vmireavizВестник медицинского института «РЕАВИЗ». Реабилитация, Врач и ЗдоровьеBulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH)2226-762X2782-1579РЕАВИЗ10.20340/vmi-rvz.2023.2.CLIN.5vmireaviz-653Research ArticleКлиническая медицинаClinical medicineНизкодозная компьютерная томография всего скелета у первичных пациентов со множественной миеломойWhole-body low-dose computed tomography in primary patients with multiple myelomahttps://orcid.org/0000-0003-3644-6058ДанилинаА. М.DanilinaA. M.

Данилина Анжелика Михайловна, врач-гематолог отделения химиотерапии гематологических заболеваний, 

125167, Москва, Новый Зыковский пр., 4

Anzhelika M. Danilina, Hematologist, Department of Chemotherapy for Hematological Diseases,

4 Novy Zykovsky pr., Moscow, 125167

angelikadanilina@mail.ruhttps://orcid.org/0000-0002-4966-8146МенделееваЛ. П.MendeleevaL. P.

Менделеева Лариса Павловна, д-р мед. наук, профессор, руководитель управления по научнойи образовательной работе, заведующий отделом химиотерапии парапротеинемических гемобластозов, врач-гематолог,

125167, Москва, Новый Зыковский пр., 4

Larisa P. Mendeleeva, Dr. Sci. (Med.), Professor, Head of the Department for Scientific and Educational Work, Head of the Department of Chemotherapy for Paraproteinemic Hemoblastoses, Hematologist, 

4 Novy Zykovsky pr., Moscow, 125167

mendeleeva.l@blood.ruhttps://orcid.org/0000-0003-4683-4118КостинаИ. Э.KostinaI. E.

Костина Ирина Эдуардовна, канд. мед. наук, заведующий рентгеновским отделением, врач-рентгенолог, 

125167, Москва, Новый Зыковский пр., 4

Irina E. Kostina, Cand. Sci. (Med.), Head of the X-ray Department, Radiologist, 

4 Novy Zykovsky pr., Moscow, 125167

kostina.i@blood.ruhttps://orcid.org/0000-0002-4155-7820ГрибановаЕ. О.GribanovaE. O.

Грибанова Елена Олеговна, канд. мед. наук, заведующий отделением химиотерапии гематологических заболеваний, врач-гематолог, 

125167, Москва, Новый Зыковский пр., 4

Elena O. Gribanova, Cand. Sci. (Med.), Head of the Department of Chemotherapy for Hematological Diseases, Hematologist, 

4 Novy Zykovsky pr., Moscow, 125167

gribanova.e@blood.ruhttps://orcid.org/0000-0003-1221-3495РыжкоВ. В.RyzhkoV. V.

Рыжко Вячеслав Владимирович, канд. мед. наук, врач-гематолог отделения химиотерапии гематологических заболеваний, 

125167, Москва, Новый Зыковский пр., 4

Vyacheslav V. Ryzhko, Cand. Sci. (Med.), Hematologist, Department of Chemotherapy for Hematological Diseases, 

4 Novy Zykovsky pr., Moscow, 125167

ryzhko.v@blood.ruhttps://orcid.org/0000-0001-8973-9407БальжановаЯ. Б.Bal'zhanovaYa. B.

Бальжанова Янжима Базаровна, канд. мед. наук, научный сотрудник, врач-гематолог отделения химиотерапии гематологических заболеваний,

125167, Москва, Новый Зыковский пр., 4

Yanzhima B. Balzhanova, Cand. Sci. (Med.), Researcher, Hematologist, Department of Chemotherapy of Hematological Diseases,

4 Novy Zykovsky pr., Moscow, 125167

ybalzh11@gmail.comНациональный медицинский исследовательский центр гематологииРоссияNational Medical Research Center for HematologyRussian Federation2023130220231326269Copyright © Данилина А.М., Менделеева Л.П., Костина И.Э., Грибанова Е.О., Рыжко В.В., Бальжанова Я.Б., 20232023Данилина А.М., Менделеева Л.П., Костина И.Э., Грибанова Е.О., Рыжко В.В., Бальжанова Я.Б.Danilina A.M., Mendeleeva L.P., Kostina I.E., Gribanova E.O., Ryzhko V.V., Bal'zhanova Y.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestnik.reaviz.ru/jour/article/view/653Актуальность

Актуальность. Чёткая визуализация костных поражений необходима для диагностики множественной миеломы (ММ), определения распространённости процесса и оценки ответа на лечение. Компьютерная томография (КТ) обладает высокой чувствительностью обнаружения остеолиза и плазмоцитом, более точно определяет риск возникновения переломов. В НМИЦ гематологии с 2014 года в программу диагностики при ММ включена методика низкодозной КТ всего скелета.

Цель исследования

Цель исследования: продемонстрировать чувствительность метода низкодозной компьютерной томографии всего скелета и охарактеризовать частоту остеодеструкций в зависимости от локализации и размеров у первичных пациентов со ММ.

Материалы и методы

Материалы и методы. В исследование было включено 50 пациентов с впервые выявленной ММ. Диагноз устанавливался в соответствии с международными диагностическими критериями. С целью оценки состояния костной ткани выполнялась низкодозная компьютерная томография всего скелета. В соответствии с классификациями Durie-Salmon у 62 % и ISS у 66 % пациентов была установлена III стадия заболевания.

Результаты

Результаты. У 96 % пациентов был обнаружен остеодеструктивный процесс. У 30 % пациентов поражение костей было единственным критерием CRAB. Наиболее часто было отмечено поражение костей таза (92 %). Реже всего очаги деструкции встречались в костях верхних и нижних конечностей (42 %) и преимущественно были мелкими. Наличие внутрикостной плазмоцитомы было отмечено в 40 % случаев.

Заключение

Заключение. Метод низкодозной компьютерной томографии является высокочувствительным, позволяет своевременно диагностировать симптоматическую миелому, обнаруживать патологические переломы и своевременно назначать адекватную специфическую терапию. 

Imaging of bone lesions has an important role in diagnosis of multiple myeloma (MM) and evaluating the response to treatment. Computed tomography scan (CT) allows to detect osteolysis, plasmacytoma and the risk of fractures with high sensitivity. In the National Research Center For Hematologysince 2014 all patients with MM are diagnosed with the whole-body low-dose CT.

The aim of the study was to demonstrate the sensitivity of the whole-body low-dose CT and to characterize localization, number and size of bone lesions in primary MM patients.

Materials and methods

Materials and methods. 50 patients with newly diagnosed MM were enrolled in the study. The diagnosis was established in accordance with international diagnostic criteria. All patients received the whole-body low-dose CT. According to the Durie-Salmon and ISS staging systems 62% and 66% of patients had stage III, respectively.

Results

Results. 96% of MM patients had bone lesions. In 30% of patients, bone involvement was the only criterion for CRAB. Pelvic bone lesions was most often diagnosed (92%). The destruction of the long bones of the arms and legs were most rarely detected (42% of patients) and mostly small. The presence of intraosseous plasmocytoma was noted in 40% of cases.

Conclusion

Conclusion. The whole-body low dose CT was found to be the most sensitive modality for detection osteolytic bone lesions. Low-dose CT is available in MM case with bone disease only, for establish symptomatic stage. This patients require immedate antimyeloma treatment. 

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The authors declare that there are no conflicts of interest present.