18F-FDG PET/CT, 99mTc-MIBI, and MRI in the Prediction of Outcome of Patients With Multiple Myeloma: A Comparative Study. (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: multiple myeloma -- 18F-FDG PET/CT -- 99mTc-MIBI -- MRI -- prognosis; Nuclear medicine -- Periodicals; Radioisotope scanning -- Periodicals; Nuclear Medicine -- Periodicals; 616.07575
• DOI: 10.1097/RLU.0000000000000696
• Languages: English
• ISSNs: 0363-9762

Abstract

Abstract : Purpose: The aim of this study was to compare the relative contribution of 18 F-FDG PET/CT, 99m Tc-MIBI, and MRI in predicting progression-free survival (PFS) and overall survival (OS) in multiple myeloma (MM) patients. Patients and Methods: Thirty-three newly diagnosed MM patients had been evaluated in a previous study by 18 F-FDG PET/CT, 99m 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. Results: 18 F-FDG PET/CT, 99m 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 18 F-FDG PET/CT focal uptake and 99m Tc-MIBI focal and diffuse uptake predicted PFS ( P = 0.0006), whereas 18 F-FDG PET/CT focal uptake and 99m Tc-MIBI focal uptake predicted OS ( P = 0.0010). Although MRI diffuse pattern predicted PFS at univariate analysis ( P = 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 18 F-FDG PET/CT and 2 in both cases for 99m 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 18 F-FDG PET/CT or 99m Tc-MIBI lower than the respective cutoff ( P = 0.03, P = 0.004, and P < 0.0001, respectively). Finally, PFS was significantly better in patients showing absent/faint diffuse 99m Tc-MIBI uptake than in those having moderate/intense diffuse uptake ( P = 0.0012). Conclusions: 18 F-FDG PET/CT and 99m Tc-MIBI may be useful in predicting PFS and OS in myeloma patients.