Abstract
Purpose
Hybrid positron emission tomography/computed tomography (PET/CT) has now become available, as well as whole-body, low-dose multidetector row computed tomography (MDCT) or magnetic resonance imaging (MRI). The radioactive glucose analogue 18F-fluorodeoxyglucose (FDG) is the most widely used tracer but has a relatively low sensitivity in detecting multiple myeloma (MM). We compared FDG with a more recent metabolic tracer, 18F-fluorocholine (FCH), for the detection of MM lesions at time of disease relapse or progression.
Methods
We analyzed the results of FDG and FCH imaging in 21 MM patients undergoing PET/CT for suspected relapsing or progressive MM. For each patient and each tracer, an on-site reader and a masked reader independently determined the number of intraosseous and extraosseous foci of tracer and the intensity of uptake as measured by their SUVmax and the corresponding target/non-target ratio (T/NT).
Results
In the skeleton of 21 patients, no foci were found for two cases, uncountable foci were observed in four patients, including some mismatched FCH/FDG foci. In the 15 patients with countable bone foci, the on-site reader detected 72 FDG foci vs. 127 FCH foci (+76 %), whereas the masked reader detected 69 FDG foci vs. 121 FCH foci (+75 %), both differences being significant. Interobserver agreement on the total number of bone foci was very high, with a kappa coefficient of 0.81 for FDG and 0.89 for FCH. Measurement of uptake in the matched foci that took up both tracers revealed a significantly higher median SUVmax and T/NT for FCH vs. FDG. Almost all unmatched foci were FCH-positive FDG-negative (57/59 = 97 % on-site and 56/60 = 93 % on masked reading); they were more frequently observed than matched foci in the head and neck region.
Conclusions
These findings suggest that PET/CT performed for suspected relapsing or progressive MM would reveal more lesions when using FCH rather than FDG.
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References
Dimopoulos M, Terpos E, Comenzo RL, et al. International Myeloma Working Group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple Myeloma. Leukemia. 2009;23:1545–56.
Greipp PR, San Miguel J, Durie BG, et al. International staging system for multiple myeloma. J Clin Oncol. 2005;23:3412–20.
Derlin T, Weber C, Habermann CR, et al. (18)F-FDG PET/CT for detection and localization of residual or recurrent disease in patients with multiple myeloma after stem cell transplantation. Eur J Nucl Med Mol Imaging. 2012;39:493–500.
Zamagni E, Patriarca F, Nanni C, et al. Prognostic relevance of 18-F FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation. Blood. 2011;118:5989–95. Erratum in: Blood. 2012;120:2349.
Mai EK, Hielscher T, Kloth JK, et al. A magnetic resonance imaging-based prognostic scoring system to predict outcome in transplant-eligible patients with multiple myeloma. Haematologica. 2015;100:818–25.
Ailawadhi S, Abdelhalim AN, Derby L, et al. Extent of disease burden determined with magnetic resonance imaging of the bone marrow is predictive of survival outcome in patients with multiple myeloma. Cancer. 2010;116:84–92.
Elliott BM, Peti S, Osman K, et al. Combining FDG-PET/CT with laboratory data yields superior results for prediction of relapse in multiple myeloma. Eur J Haematol. 2011;86:289–98.
Durie BG. The role of anatomic and functional staging in myeloma: description of Durie/Salmon PLUS staging system. Eur J Cancer. 2006;42:1539–43.
Mihailovic J, Goldsmith SJ. Multiple Myeloma: 18F-FDG-PET/CT and diagnostic imaging. Semin Nucl Med. 2015;45:16–31.
Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15:538–48.
Rajkumar SV, Harousseau JL, Durie B, et al. Consensus recommendations for the uniform reporting of clinical trials: report of the International Myeloma Workshop Consensus Panel 1. Blood. 2011;117:4691–5.
Anderson KC, Alsina M, Bensinger W, et al. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: multiple myeloma. J Natl Compr Canc Netw. 2009;7:908–42.
Mesguich C, Fardanesh R, Tanenbaum L, Chari A, Jagannath S, Kostakoglu L. State of the art imaging of multiple myeloma: comparative review of FDG PET/CT imaging in various clinical settings. Eur J Radiol. 2014;83:2203–23.
Hillengass J, Ayyaz S, Kilk K, et al. Changes in magnetic resonance imaging before and after autologous stem cell transplantation correlate with response and survival in multiple myeloma. Haematologica. 2012;97:1757–60.
Weng WW, Dong MJ, Zhang J, Yang J, Xu Q, Zhu YJ, et al. A systematic review of MRI, Scintigraphy, FDG-PET and PET/CT for diagnosis of multiple myeloma related bone disease - Which is best? Asian Pac J Cancer Prev. 2014;15:9879–84.
Schirrmeister H, Bommer M, Buck AK, et al. Initial results in the assessment of multiple myeloma using 18F-FDG PET. Eur J Nucl Med Mol Imaging. 2002;29:361–6.
