Positron Emission Tomography (PET) Imaging of Multiple Myeloma in a Post-Treatment Setting.

Giulia Ferrarazzo,Selene Capitanio,Stefano Raffa,Maria Isabella Donegani,Alberto Stefano Tagliafico,Silvia Chiola,Alberto Miceli,Silvia Morbelli,Matteo Bauckneht

doi:10.3390/diagnostics11020230

Abstract

2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (FDG PET/CT) has an established clinical value in the diagnosis and initial staging of multiple myeloma (MM). In the last ten years, a vast body of literature has shown that this tool can also be of high relevance for monitoring therapy responses, making it the recommended imaging approach in this field. Starting from the strengths and weaknesses of radiological imaging in MM, the present review aims to analyze FDG PET/CT’s current clinical value focusing on therapy response assessment and objective interpretation criteria for therapy monitoring. Given the potential occurrence of patients with MM showing non-FDG-avid bone disease, new opportunities can be provided by non-FDG PET tracers. Accordingly, the potential role of non-FDG PET tracers in this setting has also been discussed.

Highlights

Multiple myeloma (MM) is the second most common hematologic malignancy and is associated with the abnormal proliferation of well-differentiated plasma cells [1]
The evolution from MGUS/smoldering multiple myeloma (SMM) to active MM is associated with the appearance of clinical signs of organ damage including renal insufficiency, hypercalcemia and anemia as well as the presence of bone involvement documented by radiological imaging
These findings supported FDG imaging inclusion in the consensus recommendations by the International Myeloma Working Group (IMWG) [3,18]. On these bases, starting from the strengths and weaknesses of radiological imaging in MM, the present review aims to analyze the current state of the art of FDG positron emission tomography (PET)/computed tomography (CT)

Summary

Introduction

Multiple myeloma (MM) is the second most common hematologic malignancy and is associated with the abnormal proliferation of well-differentiated plasma cells [1]. In the last years, a vast body of literature has demonstrated the added value of 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (FDG PET/CT) over standard imaging in many phases of the disease including the initial diagnosis and staging [3,4,5,6,7,8], restaging at relapse [9,10,11], prognostic assessment [9,12,13,14,15] and monitoring therapy response This latter indication has been increasingly studied due to the emerging capability of FDG imaging to detect with high sensitivity the persistence of residual active clonal plasma cells within residual lytic lesions, which are of adverse prognostic significance [16]. FDG PET/CT is superior to MRI in the early detection of a response to salvage therapy [17]

Methods

Results

Conclusion