Skip to main content

Advertisement

SpringerLink
Log in

Hybrid simultaneous whole-body 2-[18F]FDG-PET/MRI imaging in newly diagnosed multiple myeloma: first diagnostic performance and clinical added value results

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Mixing diagnostic and prognostic data provided by whole-body MRI (WB-MRI) and 2-18F-fluorodeoxyglucose (2-[18F]FDG) positron emission tomography (2-[18F]FDG-PET) from a single simultaneous imaging technique for newly diagnosed multiple myeloma (NDMM) initial workup seems attractive. However, to date, the published data are scarce and this possibility has not been fully explored. In this prospective study, we aimed to explore the diagnostic performance and added clinical value of WB-2-[18F]FDG-PET/MRI imaging in NDMM.

Methods

All patients with confirmed NDMM at the Nantes University Hospital were prospectively enrolled in this study and underwent WB-2-[18F]FDG-PET/MRI imaging on a 3-T Biograph mMR before receiving treatment. Before imaging, they were considered either as symptomatic or as smoldering MM (SMM). Diagnostic performance of global WB-2-[18F]FDG-PET/MRI imaging, as well as PET and MRI separately for FL and diffuse BMI detection, was assessed and compared in each group. PET-based (maximal standardized uptake value, SUVmax) and MRI-based (mean apparent diffusion coefficient value, ADCmean) quantitative features were collected for FL/para-medullary disease (PMD)/bone marrow and were compared.

Results

A total of 52 patients were included in this study. PET and MRI were equally effective at detecting patients with FL (69% vs. 75%) and with diffuse BMI (62% for both) in the symptomatic MM group. WB-2-[18F]FDG-PET/MRI imaging detected FL in 22% of patients with SMM (with a higher diagnostic performance for MRI), resulting in a significant impact on clinical management in this population. SUVmax and ADCmean quantitative features were weakly or not correlated.

Conclusions

WB-2-[18F]FDG-PET/MRI could represent the next-generation imaging modality for MM.

Key Points

• Whole-body 2-[18F]FDG-PET/MRI imaging detected at least one focal bone lesion in 75% of patients with symptomatic multiple myeloma, and PET and MRI were equally effective at identifying patients with a focal bone lesion.

• Whole-body 2-[18F]FDG-PET/MRI imaging detected a focal bone lesion in 22% of patients with smoldering multiple myeloma (with a higher diagnostic performance for MRI).

• MRI had a significant impact on clinical management of smoldering multiple myeloma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

2-[18F]FDG:

2-18F-fluorodeoxyglucose

ADC:

Apparent diffusion coefficient

BMI:

Bone marrow involvement

CT:

Computed tomography

DCE:

Dynamic contrast enhanced

DWI:

Diffusion-weighted imaging

EMD:

Extra-medullary disease

FL:

Focal bone lesion

IMWG:

International Myeloma Working Group

MDE:

Myeloma defining event

MM:

Multiple myeloma

MRAC:

Magnetic resonance attenuation correction

NDMM:

Newly diagnosed multiple myeloma

PET:

Positron emission tomography

PMD:

Para-medullary disease

ROC:

Receiver-operating characteristic

ROI:

Region of interest

SMM:

Smoldering multiple myeloma

SUVmax :

Maximal standardized uptake value

WB-2-[18F]FDG-PET/MRI:

Whole-body 2-18F-fluorodeoxyglucose-positron emission tomography coupled with magnetic resonance imaging

References

  1. Rajkumar SV, Dimopoulos MA, Palumbo A et al (2014) International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 15:e538–e548

    Article  PubMed  Google Scholar 

  2. Hillengass J, Usmani S, Rajkumar SV et al (2019) International Myeloma Working Group consensus recommendations on imaging in monoclonal plasma cell disorders. Lancet Oncol 20(6):e302–e312

    Article  PubMed  Google Scholar 

  3. Hillengass J, Fechtner K, Weber M-A et al (2010) Prognostic significance of focal lesions in whole-body magnetic resonance imaging in patients with asymptomatic multiple myeloma. J Clin Oncol 28(9):1606–10

