","unstructured":"Kosmala A, Weng AM, Heidemeier A, Krauss B, Knop S, Bley TA, et al. Multiple myeloma and dual-energy CT: diagnostic accuracy of virtual non-calcium technique for detection of bone marrow infiltration of the spine and pelvis. Radiology 2018; 286: 205\u201313. doi: 10.1148\/radiol.2017170281","DOI":"10.1148\/radiol.2017170281"},{"key":"2026071211371431280_j_raon-2024-0003_ref_010","doi-asserted-by":"crossref","unstructured":"Hillengass J, Usmani S, Rajkumar SV, Durie BGM, Mateos MV, Lonial S, et al. International Myeloma Working Group consensus recommendations on imaging in monoclonal plasma cell disorders. Lancet Oncol 2019; 20: e302\u2013e312. doi: 10.1016\/S1470-2045(19)30309-2","DOI":"10.1016\/S1470-2045(19)30309-2"},{"key":"2026071211371431280_j_raon-2024-0003_ref_011","doi-asserted-by":"crossref","unstructured":"Shah LM, Hanrahan CJ. MRI of spinal bone marrow: part I, techniques and normal age-related appearances. AJR Am J Roentgenol 2011; 197: 1298\u2013308. doi: 10.2214\/AJR.11.7005","DOI":"10.2214\/AJR.11.7005"},{"key":"2026071211371431280_j_raon-2024-0003_ref_012","doi-asserted-by":"crossref","unstructured":"Padhani AR, Koh DM, Collins DJ. Whole-body diffusion-weighted MR imaging in cancer: current status and research directions. Radiology 2011; 261: 700\u201318. doi: 10.1148\/radiol.11110474","DOI":"10.1148\/radiol.11110474"},{"key":"2026071211371431280_j_raon-2024-0003_ref_013","doi-asserted-by":"crossref","unstructured":"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; 18: e206\u2013e217. doi: 10.1016\/S1470-2045(17)30189-4","DOI":"10.1016\/S1470-2045(17)30189-4"},{"key":"2026071211371431280_j_raon-2024-0003_ref_014","doi-asserted-by":"crossref","unstructured":"Fervers P, Fervers F, Kottlors J, Lohneis P, Pollman-Schweckhorst P, Zaytoun H, et al. Feasibility of artificial intelligence-supported assessment of bone marrow infiltration using dual-energy computed tomography in patients with evidence of monoclonal protein - a retrospective observational study. Eur Radiol 2022; 32: 2901\u201311. doi: 10.1007\/s00330-021-08419-2","DOI":"10.1007\/s00330-021-08419-2"},{"key":"2026071211371431280_j_raon-2024-0003_ref_015","doi-asserted-by":"crossref","unstructured":"Fervers P, Glauner A, Gertz R, T\u00e4ger P, Kottlors J, Maintz D, et al. Virtual calcium-suppression in dual energy computed tomography predicts metabolic activity of focal MM lesions as determined by fluorodeoxyglucose positron-emission-tomography. Eur J Radiol 2021; 135: 109502. doi: 10.1016\/j.ejrad.2020.109502","DOI":"10.1016\/j.ejrad.2020.109502"},{"key":"2026071211371431280_j_raon-2024-0003_ref_016","doi-asserted-by":"crossref","unstructured":"Brandelik SC, Skornitzke S, Mokry T, Sauer S, Stiller W, Nattenm\u00fcller J, et al. Quantitative and qualitative assessment of plasma cell dyscrasias in dual-layer spectral CT. Eur Radiol 2021; 31: 7664\u201373. doi: 10.1007\/s00330-021-07821-0","DOI":"10.1007\/s00330-021-07821-0"},{"key":"2026071211371431280_j_raon-2024-0003_ref_017","doi-asserted-by":"crossref","unstructured":"Moulopoulos LA, Koutoulidis V, Hillengass J, Zamagni E, Aquerreta JD, Roche CL, et al. Recommendations for acquisition, interpretation and reporting of whole body low dose CT in patients with multiple myeloma and other plasma cell disorders: a report of the IMWG Bone Working Group. Blood Cancer J 2018; 8: 95. doi: 