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Published on: October 19, 2014
Adult advanced chronic lymphocytic leukemia: computational analysis of whole-body CT documents a bone structure
Francesco Fiz1, Cecilia Marini, Roberta Piva
1From the Departments of Nuclear Medicine Unit (F. Fiz, R.P., F.B., S.M., G.B., G.S.), Hematology (M. Miglino), Hematology and Bone Marrow Transplantation (A.B.), and Epidemiology (P.B.), IRCCS San Martino-IST, University of Genoa, L.go R. Benzi 10, 16132 Genoa, Italy; CNR Institute of Molecular Bioimaging and Physiology, Milan, Section of Genoa, Genoa, Italy (C.M.); Nuclear Medicine Unit, U. Parini Hospital, Aosta, Italy (M. Massollo); Department of Mathematics, University of Genoa, Genoa, Italy (C.C., M.P.); and Stem Cell Laboratory, IRCCS Pediatric Institute G. Gaslini, Genoa, Italy (F. Frassoni).
Purpose:
To assess the presence of alteration of bone structure and bone marrow metabolism in adult patients who were suspected of having advanced chronic lymphocytic leukemia (ACLL) by using a computational prognostic model that was based on computational analysis of positron emission tomography (PET)/computed tomography (CT) images.
Materials And Methods:
In this retrospective study, all patients signed written informed consent as a requisite to undergo PET/CT examination. However, due to its observational nature, approval from the ethical committee was not deemed necessary. Twenty-two previously untreated chronic lymphocytic leukemia patients underwent PET/CT for disease progression. PET/CT images were analyzed by using dedicated software, capable of recognizing an external 2-pixel bone ring whose Hounsfield coefficient served as cutoff to recognize trabecular and compact bone. PET/CT data from 22 age- and sex-matched control subjects were used as comparison. All data are reported as means ± standard deviations. The Student t test, log-rank, or Cox proportional hazards model were used as appropriate, considering a difference with a P value of less than .05 as significant.
Results:
Trabecular bone was expanded in ACLL patients and occupied a larger fraction of the skeleton with respect to control subjects (mean, 39% ± 5 [standard deviation] vs 31% ± 7; ie, 32 of 81 mL/kg of ideal body weight vs 27 of 86 mL/kg of ideal body weight, respectively; P < .001). After stratification according to median value, patients with a ratio of trabecular to skeletal bone volume of more than 37.3% showed an actuarial 2-year survival of 18%, compared with 82% for those with a ratio of less than 37.3% (P < .001), independent from age, sex, biological markers, and disease duration.
Conclusion:
These data suggest that computational assessment of skeletal alterations might represent a new window for prediction of the clinical course of the disease.
