scholarly journals Amino Acid and Proliferation PET/CT for the Diagnosis of Multiple Myeloma

2022 ◽  
Vol 1 ◽  
Author(s):  
Ryogo Minamimoto
Keyword(s):  
Computed Tomography ◽  
Multiple Myeloma ◽  
Amino Acid ◽  
Fdg Pet ◽  
Hematologic Malignancy ◽  
Staging System ◽  
Bone Lesions ◽  
Pet Tracers ◽  
Pet Ct ◽  
Fdg Pet Ct

Multiple myeloma (MM) is a hematologic malignancy characterized by infiltration of monoclonal plasma cells in the bone marrow (BM). The standard examination performed for the assessment of bone lesions has progressed from radiographic skeletal survey to the more advanced imaging modalities of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT). The Durie–Salmon PLUS staging system (upgraded from the Durie–Salmon staging system) applies 2-[18F]-fluoro-2-deoxy-glucose (18F-FDG) PET/CT, and MRI findings to the staging of MM, and 18F-FDG PET/CT has been incorporated into the International Myeloma Working Group (IMWG) guidelines for the diagnosis and staging of MM. However, 18F-FDG PET/CT has significant limitations in the assessment of diffuse BM infiltration and in the differentiation of MM lesions from inflammatory or infectious lesions. The potential of several new PET tracers that exploit the underlying disease mechanism of MM has been evaluated in terms of improving the diagnosis. L-type amino acid transporter 1 (LAT1), a membrane protein that transports neutral amino acids, is associated with cell proliferation and has strong ability to represent the status of MM. This review evaluates the potential of amino acid and proliferation PET tracers for diagnosis and compares the characteristics and accuracy of non-FDG tracers in the management of patients with MM.

scholarly journals Imaging of Monoclonal Gammapathy of Undetermined Significance and Smoldering Multiple Myeloma

Cancers ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 486 ◽  
Author(s):  
Bastien Jamet ◽  
Clément Bailly ◽  
Thomas Carlier ◽  
Cyrille Touzeau ◽  
Anne-Victoire Michaud ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multiple Myeloma ◽  
Fdg Pet ◽  
Whole Body ◽  
Bone Lesions ◽  
Rapid Progression ◽  
Smoldering Multiple Myeloma ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Undetermined Significance

Multiple myeloma (MM) is always preceded by an initial monoclonal gammopathy of undetermined significance (MGUS) that then develops into asymptomatic or smoldering multiple myeloma (SMM), which constitutes an intermediate clinical stage between MGUS and MM. According to a recent study, risk factors for faster MGUS to MM progression include an M protein of 1.5 g/dL or more and an abnormal free light chain ratio in patients with non-IgM MGUS. Therefore, the International Myeloma Working Group (IMWG) decided to recommend whole-body computed tomography (WBCT) for patients with high-risk MGUS in order to exclude early bone destruction. Studies evaluating magnetic resonance imaging (MRI) in SMM found an optimal cutoff of two or more focal lesions to be of prognostic significance for fast progression into symptomatic disease and considered this biomarker as a myeloma-defining event (MDE) needing to start therapy with the aim to avoid progression to harmful bone lesions. Moreover, studies assessing positron emission tomography (PET) with computed tomography (CT) using 18F-deoxyglucose (FDG) (FDG-PET/CT) in SMM showed that presence of focal bone lesion without underlying osteolysis is associated with a rapid progression to symptomatic MM. Latest IMWG guidelines recommended to perform WBCT (either CT alone or as part of an FDG-PET/CT protocol) as the first imaging technique at suspected SMM and, if these images are negative or inconclusive, to perform whole-body MRI. The goal of this paper is to clarify the role of different imaging modalities in MGUS and SMM workups.

scholarly journals Comparison of the diagnostic performance and impact on management of 18F-FDG PET/CT and whole-body MRI in multiple myeloma

2021 ◽  
Author(s):  
Olwen Westerland ◽  
◽  
Ashik Amlani ◽  
Christian Kelly-Morland ◽  
Michal Fraczek ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Clinical Data ◽  
Bone Disease ◽  
Fdg Pet ◽  
Diagnostic Performance ◽  
Whole Body ◽  
Bone Lesions ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

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.

