Abstract
BackgroundMultiple Myeloma (MM) is a B cell neoplasm causing lytic or osteopenic bone abnormalities. Whole body skeletal survey (WBSS), Magnetic resonance (MR) and 18F-FDG PET/CT are imaging techniques routinely used for the evaluation of bone involvement in MM patients.AimAs MM bone lesions may present low 18F-FDG uptake; the aim of this study was to assess the possible added value and limitations of 11C-Choline to that of 18F-FDG PET/CT in patients affected with MM.MethodsTen patients affected with MM underwent a standard 11C-Choline PET/CT and an 18F-FDG PET/CT within one week. The results of the two scans were compared in terms of number, sites and SUVmax of lesions.ResultsFour patients (40%) had a negative concordant 11C-Choline and 18F-FDG PET/CT scans. Two patients (20%) had a positive 11C-Choline and 18F-FDG PET/CT scans that identified the same number and sites of bone lesions. The remaining four patients (40%) had a positive 11C-Choline and 18F-FDG PET/CT scan, but the two exams identified different number of lesions. Choline showed a mean SUVmax of 5 while FDG showed a mean SUVmax of 3.8 (P = 0.042). Overall, 11C-Choline PET/CT scans detected 37 bone lesions and 18F-FDG PET/CT scans detected 22 bone lesions but the difference was not significant (P = 0.8).ConclusionAccording to these preliminary data, 11C-Choline PET/CT appears to be more sensitive than 18F-FDG PET/CT for the detection of bony myelomatous lesions. If these data are confirmed in larger series of patients, 11C-Choline may be considered a more appropriate functional imaging in association with MRI for MM bone staging.
Highlights
Multiple Myeloma (MM) is a B cell neoplasm causing lytic or osteopenic bone abnormalities
Durie et al in 2002 demonstrated that a negative 18F-FDG PET scan predicts stable monoclonal gammopathy of indeterminate significance (MGIS), identifies small lesions not detected by Whole body skeletal survey (WBSS), identifies extra-medullary lesions related to poor prognosis and predicts an early relapse if it was positive after therapy [21]
Our preliminary results show that 11C-Choline PET/CT detected more myelomatous lesions than 18F-FDG PET/ CT in our group of 10 patients
Summary
Multiple Myeloma (MM) is a B cell neoplasm causing lytic or osteopenic bone abnormalities. Durie et al in 2002 demonstrated that a negative 18F-FDG PET scan predicts stable monoclonal gammopathy of indeterminate significance (MGIS), identifies small lesions not detected by WBSS, identifies extra-medullary lesions related to poor prognosis and predicts an early relapse if it was positive after therapy [21]. These results were confirmed by other recent publications [22,23]
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