Role of 18F-FDG PET/CT in the assessment of bone involvement in newly diagnosed multiple myeloma: preliminary results

Nanni, Cristina; Zamagni, Elena; Farsad, Mohsen; Castellucci, Paolo; Tosi, Patrizia; Cangini, Delia; Salizzoni, Eugenio; Canini, Romeo; Cavo, Michèle; Fanti, Stefano

doi:10.1007/s00259-005-0004-3

Cited by 136 publications

(96 citation statements)

References 32 publications

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“…17 Similarly, an infiltrative pattern of spinal myeloma involvement was observed with 25% greater sensitivity by using MRI compared with 18F-FDG-PET/CT. 18 Thus, sensitivity for the assessment of mild, diffuse bone marrow involvement seems to represent a limitation for all imaging techniques, as also demonstrated by our CT study and by other authors who have dealt with MRI in patients with myeloma. Wasser et al reported that diffuse bone marrow infiltration by myeloma could be detected reliably by MRI only in patients with advanced involvement.…”

Section: Discussionsupporting

confidence: 56%

The benefit of using whole‐body, low‐dose, nonenhanced, multidetector computed tomography for follow‐up and therapy response monitoring in patients with multiple myeloma

Horger

Kanz

Denecke

et al. 2007

Cancer

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BACKGROUND. The objectives of this study were to assess the status and clinical course of patients with multiple myeloma based on the direct visualization of changes in medullary, extramedullary, and focal osteolytic myeloma involvement by using whole‐body, low‐dose, multidetector computed tomography (WBLD‐MDCT) and to compare those results with an assessment based on conventional hematologic parameters. METHODS. Between June 2002 and December 2005, WBLD‐MDCT scans were obtained from 131 consecutive multiple myeloma patients with or without therapy, resulting in a total of 439 examinations. The number and size of osteolytic lesions and the number, size, and density of focal or diffuse medullary and extramedullary lesions were analyzed. Those results and the results at follow‐up were related to current laboratory tests for myeloma. Validation was achieved by the combined reading of both hematologic and radiologic parameters at follow‐up. RESULTS. Association between both diagnostic modalities was assessed by using European Group for Blood and Marrow Transplantation response criteria, resulting in an agreement of κ = 0.70. Hematologic parameters proved correct in 84% of all examinations, whereas WBLD‐MDCT resulted in correct assessment in 94% of all examinations. Among 91 of 439 examinations that produced discrepant findings (21%), WBLD‐MDCT proved correct in 68 of 91 examinations (75%), as determined at further follow‐up (95% confidence interval, 66–83%; P = .000003; sign test). The combination of WBLD‐MDCT with conventional, laboratory‐based follow‐up resulted in significantly greater diagnostic accuracy compared with laboratory testing alone. CONCLUSIONS. The results from this study indicated that WBLD‐MDCT represents a reliable, imaging‐based method for the direct monitoring of the course of patients with myeloma under specific therapy, and it showed good concordance with established hematologic parameters. It is noteworthy that, in the current investigation, WBLD‐MDCT proved to be even more reliable than conventional, laboratory‐based follow‐up. Cancer 2007. © 2007 American Cancer Society.

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Section: Discussionsupporting

confidence: 56%

The benefit of using whole‐body, low‐dose, nonenhanced, multidetector computed tomography for follow‐up and therapy response monitoring in patients with multiple myeloma

Horger

Kanz

Denecke

et al. 2007

Cancer

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“…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.…”

Section: Methodological Quality Assessmentmentioning

confidence: 99%

“…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.…”

Section: Literature Searchmentioning

confidence: 99%

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

Lammeren-Venema

Regelink

Riphagen

et al. 2011

Cancer

121

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BACKGROUND:The goal of this study was to conduct a comparative analysis of whole body X-ray (WBXR) and 18 Ffluoro-deoxyglucose positron emission tomography ( 18 FDG PET) in staging and response assessment of multiple myeloma. METHODS: We performed a systematic review of studies comparing 18 FDG PET with WBXR and/or magnetic resonance imaging in terms of sensitivity for myeloma-related bone disease at staging and during follow-up. RESULTS: Eighteen studies involving 798 patients met the inclusion criteria. The mean Quality Assessment of Diagnostic Accuracy Studies (QUADAS) score, expressed as a percentage of the maximum score, was 61%. In 7 studies (n ¼ 242 patients), concordance assessment between WBXR and 18 FDG PET scan was possible, showing a higher sensitivity of the 18 FDG PET in the detection of myeloma bone lesions in 6 studies. The only study reporting on the prognostic value of 18 FDG PET at staging found that the number of FDG-avid focal lesions was an independent prognostic parameter. In addition, the limited studies on response monitoring showed that normalization of 18 FDG PET during treatment correlated with a superior clinical outcome. CONCLUSIONS: In general, 18 FDG PET has a superior sensitivity for myeloma bone lesions compared with WBXR. Future studies have to validate the additive value of myelomarelated bone disease detected on 18 FDG PET-computed tomography (CT) in predicting outcome. Response monitoring with the use of 18 FDG PET-CT during treatment is promising, allowing more precise prediction of prognosis compared with the standard response monitoring. In view of the expanding treatment options for multiple myeloma, this may provide important information for treatment decisions in the future.

