Abstract
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, and18F-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.
Highlights
Multiple myeloma (MM) is a clonal plasma cell proliferative disorder characterized by primary infiltration of bone marrow (BM), disruption of bone homeostasis, and excessive production of abnormal immunoglobulin that leads to bone destruction and marrow failure [1]
A significant correlation was confirmed between BM plasma cell (BMPC) infiltration and the mean target-to-background ratio (TBRmean) on 11C-MET in the lumbar vertebrae of smoldering MM (SMM) patients (r = 0.789), which is close to that for 68Ga-Pentixafor (r = 0.724), but higher than that for 18F-FDG positron emission tomography (PET)/computed tomography (CT) (r = 0.355) [31]
Was positive in the case of ≥59% of plasma cells in the cytology specimen. These results indicate that 11C-4DST and 11C-MET may be able to detect active MM earlier than is possible with 18F-FDG [30]
Summary
Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan. Multiple myeloma (MM) is a hematologic malignancy characterized by infiltration of monoclonal plasma cells in the bone marrow (BM). 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.
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