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Assessment of atherosclerosis in multiple myeloma and smoldering myeloma patients using 18F- sodium fluoride PET/CT

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

To compare the NaF uptake in the thoracic aorta and whole heart, as an early indicator of atherosclerosis, in multiple myeloma (MM) and smoldering multiple myeloma (SMM) patients with a healthy control (HC) group.

Methods

Forty-four untreated myeloma patients (35 MM and nine SMM) and twenty-six age and gender-matched HC subjects were collected. Each individual’s NaF uptake in three parts of the aorta (AA: ascending aorta, AR: aortic arch, DA: descending aorta) and the whole heart was segmented. Average global standardized uptake value means were derived by sum of the product of each slice area divided by the sum of those slice areas. Results were reported as target to background ratio (TBR).

Results

There was a significant difference between the NaF uptake in the thoracic aorta of myeloma and HC groups [AA (myeloma = 1.82 ± 0.21, HC = 1.24 ± 0.02), AR (myeloma = 1.71 ± 0.19, HC = 1.28 ± 0.03) and DA (myeloma = 1.96 ± 0.28, HC = 1.38 ± 0.03); P-values < 0.001]. The difference in the whole heart NaF uptake between two groups was also significant (P < 0.001).

Conclusions

We observed a higher uptake of NaF in the thoracic aorta and whole heart of myeloma patients in comparison to the matched control group.

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Abbreviations

AA:

Ascending aorta

AR:

Aortic arch

DA:

Descending aorta

BA:

Background activity

CVD:

Cardiovascular disease

NaF:

18F-sodium fluoride

CT:

Computed tomography

MRI:

Magnetic resonance imaging

CVR:

Cardiovascular risk factor

PET:

Positron emission tomography

SUV:

Standardized uptake value

TBR:

Target to background ratio

ROI:

Regions of interest

MM:

Multiple myeloma

SMM:

Smoldering multiple myeloma

TAC:

Thoracic aorta calcification

HC:

Healthy control

MGUS:

Monoclonal gammopathy of undetermined significance

LDCT:

Low-dose CT

mCS:

Microscopic calcium score

rmCS:

Relative microscopic calcium score

CS:

Ca score

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Disclosure

All authors declare that they have no conflict of interest.

Ethical Approval

The protocol was approved by the Danish Ethics Committee (S-20120209), the Danish Data Protection Agency (2008-58-0035) and registered at clinicaltrials.gov (NCT02187731 and NCT01724749).

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Author information

Author notes

  1. Leila S. Arani and Mahdi Zirakchian Zadeh contributed equally to this work

Authors and Affiliations

  1. Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA

    Leila S. Arani MD, Mahdi Zirakchian Zadeh MD, MHM, Babak Saboury MD, MPH, Mona-Elisabeth Revheim MD, PhD, MHA, Austin J. Borja BA, Davoud Samadi Samarin MD, Siavash Mehdizadeh Seraj MD, Eman Kalbush MD, Cyrus Ayubcha MSc, Tom J. Werner MSc & Abass Alavi MD, MD (Hon), PHD (Hon), DSc (Hon)

  2. Dental School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Mahdi Zirakchian Zadeh MD, MHM

  3. Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, USA

    Babak Saboury MD, MPH & Michael A. Morris MD, MS

  4. Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway

    Mona-Elisabeth Revheim MD, PhD, MHA

  5. Faculty of Medicine, University of Oslo, Oslo, Norway

    Mona-Elisabeth Revheim MD, PhD, MHA

  6. Department of Hematology, Odense University Hospital, Odense, Denmark

    Brian Øestergaard MD & Niels Abildgaard MD, DMSc

  7. Hematology Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Niels Abildgaard MD, DMSc

  8. Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

    Poul F. Høilund-Carlsen MD, DMSc

  9. Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Poul F. Høilund-Carlsen MD, DMSc

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  1. Leila S. Arani MD
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Corresponding author

Correspondence to Abass Alavi MD, MD (Hon), PHD (Hon), DSc (Hon).

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Funding

The project was funded by the Region of Southern Denmark, University of Southern Denmark, Odense University Hospital, Harboe Foundation, The A.P.Møller Foundation (Fonden til lægevidenskabens fremme), Aase & Ejnar Danielsen Foundation, The Family Hede Nielsen Foundation.

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Arani, L.S., Zirakchian Zadeh, M., Saboury, B. et al. Assessment of atherosclerosis in multiple myeloma and smoldering myeloma patients using 18F- sodium fluoride PET/CT. J. Nucl. Cardiol. 28, 3044–3054 (2021). https://doi.org/10.1007/s12350-020-02446-0

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