Whole-Body MRI Versus PET in Assessment of Multiple Myeloma Disease Activity

Shortt, Conor P.; Gleeson, Tadhg G.; Breen, Karen; McHugh, John; O’Connell, Martin; O’Gorman, Peter; Eustace, Stephen

doi:10.2214/ajr.08.1633

Cited by 170 publications

(87 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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%

“…If present, EMD was described by location, size, number, and SUV (SUV-EMD). Shortt, 2009 Disease activity was assessed on attenuation-corrected PET images with a maximal SUV of >2.5 denoting 18 FDG-avid lesions. Durie, 2002 All areas of focal uptake were interpreted as positive for myeloma unless they were on sites of known accumulation, including the kidney and bladder, gastrointestinal tract, and certain skeletal areas showing symmetric joint uptake.…”

Section: Fdg Pet or Pet-ct In Response Monitoringmentioning

confidence: 99%

See 1 more Smart Citation

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

Lammeren-Venema

Regelink

Riphagen

et al. 2011

Cancer

120

View full text Add to dashboard Cite

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.

show abstract

Section: Literature Searchmentioning

confidence: 99%

Section: Fdg Pet or Pet-ct In Response Monitoringmentioning

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

120

View full text Add to dashboard Cite

show abstract

“…8,[12][13][14] MRI has a sensitivity of 68%, a specificity of 83%, a positive predictive value of 88% and is superior to PET-CT. 15 Furthermore, the development of fast sequences allows MRI to be performed as a whole-body protocol (wb-MRI), replacing the use of spinal MRI alone. 16 Focal lesions and diffuse tumor cell infiltration detected by wb-MRI have been demonstrated to be of prognostic significance for predicting progression free and overall survival in monoclonal plasma cell diseases.…”

mentioning

confidence: 99%

Appearance of monoclonal plasma cell diseases in whole‐body magnetic resonance imaging and correlation with parameters of disease activity

Kloth

Hillengaß

Listl

et al. 2014

Intl Journal of Cancer

View full text Add to dashboard Cite

The aim of our study was to assess in which way different infiltration patterns of monoclonal plasma cell diseases in wholebody (wb) magnetic resonance imaging (MRI) are associated with clinical stages, plasma cell content in bone marrow samples and established serum markers of disease activity. Institutional review board approval was obtained. We performed wb-MRI in 547 consecutive, unselected and untreated patients with monoclonal gammopathy of undetermined significance (MGUS, n 5 138), smoldering myeloma (SMM, n 5 157) and multiple myeloma (MM, n 5 252) on two 1.5 T MRI-scanners with body array coils. The studies were evaluated in consensus by two experienced radiologists blinded to the diagnosis. We observed focal lesions in 23.9% (MGUS), 34.4% (SMM) and 81.3% (MM), respectively. A diffuse infiltration pattern was detected in 38.4%, 45.9% and 71%, respectively. The differences between all infiltration patterns were significant (p < 0.0001). The presence of focal lesions and the presence of a diffuse bone marrow infiltration was associated with an increased plasma cell percentage in bone marrow samples (median 22% vs. 14%, 26% vs. 10%, both p < 0.0001) and monoclonal protein concentration (median 18 g/dl vs. 13 g/dl, p 5 0.003, 20 g/dl vs. 11 g/dl, p < 0.0001). Further categorization of the diffuse infiltration patterns in wb-MRI into "salt-and-pepper," moderate and severe identified significant associations with M-protein (median g/dl for S1P/moderate/severe 23/18/25, p 5 0.04), plasma cell percentage in the bone marrow (median 25%/24%/40%, p 5 0.02), and age (median years 67/60/57, p < 0.0001). Bone marrow infiltration in wb-MRI is significantly different between the various stages of plasma cell disease and correlates well with established markers of disease activity.Monoclonal plasma cell diseases like multiple myeloma (MM), monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma (SMM) are a group of hematologic premalignant or malignant disorders associated with monoclonal proliferation of plasma cells mainly in the bone marrow.1,2 Although MGUS, being the most common disorder of plasma cells and occurring in 2% of persons older than 50 years, has an overall annual risk of progression of only 1% per year, the rate of transformation of SMM to MM or systemic amyloidosis (AL) has been shown to be 10% per year in the first 5 years. [3][4][5][6] In the aforementioned monoclonal plasma cell disorders, the bone marrow involvement may be present in different patterns: diffuse bone marrow infiltration and focal lesions. Diffuse bone marrow infiltration is characterized by malignant plasma cells, mixed up with normal bone marrow cells, still preserving the cancellous bone structure. Focal lesions are circumscribed solid foci of plasma cells with the potential of destruction of the cancellous and cortical bone.To image these changes, plain radiographs (PRs), computed tomography (CT) and magnetic resonance imaging (MRI) are currently in routine use. 7 Although PR has been an integral part of...

