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Xiong X, Wang J, Hao Z, Fan X, Jiang N, Qian X, Hong R, Dai Y, Hu C. MRI-based bone marrow radiomics for predicting cytogenetic abnormalities in multiple myeloma. Clin Radiol 2024; 79:e491-e499. [PMID: 38238146 DOI: 10.1016/j.crad.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/27/2023] [Accepted: 12/14/2023] [Indexed: 03/09/2024]
Abstract
AIM To develop a radiomics signature applied to magnetic resonance imaging (MRI)-images to predict cytogenetic abnormalities in multiple myeloma (MM). MATERIALS AND METHODS Patients with newly diagnosed MM were enrolled retrospectively from March 2019 to September 2022. They were categorised into the high-risk cytogenetics (HRC) group and standard-risk cytogenetics (SRC) group. The patients were allocated randomly at a ratio of 7:3 into training and validation cohorts. Volumes of interest (VOI) was drawn manually on fat suppression T2-weighted imaging (FS-T2WI) and copied to the same location of the T1-weighted imaging (T1WI) sequence. Radiomics features were extracted from two sequences and selected by reproducibility and redundant analysis. The least absolute shrinkage selection operation (LASSO) algorithm was applied to build the radiomics signatures. The performance of the radiomics signatures to distinguish HRC with SRC was evaluated by ROC curves. The area under the curve (AUC), specificity, and sensitivity were also calculated. RESULTS A total of 105 MM patients were enrolled in this study. The four and 11 most significant and relevant features were selected separately from T1WI and FS-T2WI sequences to build the radiomics signatures based on the training cohort. Compared to the T1WI sequence, the radiomics signature based on the FS-T2WI sequence achieved better performance with AUCs of 0.896 and 0.729 in the training and validation cohorts respectively. A sensitivity of 0.833, specificity of 0.667, and Youden index of 0.500 were achieved for the FS-T2WI radiomics signature in the validation cohort. CONCLUSIONS The radiomics signature based on MRI provides a non-invasive and convenient tool to predict cytogenetic abnormalities in MM patients.
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Affiliation(s)
- X Xiong
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - J Wang
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou 225001, China
| | - Z Hao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - X Fan
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - N Jiang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - X Qian
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, 215163, China
| | - R Hong
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Y Dai
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, 215163, China.
| | - C Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.
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Yanamandra U, Reddy Gorla AK, Agrawal K, Mittal BR, Prakash G, Khadwal AR, Varma N, Varma S, Malhotra P. Prognostic significance of extramedullary disease (EMD) detected on pre-transplant 18F-FDG PET/CT in patients with multiple myeloma: Results of PIPET-M trial. Med J Armed Forces India 2023; 79:672-678. [PMID: 37981939 PMCID: PMC10654356 DOI: 10.1016/j.mjafi.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/11/2023] [Indexed: 11/21/2023] Open
Abstract
Background It is difficult to prognosticate the post-Autologous Stem Cell Transplant (ASCT) responses in multiple myeloma (MM) with the currently available prognostication models. 18F-FDGPET/CT has numerous advantages to prognosticate the post-transplant responses by assessing extramedullary disease (EMD) in addition to the extent of active disease. We aimed at identifying the prognostic value of EMD in predicting progression-free survival (PFS) and overall survival (OS). Methods This is a single centre prospective study from western India during a study period of 2014-2022 (with a median follow-up of patients of 6 years). All ASCT patients underwent 18F-FDG-PET/CT as part of pre-transplant workup. The conditioning and treatment protocols were not modified based on PET/CT findings. EMD on PET/CT was correlated with pre-transplant biochemical markers and post-ASCT survival/ progression (as defined by revised IMWG criteria). Statistical analysis was done using SPSS ver. 20. Results Patients with pre-ASCT EMD had a hazard-ratio for post-transplant all-cause mortality of 5.46 (p-0.045). Pre-transplant β2M and LDH were significantly higher in patients with EMD (p-0.036). The 6-year median OS in patients with and without EMD were 57.1%, and 80.6% respectively. Kaplan-Meier analysis showed poorer OS in patients with EMD χ2 (1-0.496, p-0.481). There was no significant difference in clinical or biochemical EFS among patients with EMD. Conclusion EMD detected on 18F-FDG-PET/CT has a higher hazard for mortality and is significantly correlated with pre-transplant higher β2M and LDH levels. Thus, EMD by pre-transplant 18F-FDG-PET/CT has a significant prognostic role.
