18F-fluorocholine versus 18F-fluorodeoxyglucose for PET/CT imaging in patients with suspected relapsing or progressive multiple myeloma: a pilot study.
OBJECTIVE
Hybrid positron emission tomography/computed tomography (PET/CT) has now become available, as well as whole-body, low-dose multidetector row computed tomography (MDCT) or magnetic resonance imaging (MRI). The radioactive glucose analogue 18F-fluorodeoxyglucose (FDG) is the most widely used tracer but has a relatively low sensitivity in detecting multiple myeloma (MM). We compared FDG with a more recent metabolic tracer, 18F-fluorocholine (FCH), for the detection of MM lesions at time of disease relapse or progression.


METHODS
We analyzed the results of FDG and FCH imaging in 21 MM patients undergoing PET/CT for suspected relapsing or progressive MM. For each patient and each tracer, an on-site reader and a masked reader independently determined the number of intraosseous and extraosseous foci of tracer and the intensity of uptake as measured by their SUVmax and the corresponding target/non-target ratio (T/NT).


RESULTS
In the skeleton of 21 patients, no foci were found for two cases, uncountable foci were observed in four patients, including some mismatched FCH/FDG foci. In the 15 patients with countable bone foci, the on-site reader detected 72 FDG foci vs. 127 FCH foci (+76 %), whereas the masked reader detected 69 FDG foci vs. 121 FCH foci (+75 %), both differences being significant. Interobserver agreement on the total number of bone foci was very high, with a kappa coefficient of 0.81 for FDG and 0.89 for FCH. Measurement of uptake in the matched foci that took up both tracers revealed a significantly higher median SUVmax and T/NT for FCH vs. FDG. Almost all unmatched foci were FCH-positive FDG-negative (57/59 = 97 % on-site and 56/60 = 93 % on masked reading); they were more frequently observed than matched foci in the head and neck region.


CONCLUSIONS
These findings suggest that PET/CT performed for suspected relapsing or progressive MM would reveal more lesions when using FCH rather than FDG.
Department of Nuclear Medicine, Hôpital Tenon, AP-HP, 4 rue de la Chine, Paris, 75020, France. thibaut.cassou-mounat@aphp.fr.|Department of Nuclear Medicine, Hôpital Saint Antoine, AP-HP, 184 rue du Fg St Antoine, Paris, 75012, France. thibaut.cassou-mounat@aphp.fr.|Université Pierre et Marie Curie (UPMC), Paris, France. thibaut.cassou-mounat@aphp.fr.
Thibaut
T
Cassou-Mounat
Department of Nuclear Medicine, Hôpital Tenon, AP-HP, 4 rue de la Chine, Paris, 75020, France.|Department of Nuclear Medicine, Comenius University & St. Elisabeth Oncology Institute, Bratislava, Slovakia.
Sona
S
Balogova
Department of Nuclear Medicine, Hôpital Tenon, AP-HP, 4 rue de la Chine, Paris, 75020, France.|Radiopharmacy, Hôpital Tenon, AP-HP, 4 rue de la Chine, Paris, 75020, France.
Valérie
V
Nataf
Department of Nuclear Medicine, Hôpital Tenon, AP-HP, 4 rue de la Chine, Paris, 75020, France.|Department of Nuclear Medicine, Hôpital Saint Antoine, AP-HP, 184 rue du Fg St Antoine, Paris, 75012, France.
Marie
M
Calzada
Department of Nuclear Medicine, Hôpital Tenon, AP-HP, 4 rue de la Chine, Paris, 75020, France.
Virginie
V
Huchet
Department of Nuclear Medicine, Hôpital Tenon, AP-HP, 4 rue de la Chine, Paris, 75020, France.
Khaldoun
K
Kerrou
Department of Nuclear Medicine, Hôpital Saint Antoine, AP-HP, 184 rue du Fg St Antoine, Paris, 75012, France.|Université Pierre et Marie Curie (UPMC), Paris, France.
Jean-Yves
JY
Devaux
Université Pierre et Marie Curie (UPMC), Paris, France.|INSERM, UMR_S 938, Proliferation and Differentiation of Stem Cells, 75012, Paris, France.|Département d'hématologie et de thérapie cellulaire, Hôpital Saint Antoine, AP-HP, 184 rue du Fg St Antoine, 75012, Paris, France.
Mohamad
M
Mohty
Department of Nuclear Medicine, Hôpital Tenon, AP-HP, 4 rue de la Chine, Paris, 75020, France.|Université Pierre et Marie Curie (UPMC), Paris, France.
Jean-Noël
JN
Talbot
Université Pierre et Marie Curie (UPMC), Paris, France.|INSERM, UMR_S 938, Proliferation and Differentiation of Stem Cells, 75012, Paris, France.|Département d'hématologie et de thérapie cellulaire, Hôpital Saint Antoine, AP-HP, 184 rue du Fg St Antoine, 75012, Paris, France.
Laurent
L
Garderet
D000368:Aged; D000369:Aged, 80 and over; D002794:Choline / Q000031:analogs & derivatives*; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; C514960:fluorocholine; D002794:Choline
FDG; Fluorocholine (18F) FCH; Multiple myeloma; PET/CT