10.1038\/s41408-018-0124-1","DOI":"10.1038\/s41408-018-0124-1"},{"key":"2026071211371431280_j_raon-2024-0003_ref_018","doi-asserted-by":"crossref","unstructured":"Reinert CP, Krieg E, Esser M, Nikolaou K, B\u00f6sm\u00fcller H, Horger M. Role of computed tomography texture analysis using dual-energy-based bone marrow imaging for multiple myeloma characterization: comparison with histology and established serologic parameters. Eur Radiol 2021; 31: 2357\u201367. doi: 10.1007\/s00330-020-07320-8","DOI":"10.1007\/s00330-020-07320-8"},{"key":"2026071211371431280_j_raon-2024-0003_ref_019","doi-asserted-by":"crossref","unstructured":"Hu C, Zhang Y, Xiong X, Meng Q, Yao F, Ye A, et al. Quantitative evaluation of bone marrow infiltration using dual-energy spectral computed tomography in patients with multiple myeloma. J Xray Sci Technol 2021; 29: 463\u201375. doi: 10.3233\/XST-200811","DOI":"10.3233\/XST-200811"},{"key":"2026071211371431280_j_raon-2024-0003_ref_020","doi-asserted-by":"crossref","unstructured":"Mosebach J, Thierjung H, Schlemmer HP, Delorme S. Multiple myeloma guidelines and their recent updates: implications for imaging. Rofo 2019; 191: 998\u20131009. doi: 10.1055\/a-0897-3966","DOI":"10.1055\/a-0897-3966"},{"key":"2026071211371431280_j_raon-2024-0003_ref_021","doi-asserted-by":"crossref","unstructured":"Cowan AJ, Green DJ, Kwok M, Lee S, Coffey DG, Holmberg LA, et al. Diagnosis and management of multiple myeloma: a review. JAMA 2022; 327: 464\u201377. doi: 10.1001\/jama.2022.0003","DOI":"10.1001\/jama.2022.0003"},{"key":"2026071211371431280_j_raon-2024-0003_ref_022","doi-asserted-by":"crossref","unstructured":"Thomas C, Schabel C, Krauss B, Weisel K, Bongers M, Claussen CD, et al. Dual-energy CT: virtual calcium subtraction for assessment of bone marrow involvement of the spine in multiple myeloma. AJR Am J Roentgenol 2015; 204: W324\u201331. doi: 10.2214\/AJR.14.12613","DOI":"10.2214\/AJR.14.12613"},{"key":"2026071211371431280_j_raon-2024-0003_ref_023","doi-asserted-by":"crossref","unstructured":"Ekert K, Hinterleitner C, Baumgartner K, Fritz J, Horger M. Extended texture analysis of non-enhanced whole-body MRI image data for response assessment in multiple myeloma patients undergoing systemic therapy. Cancers 2020; 12: 761. doi: 10.3390\/cancers12030761","DOI":"10.3390\/cancers12030761"},{"key":"2026071211371431280_j_raon-2024-0003_ref_024","doi-asserted-by":"crossref","unstructured":"Yu Z, Leng S, Jorgensen SM, Li Z, Gutjahr R, Chen B, et al. Evaluation of conventional imaging performance in a research whole-body CT system with a photon-counting detector array. Phys Med Biol 2016; 61: 1572\u201395. doi: 10.1088\/0031-9155\/61\/4\/1572","DOI":"10.1088\/0031-9155\/61\/4\/1572"},{"key":"2026071211371431280_j_raon-2024-0003_ref_025","doi-asserted-by":"crossref","unstructured":"Koutoulidis V, Terpos E, Papanikolaou N, Fontara S, Seimenis I, Gavriatopoulou M, et al. Comparison of MRI features of fat fraction and ADC for early treatment response assessment in participants with multiple myeloma. Radiology 2022; 304: 137\u201344. doi: 10.1148\/radiol.211388","DOI":"10.1148\/radiol.211388"},{"key":"2026071211371431280_j_raon-2024-0003_ref_026","doi-asserted-by":"crossref","unstructured":"Sidiqi MH, Aljama M, Kumar SK, Jevremovic D, Buadi FK, Warsame R, et al. The role of bone marrow biopsy in patients with plasma cell disorders: should all