    Article  PubMed  Google Scholar 

  4. Kastritis E, Moulopoulos LA, Terpos E, Koutoulidis V, Dimopoulos MA (2014) The prognostic importance of the presence of more than one focal lesion in spine MRI of patients with asymptomatic (smoldering) multiple myeloma. Leukemia 28(12):2402–2403

    Article  CAS  PubMed  Google Scholar 

  5. Zamagni E, Nanni C, Gay F et al (2016) 18F-FDG PET/CT focal, but not osteolytic, lesions predict the progression of smoldering myeloma to active disease. Leukemia 30(2):417–422

    Article  CAS  PubMed  Google Scholar 

  6. Moreau P, Attal M, Caillot D et al (2017) Prospective evaluation of magnetic resonance imaging and [18F] fluorodeoxyglucose positron emission tomography-computed tomography at diagnosis and before maintenance therapy in symptomatic patients with multiple myeloma included in the IFM/DFCI 2009 trial: results of the IMAJEM study. J Clin Oncol 35(25):2911–2918

  7. Zamagni E, Patriarca F, Nanni C et al (2011) Prognostic relevance of 18-F FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation. Blood 118(23):5989–5995

    Article  CAS  PubMed  Google Scholar 

  8. Bartel TB, Haessler J, Brown TLY et al (2009) F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myeloma. Blood 114(10):2068–2076

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Abe Y, Ikeda S, Kitadate A et al (2019) Low hexokinase-2 expression-associated false-negative (18) F-FDG PET/CT as a potential prognostic predictor in patients with multiple myeloma. Eur J Nucl Med Mol Imaging 46(6):1345–1350

    Article  CAS  PubMed  Google Scholar 

  10. Jamet B, Morvan L, Nanni C et al (2021) Random survival forest to predict transplant-eligible newly diagnosed multiple myeloma outcome including FDG-PET radiomics: a combined analysis of two independent prospective European trials. Eur J Nucl Med Mol Imaging 48(4):1005–1015

    Article  CAS  PubMed  Google Scholar 

  11. Benaniba L, Tessoulin B, Trudel S et al (2019) The MYRACLE protocol study: a multicentric observational prospective cohort study of patients with multiple myeloma. BMC Cancer 19(1):855

    Article  PubMed  PubMed Central  Google Scholar 

  12. Messiou C, Hillengass J, Delorme S et al (2019) Guidelines for acquisition, interpretation, and reporting of whole-body MRI in myeloma: myeloma response assessment and diagnosis system (MY-RADS). Radiology 291(1):5–13

    Article  PubMed  Google Scholar 

  13. Dutoit J, Vanderkerken M, Verstraete KL (2013) Value of whole body MRI and dynamic contrast enhanced MRI in the diagnosis, follow-up and evaluation of disease activity and extent in multiple myeloma. Eur J Radiol 82(9):1444–1452

    Article  PubMed  Google Scholar 

  14. Nanni C, Zamagni E, Versari A et al (2016) Image interpretation criteria for FDG PET/CT in multiple myeloma: a new proposal from an Italian expert panel. IMPeTUs (Italian Myeloma criteria for PET USe). Eur J Nucl Med Mol Imaging 43(3):414–421

    Article  CAS  PubMed  Google Scholar 

  15. Messiou C, Collins DJ, Morgan VA, Desouza NM (2011) Optimising diffusion weighted MRI for imaging metastatic and myeloma bone disease and assessing reproducibility. Eur Radiol 21(8):1713–1718

    Article  CAS  PubMed  Google Scholar 

  16. Kyle RA, Gertz MA, Witzig TE et al (2003) Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 78:21–33

    Article  PubMed  Google Scholar 

  17. Westerland O, Amlani A, Kelly-Morland C et al (2021) Comparison of the diagnostic performance and impact on management of 18F-FDG PET/CT and whole-body MRI in multiple myeloma. Eur J Nucl Med Mol Imaging 48(8):2558–2565

    Article  PubMed  PubMed Central  Google Scholar 

  18. Burns R, Mulé S, Blanc-Durand P et al (2021) Optimization of whole-body 2-[18F]FDG-PET/MRI imaging protocol for the initial staging of patients with myeloma. Eur Radiol. 32(5):3085–3096