scholarly journals Imaging of treatment response and minimal residual disease in multiple myeloma: state of the art WB-MRI and PET/CT

2021 ◽  
Author(s):  
Frederic E. Lecouvet ◽  
Marie-Christiane Vekemans ◽  
Thomas Van Den Berghe ◽  
Koenraad Verstraete ◽  
Thomas Kirchgesner ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Minimal Residual Disease ◽  
Fdg Pet ◽  
Residual Disease ◽  
Whole Body ◽  
Bone Lesions ◽  
Next Generation ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Minimal Residual

AbstractBone imaging has been intimately associated with the diagnosis and staging of multiple myeloma (MM) for more than 5 decades, as the presence of bone lesions indicates advanced disease and dictates treatment initiation. The methods used have been evolving, and the historical radiographic skeletal survey has been replaced by whole body CT, whole body MRI (WB-MRI) and [18F]FDG-PET/CT for the detection of bone marrow lesions and less frequent extramedullary plasmacytomas.Beyond diagnosis, imaging methods are expected to provide the clinician with evaluation of the response to treatment. Imaging techniques are consistently challenged as treatments become more and more efficient, inducing profound response, with more subtle residual disease. WB-MRI and FDG-PET/CT are the methods of choice to address these challenges, being able to assess disease progression or response and to detect “minimal” residual disease, providing key prognostic information and guiding necessary change of treatment.This paper provides an up-to-date overview of the WB-MRI and PET/CT techniques, their observations in responsive and progressive disease and their role and limitations in capturing minimal residual disease. It reviews trials assessing these techniques for response evaluation, points out the limited comparisons between both methods and highlights their complementarity with most recent molecular methods (next-generation flow cytometry, next-generation sequencing) to detect minimal residual disease. It underlines the important role of PET/MRI technology as a research tool to compare the effectiveness and complementarity of both methods to address the key clinical questions.

Het gebruik van 18F-FDG PET/CT ter evaluatie van multipel myeloom

2021 ◽  
Author(s):  
K. VOET ◽  
B. VAN DEN BROECK ◽  
I. GOETHALS ◽  
F. OFFNER
Keyword(s):  
Multiple Myeloma ◽  
Fdg Pet ◽  
Total Lesion Glycolysis ◽  
Classification Systems ◽  
Bone Lesions ◽  
Response Evaluation ◽  
Reliable Technique ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

The use of 18F-FDG PET/CT to evaluate patients with multiple myeloma. Detection of bone lesions are important to diagnose multiple myeloma. In this study we investigate the role of an 18F-FDG PET/CT exam. Fifteen newly diagnosed multiple myeloma patients were included in this retrospective study. A 18F-FDG PET/CT was performed at diagnosis and after induction therapy. The response of a treatment is examined by semi-quantitative parameters (standardised 18F-FDG uptake values) and volumetric parameters (metabolic tumor volume and total lesion glycolysis). The aim of this study is to evaluate the use of these parameters for response evaluation and risk assessment in multiple myeloma. The prognostic value of an increased metabolic activity of the spleen is also examined. All semi-quantitative and volumetric parameters in this study are useful for response evaluation. Lower values of maximum or mean standardized uptake values (SUVmax, SUVmean) and total lesion glycolysis at diagnosis are prognostic favourable. We could not prove prognostic relevance for a spleen to liver ratio. Due to the small study population, all these results have to be confirmed in a larger patient cohort. 18F-FDG PET/CT is a reliable technique for response evaluation and risk stratification in multiple myeloma. In the future semi-quantitative and volumetric parameters will probably be incorporated in the risk classification systems of multiple myeloma patients.

Role of 18f-FDG PET/CT in the Management of Multiple Myeloma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3492-3492
Author(s):  
Elena Zamagni ◽  
Cristina Nanni ◽  
Patrizia Tosi ◽  
Stefano Fanti ◽  
Delia Cangini ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Disease ◽  
Fdg Pet ◽  
Bone Lesions ◽  
Pet Ct ◽  
Lytic Bone Lesions ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Ct And Mri

