https://doi.org/10.4081/hr.2021.9037 Viktor Dalen Medical Faculty, University of Oslo, Norway. Anne-Sofie Vegsgaard Olsen Medical Faculty, University of Oslo, Norway. Claude-Pierre Jerome Department of Radiology, Akershus University Hospital, Lørenskog, Norway. Jonn-Terje Geitung Department of Radiology, Akershus University Hospital, Lørenskog; Institute of Clinical Medicine, University of Oslo, Norway. Anders E.A. Dahm | aeadahm@gmail.com Institute of Clinical Medicine, University of Oslo; Department of Haematology, Akershus University Hospital, Lørenskog, Norway. Abstract

Skeletal disease is common in multiple myeloma. We investigated the inter-observer agreement and diagnostic accuracy of spinal fractures diagnosed by computer tomography (CT) and magnetic resonance imaging (MRI) from 12 myeloma patients. Two radiologists independently assessed the images. CT, MRI, and other images were combined to a gold standard. The inter-observer agreement was assessed with Cohen’s kappa. Radiologist 1 diagnosed 20 malignant spinal fractures on CT and 26 on MRI, while radiologist 2 diagnosed 12 malignant spinal fractures on CT and 22 on MRI. In comparison the gold standard diagnosed 10 malignant spinal fractures. The sensitivity for malignant fractures varied from 0.5 to 1 for CT and MRI, and the specificity varied from 0.17 to 0.67. On MRI, the specificity for malignant spinal fractures was 0.17 for both radiologists. The inter-observer agreement for malignant spinal fractures on CT was -0.42 (Cohen’s kappa) and -0.13 for MRI, while for osteoporotic fractures it was -0.24 for CT and 0.53 for MRI. We conclude that malignant spinal fractures were over-diagnosed on CT and MRI. The inter-observer agreement was extremely poor.

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References

1. Moreau P, San Miguel J, Sonneveld P, et al. Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28:iv52-iv61.
2. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15:e538-48.
3. Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003;78:21-33.
4. Chantry A, Kazmi M, Barrington S, et al. Guidelines for the use of imaging in the management of patients with myeloma. Br J Haematol. 2017;178:380-93.
5. Hillengass J, Usmani S, Rajkumar SV, et al. International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders. Lancet Oncol. 2019;20:e302-e12.
6. Regelink JC, Minnema MC, Terpos E, et al. Comparison of modern and conventional imaging techniques in establishing multiple myeloma-related bone disease: a systematic review. Br J Haematol. 2013;162:50-61.
7. Dimopoulos MA, Hillengass J, Usmani S, et al. Role of magnetic resonance imaging in the management of patients with multiple myeloma: a consensus statement. J Clin Oncol. 2015;33:657-64.
8. Baur-Melnyk A, Buhmann S, Becker C, et al. Whole-body MRI versus whole-body MDCT for staging of multiple myeloma. AJR Am J Roentgenol. 2008;190:1097-104.
9. Ippolito D, Talei Franzesi C, Spiga S, et al. Diagnostic value of whole-body ultra-low dose computed tomography in comparison with spinal magnetic resonance imaging in the assessment of disease in multiple myeloma. Br J Haematol. 2017;177:395-403.
10. Mahnken AH, Wildberger JE, Gehbauer G, et al. Multidetector CT of the spine in multiple myeloma: comparison with MR imaging and radiography. AJR Am J Roentgenol. 2002;178:1429-36.
11. Gleeson TG, Moriarty J, Shortt CP, et al. Accuracy of whole-body low-dose multidetector CT (WBLDCT) versus skeletal survey in the detection of myelomatous lesions, and correlation of disease distribution with whole-body MRI (WBMRI). Skeletal Radiol. 2009;38:225-36.
12. Hillengass J, Moulopoulos LA, Delorme S, et al. Whole-body computed tomography versus conventional skeletal survey in patients with multiple myeloma: a study of the International Myeloma Working Group. Blood Cancer J. 2017;7:e599.
13. Ippolito D, Besostri V, Bonaffini PA, et al. Diagnostic value of whole-body low-dose computed tomography (WBLDCT) in bone lesions detection in patients with multiple myeloma (MM). Eur J Radiol. 2013;82:2322-7.
14. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22:276-82.
15. Zacchino M, Bonaffini PA, Corso A, et al. Inter-observer agreement for the evaluation of bone involvement on Whole Body Low Dose Computed Tomography (WBLDCT) in Multiple Myeloma (MM). Eur Radiol. 2015;25:3382-9.
16. Lai AYT, Riddell A, Barwick T, et al. Interobserver agreement of whole-body magnetic resonance imaging is superior to whole-body computed tomography for assessing disease burden in patients with multiple myeloma. Eur Radiol. 2020;30:320-7.

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Keywords:

Diagnostic specificity, malignant fractures, osteoporotic fractures, diagnostic imaging, haematology, multiple myeloma

How to Cite

Dalen, V., Vegsgaard Olsen, A.-S., Jerome, C.-P., Geitung, J.-T., & Dahm, A. E. (2021). Low diagnostic accuracy and inter-observer agreement on CT and MRI in diagnosis of spinal fractures in multiple myeloma. Hematology Reports, 13(3). https://doi.org/10.4081/hr.2021.9037