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.
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.
Zamagni
Elena
E
Istituto di Ematologia ed Oncologia Medica "Seràgnoli" Università degli Studi di Bologna, Policlinico S. Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy.
Nanni
Cristina
C
Patriarca
Francesca
F
Englaro
Emanuela
E
Castellucci
Paolo
P
Geatti
Onelio
O
Tosi
Patrizia
P
Tacchetti
Paola
P
Cangini
Delia
D
Perrone
Giulia
G
Ceccolini
Michela
M
Brioli
Annamaria
A
Buttignol
Silvia
S
Fanin
Renato
R
Salizzoni
Eugenio
E
Baccarani
Michele
M
Fanti
Stefano
S
Cavo
Michele
M
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*
D019788:Fluorodeoxyglucose F18