Correlation between the uptake of Tc-99m-sestaMIBI and prognostic factors in patients with multiple myeloma

Abstract

Technetium 99m-2-methoxyisobutil-isonitrile (Tc-99m-MIBI), also called sestaMIBI, has been used successfully to detect malignant tumours at diagnosis. Recently, it has been proposed as a safe and effective tracer in patients with multiple myeloma (MM). The purpose of this study was to demonstrate the value of the Tc-99m-MIBI uptake in disease detection and to assess the correlation between the uptake of this scintigraphy agent and prognostic factors in newly diagnosed MM patients. Thirty-five untreated patients were enrolled in the study. Tc-99m-MIBI scanning was performed in 33 patients after intravenous injection of 7.4 MBq/kg. Whole-body anterior and posterior scans were obtained after 30 min, 60 min, 2 and 4 h. The correlation between known prognostic factors of MM and the intensity of Tc-99m-MIBI uptake was assessed. Our results showed seven patients with an intensity score of I0, 12 patients with I1, eight patients with I2 and six patients with a score of I3. There was a positive correlation between Tc-99m-MIBI intensity and C-reactive protein (CRP; r=0.506, P < 0.01), erythrocyte sedimentation rate (ESR; r=0.368, P < 0.05), beta2- microglobulin (beta2M; r=0.749, P < 0.001), interleukin-6 (IL-6; r=0.823, P < 0.001), soluble Interleukin-6 receptor (sIL-6r; r=0.806, P < 0.001), serum calcium (r=0.578, P < 0.001) and bone alkaline phosphatase (BAP; r=0.472, P < 0.01). An inverse correlation was found between Tc-99m-MIBI intensity and osteocalcin (OC) and type I procollagen carboxyterminal propeptide (PICP). In conclusion, the results of this study suggest that more extensive disease activity, as determined by high levels of CRP, beta2M, IL-6 and sIL-6r correlated with a higher uptake of the radiotracer.

Technetium‐99m sestamibi scintigraphy is sensitive and specific for the staging and the follow‐up of patients with multiple myeloma: a multicentre study on 397 scans

“…Several studies speculated on the possible prognostic impact of 99mTc‐MIBI scintigraphy for MM patients (Pace et al , 2001, 2005a,b, 2006; Alexandrakis et al , 2002, 2003; Athanasoulis et al , 2003). Alexandrakis et al (2002) first investigated the 99mTc‐MIBI potential predictive value in patients with MM. The purpose of their study was to demonstrate the value of the 99mTc‐MIBI uptake in disease detection and to assess the correlation between the uptake of this scintigraphy agent and prognostic factors in newly diagnosed MM patients.…”

“…However, these studies (Pace et al , 2001, 2005a; Alexandrakis et al , 2002) were conducted on a small number of patients, and none of them evaluated the impact of 99mTc‐MIBI scintigraphy on progression‐free and overall survival. For all these reasons, new prospective studies are warranted to understand the meaning of positive and negative scans and to confirm the prognostic role of this procedure.…”

Elevated pre-transplant C-reactive protein identifies a high-risk subgroup in multiple myeloma patients undergoing delayed autologous stem cell transplantation

“…Earlier studies have also shown an independent correlation of CRP with disease activity at diagnosis and after treatment, as detected by technetium 99 m-sestamibi scintigraphy. 24,25 Elevated CRP at diagnosis is also strongly associated with the presence of greater than seven focal lesions on magnetic resonance imaging, greater than five focal lesions on metastatic bone survey (P o 0.001 for both) 26 and more than three FDG-avid lesions on positron emission tomography. 27 Owing to a strong correlation of elevated CRP with focal lesions in the medullary and extramedullary compartments, the lack of association between CRP and pre- Pre-transplant C-reactive protein in myeloma R Chakraborty et al transplant response is plausible as focal involvement in the marrow could be missed by a single BM examination.…”

Nonsecretory multiple myeloma in a horse

“…Newer radionucleotide tracers, such as technetium-99m-2 methoxy-isobutyl-isonitrile ( 99m Tc-MIBI or sestaMIBI), are superior to radiography (Alper et al 2003;Mileshkin et al 2004). Images produced with this technique can be used not only for diagnosis, but also for prognosis and for determining the response to treatment (Alexandrakis et al 2001(Alexandrakis et al , 2002. Immunoscintigraphy using technetium-99m-anti-granulocyte antibodies has also been shown to be more sensitive than conventional radiographs or 99m Tc-MDP, picking up 74% vs. 47 and 32% of myeloma lesions, respectively (Sohn et al 2002).…”