Bredella MA, Steinbach L, Caputo G, Segall G, Hawkins R. Value of FDG PET in the assessment of patients with multiple myeloma. AJR Am J Roentgenol. 2005;184:1199–204.
Durie B, Waxman A, D’Agnolo A, Williams CM. Whole-body (18)F-FDG PET identifies high-risk myeloma. J Nucl Med. 2002;43:1457–63.
Spinnato P, Bazzocchi A, Brioli A, et al. Contrast enhanced MRI and 18F-FDG PET-CT in the assessment of multiple myeloma: a comparison of results in different phases of the disease. Eur J Radiol. 2012;81:4013–8.
Shortt CP, Gleeson TG, Breen KA, et al. Whole-body MRI versus PET in assessment of multiple myeloma disease activity. AJR Am J Roentgenol. 2009;192:980–6.
Yasar Z, Acat M, Onaran H, Dincer HE, Cetinkaya E, Korkmaz AN. False-positive 18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) scans mimicking malignancies. Med Glas (Zenica). 2015;12:40–6.
Dankerl A, Liebisch P, Glatting G, et al. Multiple myeloma: molecular imaging with 11C-methionine PET/CT – initial experience. Radiology. 2007;242:498–508.
Nakamoto Y, Kurihara K, Nishizawa M, et al. Clinical value of 11C-methionine PET/CT in patients with plasma cell malignancy: comparison with 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging. 2013;40:708–15.
Ho CL, Chen S, Leung YL, et al. 11C-Acetate PET/CT for metabolic characterization of multiple myeloma: a comparative study with 18F-FDG PET/CT. J Nucl Med. 2014;55:749–52.
Lin C, Ho CL, Ng SH, et al. (11)C-acetate as a new biomarker for PET/CT in patients with multiple myeloma: initial staging and postinduction response assessment. Eur J Nucl Med Mol Imaging. 2014;41:41–9.
Nanni C, Zamagni E, Cavo M, et al. 11C-choline vs. 18F-FDG PET/CT in assessing bone involvement in patients with multiple myeloma. World J Surg Oncol. 2007;5:68.
Seo S, Hatano E, Higashi T, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography predicts tumor differentiation, P-glycoprotein expression, and outcome after resection in hepatocellular carcinoma. Clin Cancer Res. 2007;13:427–33.
Talbot JN, Gutman F, Fartoux L, et al. PET/CT in patients with hepatocellular carcinoma using [18F]fluorocholine: preliminary comparison with [18F]FDG PET/CT. Eur J Nucl Med Mol Imaging. 2006;33:1285–9.
DeGrado TR, Coleman RE, Wang S, et al. Synthesis and evaluation of 18F-labeled choline as an oncologic tracer for positron emission tomography: initial findings in prostate cancer. Cancer Res. 2001;61:110–7.
Talbot JN, Fartoux L, Balogova S, et al. Detection of hepatocellular carcinoma with PET/CT: a prospective comparison of 18F-Fluorocholine and 18F-FDG in patients with cirrhosis or chronic liver disease. J Nucl Med. 2010;51:1699–706.
Calabria F, Chiaravalloti A, Schillaci O. 18F-Choline PET/CT pitfalls in image interpretation. An update on 300 examined patients with prostate cancer. Clin Nucl Med. 2014;39:122–30.
Boellaard R, O’Doherty MJ, Weber WA, et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2010;37:181–200.
Bartel TB, Haessler J, Brown TL, et al. F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myeloma. Blood. 2009;114:2068–76.
Sasagawa T, Okita M, Murakami J, Kato T, Watanabe A. Abnormal serum lysophospholipids in multiple myeloma patients. Lipids. 1999;34:17–21.
Vij R, Fowler KJ, Shokeen M. New approaches to molecular imaging of multiple myeloma. J Nucl Med. 2016;57:1–4.
Xin C, Ruixue C, Fang L, Hongming Z. Lesions of multiple myeloma adjacent to the skull are better visualized on F-18 fluoroethyldimethyl-2-hydroxyethylammonium (FECH) PET images than on F-18 FDG PET images. Clin Nucl Med. 2011;36:912–4.
Machida H, Shinohara T, Hino H, et al. Immunoglobulin D-lambda type multiple myeloma presenting with FDG-PET/CT negative bone marrow involvement. Intern Med. 2011;50:1483–7.
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All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. The study was approved by the institutional review board (Ethics Committee of Ile de France V; n°15063).
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Cassou-Mounat, T., Balogova, S., Nataf, V. et al. 18F-fluorocholine versus 18F-fluorodeoxyglucose for PET/CT imaging in patients with suspected relapsing or progressive multiple myeloma: a pilot study. Eur J Nucl Med Mol Imaging 43, 1995–2004 (2016). https://doi.org/10.1007/s00259-016-3392-7
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DOI: https://doi.org/10.1007/s00259-016-3392-7