Diagnostic performance of 18 F‐FDG‐PET/CT compared to standard skeletal survey for detecting bone destruction in smouldering multiple myeloma: time to move forward

Abstract Purpose Comparative data on the impact of imaging on management is lacking for multiple myeloma. This study compared the diagnostic performance and impact on management of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and whole-body magnetic resonance imaging (WBMRI) in treatment-naive myeloma. Methods Forty-six patients undergoing 18F-FDG PET/CT and WBMRI were reviewed by a nuclear medicine physician and radiologist, respectively, for the presence of myeloma bone disease. Blinded clinical and imaging data were reviewed by two haematologists in consensus and management recorded following clinical data ± 18F-FDG PET/CT or WBMRI. Bone disease was defined using International Myeloma Working Group (IMWG) criteria and a clinical reference standard. Per-patient sensitivity for lesion detection was established. McNemar test compared management based on clinical assessment ± 18F-FDG PET/CT or WBMRI. Results Sensitivity for bone lesions was 69.6% (32/46) for 18F-FDG PET/CT (54.3% (25/46) for PET component alone) and 91.3% (42/46) for WBMRI. 27/46 (58.7%) of cases were concordant. In 19/46 patients (41.3%) WBMRI detected more focal bone lesions than 18F-FDG PET/CT. Based on clinical data alone, 32/46 (69.6%) patients would have been treated. Addition of 18F-FDG PET/CT to clinical data increased this to 40/46 (87.0%) patients (p = 0.02); and WBMRI to clinical data to 43/46 (93.5%) patients (p = 0.002). The difference in treatment decisions was not statistically significant between 18F-FDG PET/CT and WBMRI (p = 0.08). Conclusion Compared to 18F-FDG PET/CT, WBMRI had a higher per patient sensitivity for bone disease. However, treatment decisions were not statistically different and either modality would be appropriate in initial staging, depending on local availability and expertise.

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Bone marrow MRI versus 18F-FDG-PET/CT for detecting multiple myeloma lesions: diagnostic performance and clinical relevance

Clinical Lymphoma Myeloma & Leukemia ◽

10.1016/j.clml.2019.09.053 ◽

2019 ◽

Vol 19 (10) ◽

pp. e35-e36

Author(s):

Frédéric Lecouvet ◽

Dimitar Boyadzhiev ◽

Laurence Collette ◽

Maude Berckmans ◽

Nicolas Michoux ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Fdg Pet ◽

Clinical Relevance ◽

Diagnostic Performance ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Diagnostic performance of 18F-FDG PET/CT and whole-body MRI before and early after treatment of multiple myeloma: a prospective comparative study

Japanese Journal of Radiology ◽

10.1007/s11604-018-0738-z ◽

2018 ◽

Vol 36 (6) ◽

pp. 382-393 ◽

Cited By ~ 6

Author(s):

Mohammad Abd Alkhalik Basha ◽

Maged Abdel Gelil Hamed ◽

Rania Refaat ◽

Mohamad Zakarya AlAzzazy ◽

Manar A. Bessar ◽

...

Keyword(s):

Multiple Myeloma ◽

Comparative Study ◽

Fdg Pet ◽

Diagnostic Performance ◽

Whole Body ◽

Whole Body Mri ◽

Pet Ct ◽

Prospective Comparative Study ◽

18F Fdg ◽

Fdg Pet Ct

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A First Report on [18F]FPRGD2 PET/CT Imaging in Multiple Myeloma

Contrast Media & Molecular Imaging ◽

10.1155/2017/6162845 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7

Author(s):

Nadia Withofs ◽

François Cousin ◽

Bernard De Prijck ◽

Christophe Bonnet ◽

Roland Hustinx ◽

...

