Abstract
Multiple myeloma (MM) is a plasma cell disorder, characterized by clonal proliferation of malignant plasma cells in the bone marrow. Bone disease is the most frequent feature and an end-organ defining indicator of MM. In this context, imaging plays a pivotal role in the management of the malignancy. For several decades whole-body X-ray survey (WBXR) has been applied for the diagnosis and staging of bone disease in MM. However, the serious drawbacks of WBXR have led to its gradual replacement from novel imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT). PET/CT, with the tracer 18F-fluorodeoxyglucose (18F-FDG), is now considered a powerful diagnostic tool for the detection of medullary and extramedullary disease at the time of diagnosis, a reliable predictor of survival as well as the most robust modality for treatment response evaluation in MM. On the other hand, 18F-FDG carries its own limitations as a radiopharmaceutical, including a rather poor sensitivity for the detection of diffuse bone marrow infiltration, a relatively low specificity, and the lack of widely applied, established criteria for image interpretation. This has led to the development of several alternative PET tracers, some of which with promising results regarding MM detection. The aim of this review article is to outline the major applications of PET/CT with different radiopharmaceuticals in the clinical practice of MM.
Highlights
Multiple myeloma (MM) is a neoplastic plasma cell disorder, characterized by the uncontrolled, clonal proliferation of plasma cells in the bone marrow
The results of a systematic review of 18 studies comparing the above-mentioned modalities showed a higher sensitivity of magnetic resonance imaging (MRI) at detecting diffuse disease of the spine, while 18 F-FDG PET/computed tomography (CT) was more sensitive than whole-body X-ray survey (WBXR) with regard to detection of bone lesions [10]
The results of the only prospective study comparing positron emission tomography/computed tomography (PET/CT) with PET/MRI demonstrated good image quality provided by PET/MRI and high correlation between the modalities regarding the number of detected active lesions and standardized uptake value (SUV) values [14]
Summary
Multiple myeloma (MM) is a neoplastic plasma cell disorder, characterized by the uncontrolled, clonal proliferation of plasma cells in the bone marrow. The results of a systematic review of 18 studies comparing the above-mentioned modalities showed a higher sensitivity of MRI at detecting diffuse disease of the spine, while 18 F-FDG PET/CT was more sensitive than WBXR with regard to detection of bone lesions [10]. The results of the only prospective study comparing PET/CT with PET/MRI demonstrated good image quality provided by PET/MRI and high correlation between the modalities regarding the number of detected active lesions and SUV values [14]. Symptomatic MM patients, three independent PET factors have been recognized to affect both progression-free survival (PFS) and overall survival (OS) in different prospective studies These parameters are the number of focal, 18 F-FDG-avid lesions, the SUVmax of the lesions, and the presence of EMD. In a study published by the Little Rock group in 2009 involving 239 previously untreated MM
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