show abstract

“…In some earlier studies, qualitative reading of FDG PET positivity was used in MM; in these, the examination was considered positive for MM if FDG uptake was greater than the background level [5,6] . However, in most papers, semiquantitative parameters -mostly SUVmax (maximum standardized uptake value) with a cutoff value of 2.5 -were used for the characterization of pathological FDG uptake in MM patients [7][8][9][10] . Based on a recent paper, the presence of extramedullary disease (EMD), the initial SUVmax and the number of focal lesions (FL), all of which as evaluated by FDG PET/CT imaging, are deemed to be strong prognostic parameters at staging.…”

Section: Introductionmentioning

confidence: 99%

“…In some earlier studies, the FDG PET/CT was considered positive for MM if FDG uptake was greater than the background level [5,6] . However, in most papers, pathological FDG uptake is characterized by SUVmax, and SUVmax >2.5 or SUVmax ≥2.5 is considered to be abnormal and indicate a site of active disease [7][8][9][10] . Based on some recent studies, SUVmax >4.2 seems to be the best cutoff level to determine the positivity of FDG PET/CT [11,19] .…”

mentioning

confidence: 99%

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

Kajáry

Molnár

2017

Adv Mod Oncol Res

View full text Add to dashboard Cite

To evaluate the role of FDG PET/CT before and after the treatment of multiple myeloma (MM) in our clinical practice, data from 32 patients (before therapy: 10 patients; after therapy: 22 patients) and from 46 examinations (before therapy: 10; after: 36) with a median time of follow-up of 24 months (before the therapy) and 26 months (after the therapy) were evaluated. FDG PET/CT positivity was characterized by SUVmax >2.5, SUVmax >4.2, focal lesions (FLs) >3, and presence of extramedullary disease (EMD). The median progression-free survival (PFS) and the median overall survival (OS) for FDG PET/CT positive patients were shorter than for negative patients, according to all parameters. Before the therapy, significant correlation was found only between PFS and the number of FLs (p = 0.033). After the treatment, significant correlation was found between PFS and SUVmax (cut-off value 2.5: p < 0.001; cut off value 4.2: p < 0.001), between PFS and the number of FLs (p = 0.009), and between PFS and the presence of EMD (p < 0.001). Significant correlation was found between OS and SUVmax (cut-off value = 2.5, p < 0.001 and 4.2, p = 0.009), between OS and the number of FLs (p = 0.007), and between OS and the presence of EMD (p = 0.022). Our results confirmed the reliability and good prognostic value of FDG PET/CT in MM.

show abstract

Whole-Body MRI Versus PET in Assessment of Multiple Myeloma Disease Activity

Cited by 170 publications

References 28 publications

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

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

Appearance of monoclonal plasma cell diseases in whole‐body magnetic resonance imaging and correlation with parameters of disease activity

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

Contact Info

Product

Resources

About

Whole-Body MRI Versus PET in Assessment of Multiple Myeloma Disease Activity

Cited by 170 publications

References 28 publications

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

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

Appearance of monoclonal plasma cell diseases in whole‐body magnetic resonance imaging and correlation with parameters of disease activity

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

Contact Info

Product

Resources

About

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

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