Abstract Multiple myeloma (MM) is a malignant plasma cell disorder which involves the skeleton in more than 80% of patients at diagnosis. For almost four decades bone lesions have traditionally been detected by Whole Body X-Ray (WBXR) survey. Over the last years, newer methods of evaluation have been increasingly used for the detection of MM bone disease, including magnetic resonance imaging (MRI) of the spine. In comparison with WBXR, MRI has proven to be more sensitive, although its partial field of view (FOV) is a main limitation in clinical practice. 18F-FDG PET/CT is a non invasive and total body imaging method that may be usefully employed to explore bones and soft tissues in MM, to assess the degree and extent of active MM bone disease, as well as to evaluate response to therapy by distinguishing between active and inactive bone lesions. Aim of the present study was to compare WBXR survey, MRI and 18F-FDG PET/CT scanning in a series of 28 consecutive patients with newly diagnosed MM. Moreover, we compared post-treatment evaluation with MRI and 18F-FDG PET/CT with clinical response in 14/28 patients who received double autologous transplantation as up-front therapy for MM. All patients underwent WBXR, MRI and 18F-FDG PET/CT at baseline and 3 months after the second transplantation. Findings of 18 F-FDG PET/CT were compared to those of WBXR and MRI with respect to number and site of detected bone lesions. Results of comparison of 18 F-FDG PET/CT with WBXR at diagnosis were as follows: in 16/28 pts (57%) 18 F-FDG PET/CT detected more lesions, all of whom were located in the skeleton; notably, 9 of these 16 patients had a completely negative WBXR survey. In 12/28 pts (43%) both methods were superimposable. Results of comparison of 18 F-FDG PET/CT with MRI at diagnosis were as follows: in 7/28 pts (25%), 18 F-FDG PET/CT detected more lytic bone lesions which were all located out of the FOV of MRI (6 bone lesions, 1 soft tissue lesion); in 13/28 pts (46%) 18 F-FDG PET/CT and MRI detected the same number of lesions in the spine and pelvis; in 8/28 pts (29%) MRI detected an infiltrative pattern of the spine, without evidence of lytic lesions, whereas 18 F-FDG PET/CT was negative. Results of comparison of post-transplantation 18 F-FDG PET/CT and MRI with clinical response were as follows: 5 out of 12 patients with negative 18 F-FDG PET/CT were in clinical CR and the remaining 7 patients were in 3 PR. Only 7 out of 12 patients with negative 18 F-FDG PET/CT had normal MRI. In summary, in 57% of patients at diagnosis 18 F-FDG PET/CT was more sensitive than WBXR for the detection of lytic bone lesions. MRI of the spine was superior over 18 F-FDG PET/CT in 29% of patients, particularly with a diffuse bone marrow replacement. Based on these data, it can be concluded that careful evaluation of MM bone disease at diagnosis should include both MRI of the spine and 18 F- FDG PET/CT. More data are needed to understand the role of 18 F-FDG PET/CT in assessing response to treatment.

scholarly journals A prospective study comparing whole-body skeletal X-ray survey with 18F-FDG-PET/CT, 18F-NaF-PET/CT and whole-body MRI in the detection of bone lesions in multiple myeloma patients

2017 ◽  
Vol 6 (10) ◽  
pp. 205846011773880 ◽  
Author(s):  
Eva Dyrberg ◽  
Helle W. Hendel ◽  
Gina Al-Farra ◽  
Lone Balding ◽  
Vibeke B. Løgager ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Disease ◽  
Fdg Pet ◽  
Imaging Techniques ◽  
Whole Body ◽  
Bone Lesions ◽  
X Ray ◽  
Body Regions ◽  
Pet Ct ◽  
Fdg Pet Ct

