title: A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma.
abstract: OBJECTIVE
  Bone lesions in multiple myeloma (MM) have been traditionally detected by whole body X-ray (WBXR) survey although magnetic resonance imaging (MRI) has become the gold standard for detecting MM involvement of the spine and pelvis. The aim of this study was to compare a new technique, positron emission tomography (PET) with 18F fluorodeoxyglucose (FDG) integrated with computed tomography (18F-FDG PET-CT), with MRI and WBXR for baseline assessment of bone disease in MM.
  
  
  METHODS
  We prospectively compared 18F-FDG PET-CT, MRI of the spine-pelvis and WBXR in a series of 46 patients with newly diagnosed MM. In 23 patients who received up front autologous transplantation, we also compared post-treatment PET-CT scans with MR images of the spine and pelvis.
  
  
  RESULTS
  Overall, PET-CT was superior to planar radiographs in 46% of patients, including 19% with negative WBXR. In 30% of patients, PET-CT scans of the spine and pelvis failed to show abnormal findings in areas in which MRI revealed an abnormal pattern of bone marrow involvement, more frequently of diffuse type. In contrast, in 35% of patients PET-CT enabled the detection of myelomatous lesions in areas which were out of the field of view of MRI. By combining MRI of the spine- pelvis and 18F-FDG PET-CT, the ability to detect sites of active MM, both medullary and extramedullary, was as high as 92%. Following transplantation, 15 patients had negative PET-CT scans (including 13 with a very good partial response or at least a near complete response), but only 8 had normal MRI.
  
  
  CONCLUSIONS
  MRI of the spine and pelvis still remains the gold standard imaging technique for the detection of bone marrow involvement in MM. 18F-FDG PET-CT provides additional and valuable information for the assessment of myeloma bone disease in areas not covered by MRI.
authors.affiliation: Istituto di Ematologia ed Oncologia Medica "Seràgnoli" Università degli Studi di Bologna, Policlinico S. Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Zamagni
authors.forename: Cristina
authors.initials: C
authors.lastname: Nanni
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarca
authors.forename: Emanuela
authors.initials: E
authors.lastname: Englaro
authors.forename: Paolo
authors.initials: P
authors.lastname: Castellucci
authors.forename: Onelio
authors.initials: O
authors.lastname: Geatti
authors.forename: Patrizia
authors.initials: P
authors.lastname: Tosi
authors.forename: Paola
authors.initials: P
authors.lastname: Tacchetti
authors.forename: Delia
authors.initials: D
authors.lastname: Cangini
authors.forename: Giulia
authors.initials: G
authors.lastname: Perrone
authors.forename: Michela
authors.initials: M
authors.lastname: Ceccolini
authors.forename: Annamaria
authors.initials: A
authors.lastname: Brioli
authors.forename: Silvia
authors.initials: S
authors.lastname: Buttignol
authors.forename: Renato
authors.initials: R
authors.lastname: Fanin
authors.forename: Eugenio
authors.initials: E
authors.lastname: Salizzoni
authors.forename: Michele
authors.initials: M
authors.lastname: Baccarani
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
mesh_terms: D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000188:drug therapy*; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D051598:Whole Body Imaging / Q000379:methods*
chemical_list: D019788:Fluorodeoxyglucose F18