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Affiliation(s)
- Uday Yanamandra
- Professor, Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Arun Kumar Reddy Gorla
- Junior Consultant, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Kanhaiyalal Agrawal
- Associate Professor (Nuclear Medicine), All India Institute of Medical Sciences, Bhubaneshwar, India
| | - Bhagwant Rai Mittal
- Professor (Nuclear Medicine), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Gaurav Prakash
- Professor (Clinical Hematology & Medical Oncology), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Alka Rani Khadwal
- Professor (Clinical Hematology & Medical Oncology), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Neelam Varma
- Ex-Professor & Head (Hematology), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Subhash Varma
- Ex-Dean, Ex-Professor & Head (Internal Medicine), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Pankaj Malhotra
- Professor & Head (Clinical Hematology & Medical Oncology), Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Kraeber-Bodéré F, Jamet B, Bezzi D, Zamagni E, Moreau P, Nanni C. New Developments in Myeloma Treatment and Response Assessment. J Nucl Med 2023; 64:1331-1343. [PMID: 37591548 PMCID: PMC10478822 DOI: 10.2967/jnumed.122.264972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/06/2023] [Indexed: 08/19/2023] Open
Abstract
Recent innovative strategies have dramatically redefined the therapeutic landscape for treating multiple myeloma patients. In particular, the development and application of immunotherapy and high-dose therapy have demonstrated high response rates and have prolonged remission duration. Over the past decade, new morphologic or hybrid imaging techniques have gradually replaced conventional skeletal surveys. PET/CT using 18F-FDG is a powerful imaging tool for the workup at diagnosis and for therapeutic evaluation allowing medullary and extramedullary assessment. The independent negative prognostic value for progression-free and overall survival derived from baseline PET-derived parameters such as the presence of extramedullary disease or paramedullary disease, as well as the number of focal bone lesions and SUVmax, has been reported in several large prospective studies. During therapeutic evaluation, 18F-FDG PET/CT is considered the reference imaging technique because it can be performed much earlier than MRI, which lacks specificity. Persistence of significant abnormal 18F-FDG uptake after therapy is an independent negative prognostic factor, and 18F-FDG PET/CT and medullary flow cytometry are complementary tools for detecting minimal residual disease before maintenance therapy. The definition of a PET metabolic complete response has recently been standardized and the interpretation criteria harmonized. The development of advanced PET analysis and radiomics using machine learning, as well as hybrid imaging with PET/MRI, offers new perspectives for multiple myeloma imaging. Most recently, innovative radiopharmaceuticals such as C-X-C chemokine receptor type 4-targeted small molecules and anti-CD38 radiolabeled antibodies have shown promising results for tumor phenotype imaging and as potential theranostics.
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Affiliation(s)
- Françoise Kraeber-Bodéré
- Médecine nucléaire, CHU Nantes, Nantes Université, Université Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France
| | - Bastien Jamet
- Médecine nucléaire, CHU Nantes, F-44000, Nantes, France
| | - Davide Bezzi
- Department of Nuclear Medicine, Alma Mater Studiorum, University of Bologna, Bologna. Italy
| | - Elena Zamagni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Philippe Moreau
- Hématologie, CHU Nantes, Nantes Université, Université Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France; and
| | - Cristina Nanni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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4
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Bezzi D, Ambrosini V, Nanni C. Clinical Value of FDG-PET/CT in Multiple Myeloma: An Update. Semin Nucl Med 2023; 53:352-370. [PMID: 36446644 DOI: 10.1053/j.semnuclmed.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/28/2022]
Abstract
FDG-PET/CT is a standardized imaging technique that has reached a great importance in the management of patients affected by Multiple Myeloma. It is proved, in fact, that it allows a deep evaluation of therapy efficacy and provides several prognostic indexes both at staging and after therapy. For this reason, it is now recognised as a gold standard for therapy assessment. Beside this, in reacent years FDG-PET/CT contribution to the understanding of Multiple Myeloma has progressively grown. Papers have been published analyzing the prognostic value of active disease volume measurement and standardization issues, the meaning of FDG positive paramedullary and extrameduallary disease, the prognostic impact of FDG positive minimal residual disease, the relation between focal lesions and clonal eterogenity of this disease and the comparison with whole body DWI-MR in terms of detection and therapy assessment. These newer aspects not of clinical impact yet, of FDG-PET/CT in Multiple Myeloma will be presented and discussed in this review.
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Affiliation(s)
- Davide Bezzi
- Nuclear Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Valentina Ambrosini
- Nuclear Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy; Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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5
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Santoni A, Simoncelli M, Franceschini M, Ciofini S, Fredducci S, Caroni F, Sammartano V, Bocchia M, Gozzetti A. Functional Imaging in the Evaluation of Treatment Response in Multiple Myeloma: The Role of PET-CT and MRI. J Pers Med 2022; 12:jpm12111885. [PMID: 36579605 PMCID: PMC9696713 DOI: 10.3390/jpm12111885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
Bone disease is among the defining characteristics of symptomatic Multiple Myeloma (MM). Imaging techniques such as fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) and magnetic resonance imaging (MRI) can identify plasma cell proliferation and quantify disease activity. This function renders these imaging tools as suitable not only for diagnosis, but also for the assessment of bone disease after treatment of MM patients. The aim of this article is to review FDG PET/CT and MRI and their applications, with a focus on their role in treatment response evaluation. MRI emerges as the technique with the highest sensitivity in lesions' detection and PET/CT as the technique with a major impact on prognosis. Their comparison yields different results concerning the best tool to evaluate treatment response. The inhomogeneity of the data suggests the need to address limitations related to these tools with the employment of new techniques and the potential for a complementary use of both PET/CT and MRI to refine the sensitivity and achieve the standards for minimal residual disease (MRD) evaluation.
