Rapid study assessment in follow-up whole-body computed tomography in patients with multiple myeloma using a dedicated bone subtraction software

M. Sieren, F. Brenne, A. Hering, H. Kienapfel, N. Gebauer, T. Oechtering, A. F├╝rschke, F. Wegner, E. Stahlberg, S. Heldmann, J. Barkhausen and A. Frydrychowicz

European Radiology 2020.



The diagnostic reading of follow-up low-dose whole-body computed tomography (WBCT) examinations in patients with multiple myeloma (MM) is a demanding process. This study aimed to evaluate the diagnostic accuracy and benefit of a novel software program providing rapid-subtraction maps for bone lesion change detection.


Sixty patients (66 years +- 10 years) receiving 120 WBCT examinations for follow-up evaluation of MM bone disease were identified from our imaging archive. The median follow-up time was 292 days (range 200-641 days). Subtraction maps were calculated from 2-mm CT images using a nonlinear deformation algorithm. Reading time, correctly assessed lesions, and disease classification were compared to a standard reading software program. De novo clinical reading by a senior radiologist served as the reference standard. Statistics included Wilcoxon rank-sum test, Cohen's kappa coefficient, and calculation of sensitivity, specificity, positive/negative predictive value, and accuracy.


Calculation time for subtraction maps was 84 s +- 24 s. Both readers reported exams faster using subtraction maps (reader A, 438 s +- 133 s; reader B, 1049 s +- 438 s) compared to PACS software (reader A, 534 s +- 156 s; reader B, 1486 s +- 587 s; p < 0.01). The course of disease was correctly classified by both methods in all patients. Sensitivity for lesion detection in subtraction maps/conventional reading was 92%/80% for reader A and 88%/76% for reader B. Specificity was 98%/100% for reader A and 95%/96% for reader B.


A software program for the rapid-subtraction map calculation of follow-up WBCT scans has been successfully tested and seems suited for application in clinical routine. Subtraction maps significantly facilitated reading of WBCTs by reducing reading time and increasing sensitivity.

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