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Optimization of whole-body 2-[18F]FDG-PET/MRI imaging protocol for the initial staging of patients with myeloma

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Abstract

Objective

To determine the optimal 2-[18F]FDG-PET/MRI imaging protocol for the initial staging of patients with suspected or confirmed multiple myeloma.

Methods

Radiologists and nuclear medicine specialists reviewed all PET/MRI exams of 104 patients with a monoclonal gammopathy (MG). The presence of focal and diffuse bone marrow involvement (BMI) was assessed using 4 different image datasets: WB-MRI, PET, WB-PET/MRI, and WB-DCE-PET/MRI. A reference standard was established by a panel review of all baseline and follow-up imaging, and biological and pathological information. The diagnostic performance for each image dataset to detect BMI was evaluated and compared (Fisher’s exact test).

Results

Sensitivity, specificity, and accuracy for focal BMI of WB-MRI was 87%, 97%, and 92%; of PET was 78%, 97%, and 95%; of WB-PET/MRI was 93%, 97%, and 95%; and of WB-DCE-PET/MRI was 93%, 97%, and 95%, respectively. WB-PET/MRI and WB-DCE-PET/MRI were statistically superior to PET (p = 0.036) without decreasing specificity. The sensitivity, specificity, and accuracy of WB-MRI for diffuse BMI detection was 91%, 80%, and 85%; of 3DT1-PET was 53%, 89%, and 74%; of WB-PET/MRI was 98%, 66%, and 79%; and of WB-DCE-PET/MRI was 98%, 59%, and 75%, respectively. PET lacked sensitivity compared to all other dataset studies (p < 0.0001). WB-MRI had the best accuracy without reaching statistical significance when compared to the other datasets.

Conclusion

The WB-PET/MRI dataset including T1 and T2 Dixon, WB-DWI, and PET images provides optimal diagnostic performance to detect both focal lesions and diffuse BMI, with limited added value of WB-DCE for baseline staging of patients with MG.

Key Points

• The combination of morphological and functional MRI sequences and metabolic (2-[18F]FDG-PET) images increases the diagnostic performance of PET/MRI to detect focal bone lesions.

• The adjunction of dynamic contrast-enhanced sequences did not improve diagnostic performance.

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Abbreviations

2-[18F]FDG:

2-[18F]Fluoro-2-deoxy-D-glucose

3DT1-PET:

Hybrid fusion between 3D-T1-magnetic resonance attenuation correction (MRAC)-Dixon with 2-[18F]fluoro-2-deoxy-D-glucose

ADC:

Apparent diffusion coefficient

AUC:

Area under the curve

BMEmax :

Maximal bone marrow enhancement

BMI:

Bone marrow involvement

CI:

Confidence interval

CT:

Computed tomography

DCE:

Dynamic contrast enhanced

DWI:

Diffusion-weighted imaging

IMWG:

International Myeloma Working Group

ISS:

International Staging System

MG:

Monoclonal gammopathy

MRAC:

Magnetic resonance attenuation correction

MRI:

Magnetic resonance imaging

PET:

Positron emission tomography

ROC:

Receiver operating characteristics

T1T2Dixon:

Whole-body T1-weighted images combined with whole-body T2Dixon water–weighted images

WB:

Whole body

WB-DCE-PET/MRI:

The combination of WB-MRI, 3DT1-PET, and WB-DCE images

WB-PET/MRI:

The combination of WB-MRI and 3DT1-PET

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France

    Robert Burns, Sébastien Mulé, Paul Blanc-Durand, Mojdeh Tofighi, Pierre Zerbib, Laurence Baranes, Emmanuel Itti & Alain Luciani

  2. Department of Medical Imaging, 51 Av. du Maréchal de Lattre de Tassigny, Henri Mondor Hospital, AP-HP, 94010, Créteil, France

    Robert Burns, Sébastien Mulé, Pierre Zerbib, Laurence Baranes & Alain Luciani

  3. Université Paris-Est Créteil, 94010, Créteil, France

    Sébastien Mulé, Paul Blanc-Durand, Corinne Haioun, Emmanuel Itti & Alain Luciani

  4. Department of Nuclear Medicine, Henri Mondor Hospital, AP-HP, 94010, Créteil, France

    Paul Blanc-Durand, Mojdeh Tofighi & Emmanuel Itti

  5. Hematology Department, University Hospital, Creteil, France

    Karim Belhadj, Fabien Le Bras & Corinne Haioun

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  1. Robert Burns
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Correspondence to Robert Burns.

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Guarantor

The scientific guarantor of this publication is Robert Burns.

Conflict of Interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and Biometry

Two of the authors (Robert Burns and Sébastien Mulé) have significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained. (CERIM, approval number CRM-1912–048).

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Burns, R., Mulé, S., Blanc-Durand, P. et al. Optimization of whole-body 2-[18F]FDG-PET/MRI imaging protocol for the initial staging of patients with myeloma. Eur Radiol 32, 3085–3096 (2022). https://doi.org/10.1007/s00330-021-08388-6

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