Keyword(s):

Multiple Myeloma ◽

Fdg Pet ◽

Low Dose ◽

Bone Lesion ◽

Bone Destruction ◽

Whole Body ◽

Newly Diagnosed ◽

Low Dose Ct ◽

Pet Ct ◽

Fdg Pet Ct

An observational study was set up to assess the feasibility of [F18]FPRGD2 PET/CT for imaging patients with multiple myeloma (MM) and to compare its detection rate with low dose CT alone and combined [F18]NaF/[F18]FDG PET/CT images. Four patients (2 newly diagnosed patients and 2 with relapsed MM) were included and underwent whole-body PET/CT after injection of [F18]FPRGD2. The obtained images were compared with results of low dose CT and already available results of a combined [F18]NaF/[F18]FDG PET/CT. In total, 81 focal lesions (FLs) were detected with PET/CT and an underlying bone destruction or fracture was seen in 72 (89%) or 8 (10%) FLs, respectively. Fewer FLs (54%) were detected by [F18]FPRGD2 PET/CT compared to low dose CT (98%) or [F18]NaF/[F18]FDG PET/CT (70%) and all FLs detected with [F18]FPRGD2 PET were associated with an underlying bone lesion. In one newly diagnosed patient, more [F18]FPRGD2 positive lesions were seen than [F18]NaF/[F18]FDG positive lesions. This study suggests that [F18]FPRGD2 PET/CT might be less useful for the detection of myeloma lesions in patients with advanced disease as all FLs with [F18]FPRGD2 uptake were already detected with CT alone.

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Diagnostic performance of skeletal survey versus 18F-FDG-PET/CT for detecting lytic lesions in smoldering multiple myeloma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.8532 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 8532-8532

Author(s):

Elizabeth M. Hill ◽

Alexander Dew ◽

Candis Morrison ◽

Peter L. Choyke ◽

Esther Mena ◽

...

Keyword(s):

Multiple Myeloma ◽

False Positive ◽

Fdg Pet ◽

Imaging Techniques ◽

Skeletal Survey ◽

Whole Body ◽

Smoldering Multiple Myeloma ◽

Pet Ct ◽

Fdg Pet Ct ◽

Rule Out

8532 Background: Per NCCN Guidelines for smoldering multiple myeloma (SMM), whole body radiography, i.e. skeletal survey (SS), should be used to rule out osteolytic bone lesions. If negative, more sensitive imaging techniques such as whole body 18F-FDG-PET/CT(PET/CT), MRI, or low dose CT should be used to differentiate between SMM and multiple myeloma (MM). The false-negative rate of SS is high (30-70%). The frequency of false-positive SS in SMM is less well known but important because of its common use in community practice. We examine the specificity of SS in patients with a presumed diagnosis of SMM and question if SS is still warranted prior to modern imaging techniques to confirm a diagnosis of SMM. Methods: Records of patients sequentially referred from the community and evaluated for a presumed diagnosis of SMM at the National Institutes of Health Myeloma Program between April 2010 to January 2020 were reviewed. Patients with a SS and PET/CT performed within 30 days were included. Positive findings on PET/CT were defined per the 2014 IMWG criteria as one or more sites of osteolytic bone destruction seen on CT. The sensitivity and specificity of SS were calculated using PET/CT as the reference test. Results: Charts from 144 patients with presumed SMM were reviewed. A total of 76 SMM patients had both a SS and PET/CT performed within 30 days of each other. Sixty-four patients (84.2%) showed concordant results. Twelve (15.8%) patients had discordant imaging results. SS was falsely negative in 3 (4.7% (95% CI: 1.2%-14.2%)) patients and falsely positive in 9 (69.2% (95% CI: 38.9%-89.6%)) patients. SS had a sensitivity of 57.1% (95% CI: 20.2%-88.2%) and a specificity of 86.9% (95% CI: 76.2-93.5). Conclusions: In patients presumed to have SMM, disease burden is low thus highly sensitive imaging modalities are needed to rule out bone disease. This study confirms the low sensitivity of SS in the SMM population. It more importantly points out the low specificity of SS in SMM. The IMWG no longer recommends conventional SS prior to whole body CT (or PET/CT) as first imaging choice in SMM. While the argument may be made that SS should still be used upfront due to low cost and widespread availability, this study shows the risk of overestimating disease. Over 10% of patients in this series had false positive disease on SS and thus at risk of receiving unnecessary treatment. Not only concerning for patient toxicity but more so financial toxicity. If SS is used, it is important to review positive findings directly with a radiologist and consider follow-up confirmatory imaging.

