Initial results in the assessment of multiple myeloma using 18F-FDG PET

Abstract

This prospective study was undertaken to investigate the appearance of multiple myeloma on fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET). Furthermore, the accuracy of FDG-PET in detecting myeloma lesions and its influence on patient management were evaluated. Forty-three patients with known multiple myeloma (n=28) or solitary plasmacytoma (n=15) underwent FDG-PET. The results of routinely performed radiographs and of scans obtained using all available imaging modalities (MRI, CT), as well as the clinical course, were used for verification of detected lesions. Focally increased tracer uptake was observed in 38 of 41 known osteolytic bone lesions (sensitivity 92.7%) in 23 patients. In addition, 71 further bone lesions which were negative on radiographs were detected in 14 patients. Twenty-six (36.6%) of these lesions could be confirmed in ten patients. As a result of FDG-PET imaging, clinical management was influenced in five (14.0%) patients. The positive predictive value for active disease was 100% in patients with focal or mixed focal/diffuse skeletal FDG uptake and 75% in patients with diffuse bone marrow uptake. Depending on the interpretation of the PET scans in patients with diffuse bone marrow uptake, the sensitivity ranged from 83.8% to 91.9% and the specificity from 83.3% to 100%. FDG-PET thus proved highly accurate in detecting multiple myeloma, and revealed a greater extent of disease than routine radiographs in 14 of 23 (60.9%) patients who had osteolytic bone lesions. FDG-PET might contribute to the initial staging of solitary plasmacytoma.

18F‐fluoro‐deoxyglucose positron emission tomography in assessment of myeloma‐related bone disease: A systematic review

“…The studies with a methodological quality above average were the studies by Bredella et al, 10 Fonti et al, 14 Hur et al, 16,17 Schirrmeister et al, 23,24 and Zamagni et al 4,21 Comparison of 18 FDG PET or PET-CT and Conventional Imaging at Staging Of the 18 studies conducted, concordance assessment between WBXR and 18 FDG PET scan was possible in 7 (concerning 242 patients). In 6 out of these 7 studies, 18 FDG PET (with or without CT) scan showed more lytic lesions then conventional WBXR with the exception of lytic lesions located in the skull 4,[9][10][11]19,21,23,24 (Table 5). Two studies compared 18 FDG PET-CT scan with WBXR.…”

“…Finally, 18 studies involving 798 patients were included in this systematic review (Figure 1). 3,4,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] There was no disagreement between the reviewers regarding the inclusion of the articles. The characteristics of the included studies are presented in Table 2.…”

“…A diffuse increase in bone marrow activity was interpreted as positive for myeloma if the intensity of activity relative to the background was considered greater than that seen using comparable imaging in patients without bone marrow disease. Jadvar, 2002 Not mentioned Schirrmeister, 2002 All foci presenting with a significant increase in 18 FDG uptake located in the skeleton were considered indicative of myeloma. Focal increase in tracer uptake in extraskeletal regions was interpreted as EMD.…”

Multiple Myeloma, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology

“…30 Active myeloma is positive on PET scan. 31,32 PET/ CT and MRI scans are more sensitive than plain radiographs and are indicated when symptomatic areas show no abnormality on routine radiographs. FDG PET/CT results after induction therapy and stem cell transplant (SCT) help in predicting the prognosis of patients with symptomatic MM.…”

Outcome prediction in plasmacytoma of bone: a risk model utilizing bone marrow flow cytometry and light-chain analysis

“…Several studies have demonstrated that they are informative in SPB and upstage a proportion of patients. 16,[18][19][20] In a retrospective analysis, Warsame and colleagues suggested that the outcome in patients has improved since the introduction of routine PET imaging at their center because the outcome in patients with a negative PET scan was superior to those in whom PET was not performed. 10 Similarly, Fouguet et al have recently demonstrated that additional lesions on PET imaging are associated with progression to MM.…”