Comparison of 18F-sodium fluoride uptake in the whole bone, pelvis, and femoral neck of multiple myeloma patients before and after high-dose therapy and conventional-dose chemotherapy

Abstract

Aim To compare the effect of high-dose therapy (HDT consisting of high-dose chemotherapy followed by autologous stem cell transplantation) and conventional-dose chemotherapy (non-HDT) on the uptake of 18 F-sodium fluoride (NaF) in the whole bone, pelvis and femoral neck of multiple myeloma (MM) patients.Method The data of 19 MM patients who received HDT (61.5, SD (5.6) years) and 11 MM patients who received conventional-dose chemotherapy (70.9, SD (7.2) years) were collected in a prospective study. NaF PET/CT imaging was performed at baseline and eight weeks and two weeks after treatment for the HDT group and the non-HDT group, respectively. A CT-based algorithm was applied to segment the bones, and the global mean SUV (GSUVmean) of the whole bone and pelvis was calculated (OsiriX MD v.9.0, Pixmeo SARL; Bernex, Switzerland). In addition, regions of interest for the whole, medial, and lateral femoral neck were delineated bilaterally. Whole bone and pelvis measurements were replicated by two observers.Results The average GSUVmean in the whole bone and pelvis of the patients who underwent HDT significantly decreased from before to after treatment (-16.27%, p= 0.02 and -16.54%, p= 0.01, respectively). A significant decrease in the whole and lateral femoral neck was also observed bilaterally in the HDT group. No significant decrease in average GSUVmean was observed in the non-HDT group. A high level of inter-observer reliability was found in intra-class correlation (ICC for pre-treatment whole bone: 0.983, posttreatment whole bone: 0.989, pre-treatment whole pelvis: 0.998, post-treatment whole pelvis: 0.996).Conclusion NaF uptake significantly decreased after treatment in patients who received high dose therapy. A high level of agreement was observed between two operators for whole bone and pelvis measurements.

A review of different methods used for quantification and assessment of FDG-PET/CT in multiple myeloma

“…They also used the same methodology for assessment of bone turnover in MM patients with a bone-seeking radiotracer [17]. The methodology showed promise in assessing bone turnover after high dose chemotherapy followed by ASCT and demonstrated a high reproducibility (Fig.…”

“…Some groups recently suggested CT-based segmentation for assessment of radiotracer uptake in the bone marrow and whole bone of MM patients, instead of focusing on focal osteolytic lesions [12][13][14][15][16]. These methodologies have been shown to be highly reproducible [3,17] but the clinal significance of them is still unclear. This review article aims to assess the different methods of PET quantification that have been proposed for the assessment of MM patients.…”

Prognostic significance of conventional and volumetric PET parameters with and without partial volume correction in the assessment of head and neck squamous cell carcinoma

“…Volumetric PET parameters such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) have been shown to overcome some of deficiencies with focusing on a more total burden of disease [15][16][17][18][19][20][21]. However, despite the recent promise of volumetric PET metrics, they are still subject to partial volume effect (PVE) [22][23][24][25]. Unlike modalities such as CT and MRI, which can obtain a spatial resolution of less than 1 mm, the spatial resolution of PET is limited to 8-10 mm [26].…”

Simultaneous Uptake of 18F-NaF and 18F-FDG by Bladder and Prostate Calculi

“…The subject is a 74-year-old man with multiple myeloma planned to receive conventional-dose chemotherapy who underwent both 18 F-NaF PET/CT and 18 F-FDG PET/CT scans as a part of the FULIMA study. 1 The average Hounsfield values for the bladder and prostatic calculi were 1053 and 338, respectively. Meanwhile, the average 18 F-NaF uptake values (SUV mean ) for the bladder and prostate calculi were 1.54 and 2.33, respectively.…”

“…Prostate calculi found within the same subject is also shown in transverse CT ( E ), fused 18 F-NaF PET/CT ( F ), and 18 F-NaF PET ( G ) views. The subject is a 74-year-old man with multiple myeloma planned to receive conventional-dose chemotherapy who underwent both 18 F-NaF PET/CT and 18 F-FDG PET/CT scans as a part of the FULIMA study 1 . The average Hounsfield values for the bladder and prostatic calculi were 1053 and 338, respectively.…”