Is there any complimentary role of F-18 NaF PET/CT in detecting of osseous involvement of multiple myeloma? A comparative study for F-18 FDG PET/CT and F-18 FDG NaF PET/CT

Abstract

Multiple myeloma (MM) is a disease characterized by a monoclonal plasma cell population in the bone marrow whereby osseous involvement is a predominant feature. The aim of this prospective study was to investigate the combined use of F-18 FDG and F-18 NaF PET/CT in the skeletal assessment of patients with MM and to compare the efficacy of these two PET tracers regarding detection of myeloma-indicative osseous lesions. A total of 26 patients (14 females and 12 males, mean age 61.8 ± 1.8 years (range 40-81 years)) with MM diagnosed according to standard criteria. All patients underwent both F-18 FDG PET/CT and F-18 NaF PET/CT scans within 1 week after the completion of the usual staging workup for MM. In total, approximately 128 focal F-18 FDG avid skeletal lesions were detected; the stage I (n = 5) patients had 10 bone lesions, the stage II (n = 11) patients had 43 lesions, and the stage III (n = 10) patients demonstrated 75 focal bone lesions. F-18 NaF PET/CTs demonstrated fewer myeloma indicative lesions than F-18 FDG PET/CTs. Totally, 57 focal bone lesions were detected with whole body F-18 NaF PET/CT (mean 2.19 ± 0.34, between 1 and 9 lesions); the five stage I patients had 6 bone lesions, the 11 stage II pts had 18 lesions, and the ten stage III patients demonstrated 33 focal bone lesions. On the other hand, F-18 NaF PET/CT demonstrated additional 135 bone lesions defined as rib fractures and other findings due to degenerative changes. In conclusion, our study implies that F-18 NaF PET/CT scan did not actually aid for assessing the myelomatous bone lesions in patients with MM. Therefore, a complementary F-18 NaF PET/CT may be an accurate modality for detecting of bone fracture in patients with MM.

A prospective study comparing whole-body skeletal X-ray survey with 18F-FDG-PET/CT, 18F-NaF-PET/CT and whole-body MRI in the detection of bone lesions in multiple myeloma patients

“…Studies elucidating the value of NaF-PET/CT in multiple myeloma patients are limited. The NaF-PET/CT results in this study are not convincing and thereby in line with other recently published prospective studies ( 10 , 12 ). A challenge for NaF-PET/CT is that NaF accumulates in the rim of the osteolytic lesions, which can make the detection of smaller myeloma lesions difficult.…”

“…In osteolytic bone lesions, NaF accumulates in the rim of the lesions corresponding to osteoblast activity ( Fig. 1c ) ( 10 – 12 ).…”

Advanced Imaging of Multiple Myeloma Bone Disease

“…MRI was superior to SS, FDG-PET-CT, and NaF-PET-CT. Detection of skeletal abnormalities by NaF-PET-CT was equivalent to SS, a finding consistent with other evaluations of NaF-PET-CT in MM patients ( 49 ).…”

Positron Emission Tomography (PET) Radiopharmaceuticals in Multiple Myeloma

“…Despite this initial enthusiasm, subsequent publications demonstrated rather discouraging results. In particular, 18 F-NaF PET/CT did not confer any superiority or complementarity to 18 F-FDG PET/CT in detection of MM lesions, showing both lower sensitivity and specificity [81][82][83]. Moreover, 18 F-NaF PET/CT does not seem to add significantly to 18 F-FDG PET/CT in the treatment response evaluation of MM patients, as shown in a study of 34 patients undergoing high-dose chemotherapy and ASCT [84].…”