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MRI versus 18F-FDG-PET/CT for detecting bone marrow involvement in multiple myeloma: diagnostic performance and clinical relevance

European Radiology ◽

10.1007/s00330-019-06469-1 ◽

2019 ◽

Vol 30 (4) ◽

pp. 1927-1937 ◽

Cited By ~ 6

Author(s):

Frédéric E. Lecouvet ◽

Dimitar Boyadzhiev ◽

Laurence Collette ◽

Maude Berckmans ◽

Nicolas Michoux ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Fdg Pet ◽

Clinical Relevance ◽

Diagnostic Performance ◽

Bone Marrow Involvement ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Prospective Comparison of 18F-choline PET/CT and 18F-FDG PET/CT in the Initial Work-up of Multiple Myeloma

Case Medical Research ◽

10.31525/ct1-nct03891914 ◽

2019 ◽

Author(s):

Keyword(s):

Multiple Myeloma ◽

Fdg Pet ◽

Choline Pet ◽

Prospective Comparison ◽

Pet Ct ◽

Initial Work ◽

18F Fdg ◽

Fdg Pet Ct ◽

Work Up

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Diagnostic performance of 18F-FDG PET/CT, ultrasonography and MRI

Nuklearmedizin ◽

10.3413/nukmed-0605-13-06 ◽

2014 ◽

Vol 53 (03) ◽

pp. 89-94 ◽

Cited By ~ 17

Author(s):

D. H. Lee ◽

J.-K Yoon ◽

S. J. Lee ◽

T. H. Kim ◽

D. K. Kang ◽

...

Keyword(s):

Lymph Node ◽

Fdg Pet ◽

Axillary Lymph Node ◽

Diagnostic Performance ◽

Axillary Lymph ◽

Diagnostic Ability ◽

Node Metastasis ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

SummaryThe aim of this study was to evaluate the diagnostic abilities of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) compared with those of ultrasonography and magnetic resonance imaging (MRI) for axillary lymph node staging in breast cancer patients. Patients, methods: Pre- operative 18F-FDG PET/non-contrast CT, ultrasonography and MRI were performed in 215 women with breast cancer. Axillary lymph node dissection was performed in all patients and the diagnostic performance of each modality was evaluated using histopathologic assessments as the reference standard. ROC curves were compared to evaluate the diagnostic ability of several imaging modalities (i. e., ultrasonography, MRI and 18F-FDG PET/CT). Results: In total, 132 patients (61.4%) had axillary lymph node metastasis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the detection of axillary lymph node metastasis were 72.3%, 77.3%, 66.7%, 81.6%, 75.3% for ultrasonography, 67.5%, 78.0%, 65.9%, 79.2%, 74.0% for MRI, and 62.7%, 88.6%, 77.6%, 79.1%, 78.6% for 18F-FDG PET/CT, respectively. There was no significant difference in diagnostic ability among the imaging modalities (i.e., ultrasonography, MRI and 18F-FDG PET/CT). The diagnostic ability of 18F-FDG PET/CT was significantly improved by combination with MRI (p = 0.0002) or ultrasonography (p < 0.0001). The combination of 18F-FDG PET/CT with ultrasonography had a similar diagnostic ability to that of all three modalities combined (18F-FDG PET/CT+ultraso- nography+MRI, p = 0.05). Conclusion: The diagnostic performance of 18F-FDG PET/CT for detection of axillary node metastasis was not significantly different from that of ultrasonography or MRI in breast cancer patients. Combining 18F-FDG PET/CT with ultrasonography or MRI could improve the diagnostic performance compared to 18F-FDG PET/CT alone.

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