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Interpretation criteria for FDG PET/CT in multiple myeloma (IMPeTUs): final results. IMPeTUs (Italian myeloma criteria for PET USe)

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

ᅟ

FDG PET/CT (18F-fluoro-deoxy-glucose positron emission tomography/computed tomography) is a useful tool to image multiple myeloma (MM). However, simple and reproducible reporting criteria are still lacking and there is the need for harmonization. Recently, a group of Italian nuclear medicine experts defined new visual descriptive criteria (Italian Myeloma criteria for Pet Use: IMPeTUs) to standardize FDG PET/CT evaluation in MM patients. The aim of this study was to assess IMPeTUs reproducibility on a large prospective cohort of MM patients.

Materials and methods

Patients affected by symptomatic MM who had performed an FDG PET/CT at baseline (PET0), after induction (PET-AI), and the end of treatment (PET-EoT) were prospectively enrolled in a multicenter trial (EMN02)(NCT01910987; MMY3033). After anonymization, PET images were uploaded in the web platform WIDEN® and hence distributed to five expert nuclear medicine reviewers for a blinded independent central review according to the IMPeTUs criteria. Consensus among reviewers was measured by the percentage of agreement and the Krippendorff’s alpha. Furthermore, on a patient-based analysis, the concordance among all the reviewers in terms of positivity or negativity of the FDG PET/CT scan was tested for different thresholds of positivity (Deauville score (DS 2, 3, 4, 5) for the main parameters (bone marrow, focal score, extra-medullary disease).

Results

Eighty-six patients (211 FDG PET/CT scans) were included in this analysis. Median patient age was 58 years (range, 35–66 years), 45% were male, 15% of them were in stage ISS (International Staging System) III, and 42% had high-risk cytogenetics. The percentage agreement was superior to 75% for all the time points, reaching 100% of agreement in assessing the presence skull lesions after therapy. Comparable results were obtained when the agreement analysis was performed using the Krippendorff’s alpha coefficient, either in every single time point of scanning (PET0, PET-AI or PET-EoT) or overall for all the scans together. DS proved highly reproducible with the highest reproducibility for score 4.

Conclusions

IMPeTUs criteria proved highly reproducible and could therefore be considered as a base for harmonizing PET interpretation in multiple myeloma. A prospective clinical validation of IMPeTUs criteria is underway.

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Authors and Affiliations

  1. Medicina Nucleare Metropolitana, Bld 30, AOU Policlinico S. Orsola-Malpighi, Via Massarenti, 9, 40138, Bologna, Italy

    Cristina Nanni, Pietro Ghedini & Stefano Fanti

  2. Nuclear Medicine, IRCSS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia, Italy

    Annibale Versari

  3. Medical Physics Division, Santa Croce e Carle Hospital, Cuneo, Italy

    Stephane Chauvie & Elisa Bertone

  4. Nuclear Medicine, Santa Croce e Carle Hospital, Cuneo, Italy

    Andrea Bianchi

  5. Nuclear Medicine, AOU S. Maria della Misericordia, Udine, Italy

    Marco Rensi

  6. Nuclear Medicine, AO Città della Salute e della Scienza, Torino, Italy

    Marilena Bellò

  7. Research, Innovation and Statistics Department. A. Lacassagne Cancer Center, Nice, France

    Andrea Gallamini

  8. Hematologic Clinic, Udine University, Udine, Italy

    Francesca Patriarca

  9. Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy

    Francesca Gay

  10. Hematology Unit, IRCCS, Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia, Italy

    Barbara Gamberi

  11. Hematology, AOU Policlinico S. Orsola-Malpighi, Bologna, Italy

    Michele Cavo & Elena Zamagni

Authors
  1. Cristina Nanni
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  2. Annibale Versari
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  3. Stephane Chauvie
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  4. Elisa Bertone
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  5. Andrea Bianchi
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  6. Marco Rensi
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  7. Marilena Bellò
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  8. Andrea Gallamini
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  9. Francesca Patriarca
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  10. Francesca Gay
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  11. Barbara Gamberi
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  12. Pietro Ghedini
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  13. Michele Cavo
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  14. Stefano Fanti
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  15. Elena Zamagni
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Corresponding author

Correspondence to Cristina Nanni.

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The authors declare that they have no conflicts of interest.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Nanni, C., Versari, A., Chauvie, S. et al. Interpretation criteria for FDG PET/CT in multiple myeloma (IMPeTUs): final results. IMPeTUs (Italian myeloma criteria for PET USe). Eur J Nucl Med Mol Imaging 45, 712–719 (2018). https://doi.org/10.1007/s00259-017-3909-8

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  • DOI: https://doi.org/10.1007/s00259-017-3909-8

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