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6
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Terao T, Matsue K. Progress of modern imaging modalities in multiple myeloma. Int J Hematol 2022; 115:778-789. [DOI: 10.1007/s12185-022-03360-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 12/26/2022]
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7
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Charalampous C, Kourelis T. Minimal Residual Disease Assessment in Multiple Myeloma Patients: Minimal Disease With Maximal Implications. Front Oncol 2022; 11:801851. [PMID: 35155198 PMCID: PMC8825476 DOI: 10.3389/fonc.2021.801851] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022] Open
Abstract
Multiple Myeloma (MM), the second most common hematologic malignancy, has been the target of many therapeutic advances over the past two decades. The introduction of novel agents, such as proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies, along with autologous hematopoietic stem cell transplantation (ASCT) in the current standard of care, has increased the median survival of myeloma patients significantly. Nevertheless, a curative treatment option continues to elude us, and MM remains an incurable disease, with patients relapsing even after achieving deep conventionally defined responses, underscoring the need for the development of sensitive methods that will allow for proper identification and management of the patients with a higher probability of relapse. Accurate detection of Minimal Residual Disease (MRD) from a bone marrow biopsy represents a relatively new approach of evaluating response to treatment with data showing clear benefit from obtaining MRD(-) status at any point of the disease course. As life expectancy for patients with MM continues to increase and deep responses are starting to become the norm, establishing and refining the role of MRD in the disease course is more relevant than ever. This review examines the different methods used to detect MRD and discusses future considerations regarding the implementation in day-to-day clinical practice and as a prospective primary endpoint for clinical trials.
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8
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Vicentini JRT, Bredella MA. Role of FDG PET in the staging of multiple myeloma. Skeletal Radiol 2022; 51:31-41. [PMID: 33813607 DOI: 10.1007/s00256-021-03771-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 02/02/2023]
Abstract
18F-Fluorodeoxyglucose (FDG) PET has been used for staging of hematologic malignancies for years. In multiple myeloma, this imaging modality can be used in many different scenarios, including initial staging, evaluation of treatment response, and investigation of residual disease or early relapse. FDG PET-CT has excellent diagnostic performance, similar to other advanced imaging modalities such as whole-body CT and MRI, and it is particularly helpful for the assessment of extramedullary disease. It also offers important prognostic information on survival and risk of relapse, both at baseline and after therapy. This review will cover the main applications, advantages, and limitations of FDG PET-CT in multiple myeloma and related clonal plasma cell proliferative disorders, such as smoldering multiple myeloma and plasmacytoma.
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Affiliation(s)
- Joao R T Vicentini
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, USA. .,Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street - YAW 6, Boston, MA, 02114, USA.
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9
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Nanni C, Zanoni L, Fanti S. Radiological and Nuclear Medicine Imaging of Multiple Myeloma. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Takahashi MES, Lorand-Metze I, de Souza CA, Mesquita CT, Fernandes FA, Carvalheira JBC, Ramos CD. Metabolic Volume Measurements in Multiple Myeloma. Metabolites 2021; 11:875. [PMID: 34940633 PMCID: PMC8703741 DOI: 10.3390/metabo11120875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 02/07/2023] Open
Abstract
Multiple myeloma (MM) accounts for 10-15% of all hematologic malignancies, as well as 20% of deaths related to hematologic malignant tumors, predominantly affecting bone and bone marrow. Positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (FDG-PET/CT) is an important method to assess the tumor burden of these patients. It is often challenging to classify the extent of disease involvement in the PET scans for many of these patients because both focal and diffuse bone lesions may coexist, with varying degrees of FDG uptake. Different metrics involving volumetric parameters and texture features have been proposed to objectively assess these images. Here, we review some metabolic parameters that can be extracted from FDG-PET/CT images of MM patients, including technical aspects and predicting MM outcome impact. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are volumetric parameters known to be independent predictors of MM outcome. However, they have not been adopted in clinical practice due to the lack of measuring standards. CT-based segmentation allows automated, and therefore reproducible, calculation of bone metabolic metrics in patients with MM, such as maximum, mean and standard deviation of the standardized uptake values (SUV) for the entire skeleton. Intensity of bone involvement (IBI) is a new parameter that also takes advantage of this approach with promising results. Other indirect parameters obtained from FDG-PET/CT images, such as visceral adipose tissue glucose uptake and subcutaneous adipose tissue radiodensity, may also be useful to evaluate the prognosis of MM patients. Furthermore, the use and quantification of new radiotracers can address different metabolic aspects of MM and may have important prognostic implications.
