Value of FDG PET in the Assessment of Patients with Multiple Myeloma

Abstract

FDG PET is able to detect bone marrow involvement in patients with multiple myeloma. FDG PET is useful in assessing extent of disease at time of initial diagnosis, contributing to staging that is more accurate. FDG PET is also useful for evaluating therapy response.

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.…”

“…Mileshkin, 2004 A lesion is reported to be positive and consistent with myeloma if the reporting nuclear medicine doctor says so. Bredella, 2005 Not mentioned Hung, 2005 Not mentioned Adam, 2007 Not mentioned Hur, 2007 All areas of diffuse or focal increases in 18 FDG uptake in bone marrow if the intensity was determined greater than the uptake of adjacent or contralateral normal tissue not located in a region of physiologically increased uptake. Hur, 2008 All focal uptake unless they were at sites of known accumulation or diffuse uptake if the intensity of activity relative to the background was considered greater than that seen using compatible imaging in patients without bone marrow disease.…”

“…In the study by Mileshkin et al, 19 6 multiple myeloma patients after (radio)therapy were evaluated; 6 out of 9 scans were negative, 3 correlated with complete remission, and the other 3 had progressive disease on routine disease markers, but the majority of the known disease sites were not 18 FDG-avid. In the study by Bredella et al, 10 3 patients underwent serial 18 FDG PET scans to assess response to chemotherapy and bone marrow transplant. In 2 patients, 18 FDG PET scan showed a decline in metabolic activity concordant with clinical improvement.…”

The role of 18F-FDG PET/CT before and after the treatment of multiple myeloma: Our clinical experience

“…Nowadays, several myeloma organizations and institutions have suggested that wholebody LDCT should replace conventional radiography for the work-up of patients with MM because of the higher sensitivity for the detection of osteolytic lesions [3] . In addition, numerous studies have shown that FDG PET/ CT is more sensitive in the detection of osteolytic lesions in MM compared to whole-body X-ray [7,8,16] . Based on a systematic review from 2012 involving 18 studies and 798 patients, FDG PET/CT was able to detect MM osteolytic lesions with a sensitivity of approximately 80%-90% and a specificity of 80%-100% [14,17] .…”