18F-FDG PET/CT, 99mTc-MIBI, and MRI in the Prediction of Outcome of Patients With Multiple Myeloma. (April 2015)

• Record Type: Journal Article
• Authors: Fonti, Rosa; Pace, Leonardo; Cerchione, Claudio; Catalano, Lucio; Salvatore, Barbara; De Luca, Serena; Pane, Fabrizio; Salvatore, Marco; Del Vecchio, Silvana
• Is Part Of: Clinical nuclear medicine. Volume 40:Number 4(2015)
• Publication Date: 2015-04
• Subjects: Nuclear medicine -- Periodicals; Radioisotope scanning -- Periodicals; Nuclear Medicine -- Periodicals; 616.07575
• DOI: 10.1097/RLU.0000000000000696
• Languages: English
• ISSNs: 0363-9762

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Purpose</title> <p>The aim of this study was to compare the relative contribution of <sup>18</sup>F-FDG PET/CT, <sup>99m</sup>Tc-MIBI, and MRI in predicting progression-free survival (PFS) and overall survival (OS) in multiple myeloma (MM) patients.</p> </sec> <sec> <title>Patients and Methods</title> <p>Thirty-three newly diagnosed MM patients had been evaluated in a previous study by <sup>18</sup>F-FDG PET/CT, <sup>99m</sup>Tc-MIBI, and spine and pelvis MRI reporting focal lesions and diffuse bone marrow involvement. Twenty-seven patients were then subjected to a mean follow-up period of 58 months, whereas 6 patients were lost.</p> </sec> <sec> <title>Results</title> <p> <sup>18</sup>F-FDG PET/CT, <sup>99m</sup>Tc-MIBI, and MRI were positive in 26, 24, and 22 patients, respectively, showing diffuse bone marrow involvement in 12, 21, and 17 patients and a total of 185, 56, and 39 focal lesions, respectively. At follow-up, 18 patients showed complete or partial remission, whereas 9 patients developed progressive disease, 7 of which died of myeloma. Univariate and subsequent multivariate analysis showed that <sup>18</sup>F-FDG PET/CT focal uptake and <sup>99m</sup>Tc-MIBI focal and diffuse uptake predicted PFS (<italic>P</italic> = 0.0006), whereas <sup>18</sup>F-FDG PET/CT focal uptake and <sup>99m</sup>Tc-MIBI focal uptake predicted OS (<italic>P</italic> = 0.0010). Although MRI diffuse pattern predicted PFS at univariate analysis (<italic>P</italic> = 0.0376), it was not retained in the model at multivariate analysis. Receiver operating characteristic curve analysis showed that the number of focal lesions best discriminating for PFS and OS prediction was 4 and 11 for <sup>18</sup>F-FDG PET/CT and 2 in both cases for <sup>99m</sup>Tc-MIBI, respectively. By Kaplan-Meier analysis and log-rank testing, PFS and OS at follow-up were significantly better in patients showing a number of focal lesions at <sup>18</sup>F-FDG PET/CT or <sup>99m</sup>Tc-MIBI lower than the respective cutoff (<italic>P</italic> = 0.03, <italic>P</italic> = 0.004, and <italic>P</italic> < 0.0001, respectively). Finally, PFS was significantly better in patients showing absent/faint diffuse <sup>99m</sup>Tc-MIBI uptake than in those having moderate/intense diffuse uptake (<italic>P</italic> = 0.0012).</p> </sec> <sec> <title>Conclusions</title> <p> <sup>18</sup>F-FDG PET/CT and <sup>99m</sup>Tc-MIBI may be useful in predicting PFS and OS in myeloma patients.</p> </sec> </abstract>