Background For decades, the most widely used imaging technique for myeloma bone lesions has been a whole-body skeletal X-ray survey (WBXR), but newer promising imaging techniques are evolving. Purpose To compare WBXR with the advanced imaging techniques 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT), 18F-sodium fluoride (NaF) PET/CT and whole-body magnetic resonance imaging (WB-MRI) in the detection of myeloma bone lesions. Material and Methods Fourteen patients with newly diagnosed multiple myeloma were prospectively enrolled. In addition to WBXR, all patients underwent FDG-PET/CT, NaF-PET/CT, and WB-MRI. Experienced specialists performed blinded readings based on predefined anatomical regions and diagnostic criteria. Results In a region-based analysis, a two-sided ANOVA test showed that the extent of detected skeletal disease depends on the scanning technique ( P < 0.0001). Tukey’s multiple comparison test revealed that WB-MRI on average detects significantly more affected regions than WBXR ( P < 0.005), FDG-PET/CT ( P < 0.0001), and NaF-PET/CT ( P < 0.05). In a patient-based analysis, a Cochran’s Q test showed that there are no significant differences in the proportion of patients with bone disease detected by the different scanning techniques ( P = 0.23). Determination of intrareader variability resulted in Kappa coefficients corresponding to moderate (FDG-PET/CT) and substantial agreement (WB-MRI, WBXR, NaF-PET/CT). Conclusion WB-MRI detects on average significantly more body regions indicative of myeloma bone disease compared to WBXR, FDG-PET/CT, and NaF-PET/CT. The lack of significance in the patient-based analysis is most likely due to the small number of study participants.

scholarly journals Extramedullary Plasmacytoma of the Gallbladder Detected on Fluorine 18-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

2016 ◽  
Vol 6 ◽  
pp. 40 ◽  
Author(s):  
Asif Ali Fakhri ◽  
Paul David Rodrigue ◽  
Amena Fatima Fakhri
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Multiple Myeloma ◽  
Fdg Pet ◽  
Extramedullary Plasmacytoma ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Fluorine 18 Fluorodeoxyglucose

Extramedullary plasmacytoma is rare in patients with diagnosed multiple myeloma. Soft tissue plasmacytoma of the gallbladder is particularly uncommon and has been described in only a handful of cases. Diagnosis of gallbladder plasmacytoma with fluorine 18-fluorodeoxyglucose (F18-FDG) positron emission tomography/computed tomography (PET/CT) has not previously been reported. We present a 65-year-old female with a history of multiple myeloma who underwent a restaging F18-FDG-PET/CT which showed a focal area of hypermetabolic activity, corresponding to a nodular lesion within the posterior gallbladder wall. The patient underwent successful cholecystectomy, with surgical pathology revealing gallbladder plasmacytoma. A follow-up scan was negative for active malignancy. This is a novel case of gallbladder plasmacytoma diagnosed on whole-body F18-FDG PET/CT – thus demonstrating the clinical value of this imaging modality in staging, restaging, and surveillance for patients with multiple myeloma.

scholarly journals Metabolic Volume Measurements in Multiple Myeloma

Metabolites ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 875
Author(s):  
Maria Emilia Seren Takahashi ◽  
Irene Lorand-Metze ◽  
Carmino Antonio de Souza ◽  
Claudio Tinoco Mesquita ◽  
Fernando Amorim Fernandes ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Adipose Tissue ◽  
Fdg Pet ◽  
Malignant Tumors ◽  
Metabolic Tumor Volume ◽  
Ct Images ◽  
Bone Lesions ◽  
Standardized Uptake Values ◽  
Pet Ct ◽  
Fdg Pet Ct

Multiple myeloma (MM) accounts for 10–15% of all hematologic malignancies, as well as 20% of deaths related to hematologic malignant tumors, predominantly affecting bone and bone marrow. Positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (FDG-PET/CT) is an important method to assess the tumor burden of these patients. It is often challenging to classify the extent of disease involvement in the PET scans for many of these patients because both focal and diffuse bone lesions may coexist, with varying degrees of FDG uptake. Different metrics involving volumetric parameters and texture features have been proposed to objectively assess these images. Here, we review some metabolic parameters that can be extracted from FDG-PET/CT images of MM patients, including technical aspects and predicting MM outcome impact. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are volumetric parameters known to be independent predictors of MM outcome. However, they have not been adopted in clinical practice due to the lack of measuring standards. CT-based segmentation allows automated, and therefore reproducible, calculation of bone metabolic metrics in patients with MM, such as maximum, mean and standard deviation of the standardized uptake values (SUV) for the entire skeleton. Intensity of bone involvement (IBI) is a new parameter that also takes advantage of this approach with promising results. Other indirect parameters obtained from FDG-PET/CT images, such as visceral adipose tissue glucose uptake and subcutaneous adipose tissue radiodensity, may also be useful to evaluate the prognosis of MM patients. Furthermore, the use and quantification of new radiotracers can address different metabolic aspects of MM and may have important prognostic implications.

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