patients with a monoclonal protein be biopsied? Blood Cancer J 2020; 10: 52. doi: 10.1038\/s41408-020-0319-0","DOI":"10.1038\/s41408-020-0319-0"},{"key":"2026071211371431280_j_raon-2024-0003_ref_027","doi-asserted-by":"crossref","unstructured":"Dupuis MM, Tuchman SA. Non-secretory multiple myeloma: from biology to clinical management. Onco Targets Ther 2016; 9: 7583\u201390. doi: 10.2147\/OTT.S122241","DOI":"10.2147\/OTT.S122241"},{"key":"2026071211371431280_j_raon-2024-0003_ref_028","doi-asserted-by":"crossref","unstructured":"Wale A, Pawlyn C, Kaiser M, Messiou C. Frequency, distribution and clinical management of incidental findings and extramedullary plasmacytomas in whole body diffusion weighted magnetic resonance imaging in patients with multiple myeloma. Haematologica 2016; 101: e142\u20134. doi: 10.3324\/haematol.2015.139816","DOI":"10.3324\/haematol.2015.139816"},{"key":"2026071211371431280_j_raon-2024-0003_ref_029","doi-asserted-by":"crossref","unstructured":"Hamdaoui H, Benlarroubia O, Ait Boujmia OK, Mossafa H, Ouldim K, Belkhayat A, et al. Cytogenetic and FISH analysis of 93 multiple myeloma Moroccan patients. Mol Genet Genomic Med 2020; 8: e1363. doi: 10.1002\/mgg3.1363","DOI":"10.1002\/mgg3.1363"},{"key":"2026071211371431280_j_raon-2024-0003_ref_030","doi-asserted-by":"crossref","unstructured":"Saxe D, Seo EJ, Bergeron MB, Han JY. Recent advances in cytogenetic characterization of multiple myeloma. Int J Lab Hematol 2019; 41: 5\u201314. doi: 10.1111\/ijlh.12882","DOI":"10.1111\/ijlh.12882"},{"key":"2026071211371431280_j_raon-2024-0003_ref_031","doi-asserted-by":"crossref","unstructured":"Zhao XQ, Zhao SY, Chen WX, Liu XW, Yan HX, Lou YJ. Correlation between clinical factors and prognosis in newly diagnosed multiple myeloma. J Coll Physicians Surg Pak 2020; 30: 601\u20135. doi: 10.29271\/jcpsp.2020.06.601","DOI":"10.29271\/jcpsp.2020.06.601"},{"key":"2026071211371431280_j_raon-2024-0003_ref_032","doi-asserted-by":"crossref","unstructured":"Usmani SZ, Crowley J, Hoering A, Mitchell A, Waheed S, Nair B, et al. Improvement in long-term outcomes with successive total therapy trials for multiple myeloma: are patients now being cured? Leukemia 2013; 27: 226\u201332. doi: 10.1038\/leu.2012.160","DOI":"10.1038\/leu.2012.160"},{"key":"2026071211371431280_j_raon-2024-0003_ref_033","doi-asserted-by":"crossref","unstructured":"Ross FM, Avet-Loiseau H, Ameye G, Guti\u00e9rrez NC, Liebisch P, O\u2019Connor S, et al. Report from the European Myeloma Network on interphase FISH in multiple myeloma and related disorders. Haematologica 2012; 97: 1272\u20137. doi: 10.3324\/haematol.2011.056176","DOI":"10.3324\/haematol.2011.056176"}],"container-title":["Radiology and Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/reference-global.com\/pdf\/10.2478\/raon-2024-0003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T23:19:34Z","timestamp":1783898374000},"score":1,"resource":{"primary":{"URL":"https:\/\/reference-global.com\/article\/10.2478\/raon-2024-0003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,6]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,6]]},"published-print":{"date-parts":[[2024,3,1]]}},"alternative-id":["10.2478\/raon-2024-0003"],"URL":"https:\/\/doi.org\/10.2478\/raon-2024-0003","relation":{},"ISSN":["1581-3207"],"issn-type":[{"value":"1581-3207","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,6]]}}}