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Quantitative contrast-enhanced CT attenuation evaluation of osseous metastases following chemotherapy

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Abstract

Purpose

Osseous metastases often undergo an osteoblastic healing response following chemotherapy. The purpose of our study was to demonstrate the quantitative CT changes in attenuation of osseous metastases before and after chemotherapy.

Materials and methods

Our study was IRB approved and HIPAA compliant. Our cohort consisted of 86 consecutive cancer patients with contrast-enhanced CTs before and 14 ± 2 (12–25) months after initiation of chemotherapy (60 ± 11 years, 36 males, 50 females). The average and maximum metastasis attenuations were measured in Hounsfield units (HU) by two readers. Treatment effects were assessed using paired t-tests and Fisher exact tests. Intraclass correlation coefficients (ICCs) were calculated. Patient records were reviewed to determine the patient’s clinical status (worse, unchanged, or improved) at the time of follow-up CT.

Results

The distribution of lesion types was as follows: lytic (30/86, 35%), blastic (43/86, 50%), and mixed lytic-blastic (13/86, 15%). There was a significant increase in average and maximum CT attenuation of metastases following chemotherapy for all patients, which remained statistically significant when stratified by lesion type, clinical status (worsening or improving/stable), cancer type (breast, lung), and radiation therapy (P < 0.05). In a subgroup of patients whose osseous metastases decreased in average attenuation (14/86, 16%), more patients had a worse clinical status (11/14, 79%) (P = 0.02). ICC was almost perfect for average attenuation and substantial for maximum attenuation.

Conclusion

Quantitative assessment of osseous metastatic disease using CT attenuation measurements demonstrated a statistically significant increase in attenuation more than 12 months after initiation of chemotherapy.

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Authors and Affiliations

  1. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA

    Connie Y. Chang, F. Joseph Simeone, Martin Torriani & Miriam A. Bredella

Authors
  1. Connie Y. Chang
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  2. F. Joseph Simeone
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  3. Martin Torriani
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  4. Miriam A. Bredella
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Corresponding author

Correspondence to Connie Y. Chang.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived for individual participants included in the study. The study was approved by the local Institutional Review Board (IRB) and is HIPAA compliant.

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Chang, C.Y., Simeone, F.J., Torriani, M. et al. Quantitative contrast-enhanced CT attenuation evaluation of osseous metastases following chemotherapy. Skeletal Radiol 46, 1385–1395 (2017). https://doi.org/10.1007/s00256-017-2706-6

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  • DOI: https://doi.org/10.1007/s00256-017-2706-6

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