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“…Recently, FDG PET/CT has been used to stage MM patients [2][3][4], to accurately evaluate response to therapy [5], to detect the site of EM disease [6] and impinging relapse [5,7]. In recent years very promising and concordant results have been reported by different groups.…”

Section: Introductionmentioning

confidence: 99%

Image interpretation criteria for FDG PET/CT in multiple myeloma: a new proposal from an Italian expert panel. IMPeTUs (Italian Myeloma criteria for PET USe)

Nanni

Zamagni

Versari³

et al. 2015

Eur J Nucl Med Mol Imaging

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Purpose FDG PET/CT is able to detect active disease in patients with multiple myeloma (MM) and can be helpful for staging and assessing therapy response, but no standard interpretation criteria have been proposed for the evaluation of FDG PET/CT in MM. Methods A group of Italian nuclear medicine physicians and haematologists met to propose new visual interpretation criteria to standardize FDG PET/CT evaluation in MM patients (Italian Myeloma criteria for PET USe; IMPeTUs) and the reproducibility of these criteria was tested. This Italian multicentre protocol was set up as a subprotocol of EMN02, an international prospective multicentre trial of the European Myeloma Network. The criteria were agreed at multidisciplinary consensus meetings. They include a description of the metabolic state of the bone marrow (BM), number and site of focal PET-positive lesions, the number of osteolytic lesions, and the presence and site of extramedullary disease, paramedullary disease and fractures. A visual degree of uptake was defined for the target lesion and extramedullary lesions according to modified Deauville criteria. MM patients who had undergone FDG PET/CT at baseline (PET-0), after induction (PET-AI) and at the end of treatment (PET-EoT) were enrolled. The patients had been prospectively enrolled in EMN02 and their PET scans were a posteriori reinterpreted in a blinded independent central review process managed by WIDEN®. Five expert nuclear medicine physicians scored the scans according to the new criteria. A case was considered read when four out of the five reviewers completed the report. Concordance among reviewers on different metrics was calculated using Krippendorff's alpha coefficient. Results A total of 17 consecutive patients were enrolled. On PET-0, the alpha coefficients for the BM score, the score for the hottest focal lesion, the number of focal lesions and the number of lytic lesions were 0.33 and 0.47, 0.40 and 0.32, respectively. On PET-AI, the alpha coefficients were 0.09 and 0.43, 0.22 and 0.21, respectively, and on PET-EoT, the alpha coefficients were 0.07, 0.28, 0.25 and 0.21, respectively. BM was generally difficult to score since grades 2 and 3 are difficult to discriminate. However, since neither of the two grades is related to BM myelomatous involvement, the difference was not

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Role of 18F-FDG PET/CT in the assessment of bone involvement in newly diagnosed multiple myeloma: preliminary results

Cited by 136 publications

References 32 publications

The benefit of using whole‐body, low‐dose, nonenhanced, multidetector computed tomography for follow‐up and therapy response monitoring in patients with multiple myeloma

The benefit of using whole‐body, low‐dose, nonenhanced, multidetector computed tomography for follow‐up and therapy response monitoring in patients with multiple myeloma

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

Image interpretation criteria for FDG PET/CT in multiple myeloma: a new proposal from an Italian expert panel. IMPeTUs (Italian Myeloma criteria for PET USe)

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Role of 18F-FDG PET/CT in the assessment of bone involvement in newly diagnosed multiple myeloma: preliminary results

Cited by 136 publications

References 32 publications

The benefit of using whole‐body, low‐dose, nonenhanced, multidetector computed tomography for follow‐up and therapy response monitoring in patients with multiple myeloma

The benefit of using whole‐body, low‐dose, nonenhanced, multidetector computed tomography for follow‐up and therapy response monitoring in patients with multiple myeloma

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

Image interpretation criteria for FDG PET/CT in multiple myeloma: a new proposal from an Italian expert panel. IMPeTUs (Italian Myeloma criteria for PET USe)

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