Value of Tc-99m sestamibi scintigraphy in the detection of bone lesions in multiple myeloma: comparison with Tc-99m methylene diphosphonate

Abstract

Technetium 99m-2-methoxyisobutylisonitrile (Tc-99m MIBI) is a lipophilic agent that accumulates preferentially within living malignant cells due to the higher transmembrane electrical potential as a consequence of the higher metabolic rate than in the surrounding normal cells. It has been effectively used to detect malignant tumors at diagnosis and follow-up and has been reported to be useful in detecting disease lesions in multiple myeloma. We studied 28 consecutive patients with multiple myeloma at diagnosis to determine the value of Tc-99m MIBI in comparison with Tc-99m methylene diphosphonate (MDP), conventional X-rays, computed tomography (CT) scan, and magnetic resonance imaging (MRI). We found 26 patients with obvious osteolytic lesions in X-rays, 22 patients with positive Tc-99m MIBI scans, and 15 patients with positive Tc-99m MDP scans. There was no coincidence of the positive lesions in the two scans, while in two patients the osteolytic areas were positive in the Tc-99m MDP scans, and in one case the osteolytic area was positive in the Tc-99m MIBI scan. The intensity of Tc-99m MIBI scans correlated with disease activity as determined by lactate dehydrogenase (LDH) (p<0.05), C-reactive protein (CRP) (p<0.01), beta2-microglobulin (p<0.05), and serum ferritin (p<0.01). We believe that Tc-99m MIBI scintigraphy can detect bone marrow lesions in myeloma patients that cannot be detected by other imaging methods and that it can be useful especially in solitary myeloma to exclude other involved sites. In addition, it could be a prognostic factor related to disease activity and multidrug resistance. We believe that a multicenter study is needed to evaluate the usefulness of this agent.

Elevation of Serum Ferritin is Associated with the Outcome of Patients with Newly Diagnosed Multiple Myeloma

“…However, one study showed that patients with hematologic malignancies have significantly higher serum ferritin levels [7]. Another study showed that the intensity of the 99mTc-MIBI scan correlates with the serum ferritin level as a marker of disease activity [10]. A third study found that elevated serum sIL-6R levels were related to the growth of myeloma cells and that the concentration was an indicator of disease activity; the sIL-6R level was correlated with the serum B2MG, CRP, ferritin, and LDH concentrations as a marker of disease activity [11].…”

Diagnostic challenges in systemic amyloidosis: a case report with clinical and laboratorial pitfalls

“…20,21 Despite being criticized in searching multiple myeloma lesions, as used in our case, 99m Tc-MIBI imaging normally shows relatively high uptake in normal metabolically active tissues, such as myocardium and has no utility in cardiac amyloid detection. [22][23][24][25][26] Tracing sympathetic innervation, 123 I-MIBGF seems to be useful for early diagnosis in cardiac amyloidosis, specifically in ATTRv. 20,21 99m Tc-Aprotinin and 123 I-SAP are potential amyloid tracers, but do not make a distinction between the different amyloid subtypes.…”