Diagnostic performance of computed tomography and diffusion-weighted imaging as first-line imaging modality according to the International Myeloma Working Group (IMWG) imaging algorithm for monoclonal plasma cell disorders

• Published in: Acta radiologica (1987) 2022-05, Vol.63 (5), p.672-683
• Main Authors: Yoon, Min A, Chee, Choong Guen, Chung, Hye Won, Lee, Dong Hyun, Kim, Kyung Won
• Format: Article
• Language: English
• Subjects: Algorithms; Diffusion Magnetic Resonance Imaging - methods; Humans; Male; Middle Aged; Multiple Myeloma - diagnostic imaging; Plasma Cells; Positron Emission Tomography Computed Tomography - methods; Tomography, X-Ray Computed; Whole Body Imaging - methods
• ISSN: 0284-1851; 1600-0455
• DOI: 10.1177/02841851211008383

Background The latest International Myeloma Working Group (IMWG) guideline recommends low-dose whole-body (WB) computed tomography (CT) as the first-line imaging technique for the initial diagnosis of plasma cell disorders. Purpose To evaluate diagnostic performances of CT and diffusion-weighted imaging (DWI) as the first-line imaging modalities and assess misclassification rates obtained following the guideline. Material and Methods Two independent radiologists analyzed CT (acquired as PET/CT) and DWI (3-T; b-values = 50 and 900 s/mm2) of patients newly diagnosed with plasma cell disorder, categorizing the number of bone lesions. Diagnostic performance of CT and DWI was compared using the McNemar test, and misclassification rates were calculated with a consensus WB-MRI reading as the reference standard. Differences in lesion number categories were assessed using marginal homogeneity and kappa statistics. Results Of 56 patients (36 men; mean age = 63.5 years), 39 had myeloma lesions. DWI showed slightly higher sensitivity for detecting myeloma lesions (97.4%) than CT (84.6%–92.3%; P > 0.05). CT showed significantly higher specificity (88.2%) than DWI (52.9%–58.8%; P