  19. Rasche L, Angtuaco E, McDonald JE et al (2017) Low expression of hexokinase-2 is associated with false-negative FDG-positron emission tomography in multiple myeloma. Blood 130(1):304

    Article  Google Scholar 

  20. Aljama MA, Sidiqi MH, Buadi FK et al (2018) Utility and prognostic value of 18F-FDG positron emission tomography-computed tomography scans in patients with newly diagnosed multiple myeloma. Am J Hematol 93(12):1518–1523

    Article  CAS  PubMed  Google Scholar 

  21. Jung S-H, Kwon SY, Min J-J et al (2019) 18F-FDG PET/CT is useful for determining survival outcomes of patients with multiple myeloma classified as stage II and III with the revised international staging system. Eur J Nucl Med Mol Imaging 46(1):107–115

    Article  PubMed  Google Scholar 

  22. Michaud-Robert AV, Zamagni E, Carlier T et al (2020) Glucose metabolism quantified by SUVmax on baseline FDG-PET/CT predicts survival in newly diagnosed multiple myeloma patients: combined harmonized analysis of two prospective phase III trials. Cancers (Basel) 12(9):2532

    Article  CAS  PubMed  Google Scholar 

  23. Cavo M, Terpos E, Nanni C et al (2017) International Myeloma Working Group. Review Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol 18:e206-2017

    Article  PubMed  Google Scholar 

  24. Moulopoulos LA, Dimopoulos MA, Christoulas D et al (2010) Diffuse MRI marrow pattern correlates with increased angiogenesis, advanced disease features and poor prognosis in newly diagnosed myeloma treated with novel agents. Leukemia 24:1206–1212

    Article  CAS  PubMed  Google Scholar 

  25. Paschali A, Panagiotidis E, Triantafyllou T et al (2021) A proposed index of diffuse bone marrow [18F]-FDG uptake and PET skeletal patterns correlate with myeloma prognostic markers, plasma cell morphology, and response to therapy. Eur J Nucl Med Mol Imaging 48(5):1487–1497

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This work has been supported in part by grants from the French National Agency for Research called “Investissements d’Avenir” IRON Labex n°ANR-11-LABX-0018–01 and INCa-DGOS-Inserm_12558 (SIRIC ILIAD).

Author information

Authors and Affiliations

  1. Nuclear Medicine Department, University Hospital, 1 Place Ricordeau, 44093, Nantes, France

    Bastien Jamet, Thomas Carlier, Clément Bailly, Caroline Bodet-Milin & Francoise Kraeber-Bodere

  2. Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France

    Thomas Carlier, Clément Bailly, Caroline Bodet-Milin, Cyrille Touzeau, Philippe Moreau & Francoise Kraeber-Bodere

  3. Haematology Department, University Hospital, Nantes, France

    Cyrille Touzeau & Philippe Moreau

  4. Siemens, France

    Aurélien Monnet

  5. Radiology Department, University Hospital, Nantes, France

    Eric Frampas

Authors
  1. Bastien Jamet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas Carlier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Clément Bailly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Caroline Bodet-Milin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aurélien Monnet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric Frampas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cyrille Touzeau
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Philippe Moreau
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Francoise Kraeber-Bodere
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bastien Jamet.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Francoise Kraeber-Bodere (FKB), head of Nantes University Hospital’s department of nuclear medicine.

Conflict of interest

The authors declare no competing interests.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Cohort overlap

Some study subjects or cohorts have previously been reported in Benaniba L, Tessoulin B, Trudel S, et al The MYRACLE protocol study: a multicentric observational prospective cohort study of patients with multiple myeloma. BMC Cancer. 2019;19(1):855.

Methodology

• prospective

• diagnostic study

• performed at one institution

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 107 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jamet, B., Carlier, T., Bailly, C. et al. Hybrid simultaneous whole-body 2-[18F]FDG-PET/MRI imaging in newly diagnosed multiple myeloma: first diagnostic performance and clinical added value results. Eur Radiol 33, 6438–6447 (2023). https://doi.org/10.1007/s00330-023-09593-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-023-09593-1

Keywords

Search

Navigation