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Affiliation(s)
| | - Irene Lorand-Metze
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-888, Brazil;
| | - Carmino Antonio de Souza
- Center of Hematology and Hemotherapy, University of Campinas (UNICAMP), Campinas 13083-878, Brazil;
| | - Claudio Tinoco Mesquita
- Departamento de Radiologia, Faculdade Medicina, Universidade Federal Fluminense (UFF), Niterói 24033-900, Brazil;
- Hospital Universitário Antônio Pedro/EBSERH, Universidade Federal Fluminense (UFF), Niterói 24033-900, Brazil;
| | - Fernando Amorim Fernandes
- Hospital Universitário Antônio Pedro/EBSERH, Universidade Federal Fluminense (UFF), Niterói 24033-900, Brazil;
| | | | - Celso Dario Ramos
- Division of Nuclear Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-888, Brazil
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11
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Intensity of bone involvement: a quantitative 18F-FDG PET/CT evaluation for monitoring outcome of multiple myeloma. Nucl Med Commun 2021; 42:1375-1381. [PMID: 34347655 DOI: 10.1097/mnm.0000000000001470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The parameter intensity of bone involvement (IBI) was recently proposed to quantitatively assess patients with multiple myeloma using 18F-fluorodeoxyglucose-PET combined with computed tomography (18F-FDG PET/CT) images. Here, we aimed to calculate IBI variation (ΔIBI) between two consecutive PET/CT of the same patient and verified its relationship with a subjective visual analysis of the images and with clinical outcome. METHODS Consecutive whole-body 18F-FDG PET/CT performed to assess the outcomes of 29 patients diagnosed with multiple myeloma were retrospectively evaluated. ΔIBI was calculated after bone segmentation, using liver standardized uptake value as a threshold to determine metabolically active volumes in the skeleton. For each pair of consecutive PET/CTs, two nuclear medicine physicians classified visually the most recent image as PET-remission, PET-progression or PET-stable when compared to the previous examination. RESULTS The lowest ΔIBI was -1.27 and the highest was 0.29. PET-remission was related to ΔIBI <0 (median = -0.10; -1.27 to +0.03), while PET-progression was related to ΔIBI >0 (median = 0.02; -0.07 to +0.29). ΔIBI around zero was found in images classified as PET-stable (median = 0.00; -0.08 to +0.06). Significant difference in ΔIBI was found between the three groups. Multivariate stepwise analysis showed that IBI value at diagnostic PET/CT, serum calcium and percentage of plasma cells in the bone marrow are independent prognostic factors. CONCLUSION Delta IBI provides quantitative data for variations of 18F-FDG uptake in the bone marrow during the follow-up of the patients. In addition, higher IBI values at diagnosis are associated with a higher risk of patient's death.
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Husseini JS, Balza R, Evangelista L, Cañamaque LG, Catalano OA. PET/MR for evaluation of musculoskeletal malignancies. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Silva Y, Riedinger JM, Chrétien ML, Caillot D, Corre J, Guillen K, Cochet A, Tabouret-Viaud C, Loffroy R. Comparison between tumour metabolism derived from 18F-FDG PET/CT and accurate cytogenetic stratification in newly diagnosed multiple myeloma patients. Quant Imaging Med Surg 2021; 11:4299-4309. [PMID: 34603985 DOI: 10.21037/qims-21-85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/14/2021] [Indexed: 12/27/2022]
Abstract
Background 18F-fluorodeoxyglucose positron emission tomography integrated with computed tomography (18F-FDG PET/CT) is a useful tool for baseline staging in newly diagnosed multiple myeloma (MM) but also for prognostic stratification. This monocentric retrospective study aimed at examining the relation between baseline tumour metabolism assessed by 18F-FDG PET/CT and linear predictor (LP) score, a new cytogenetic stratification score. Methods From March 2012 to March 2019, 57 patients with newly diagnosed MM addressed to our institution for baseline 18F-FDG PET/CT were included. LP score was determined on systematic iliac crest bone marrow samples. Obtained on CD138-sorted bone marrow plasma cells, this recent composite cytogenetic stratification is a 6-marker based weighted score using fluorescence in situ hybridization (FISH) ± single nucleotide polymorphism (SNP) arrays. We compared quantitative metabolic parameters and LP score using a Kruskal-Wallis test and visual suspicion of diffuse bone marrow involvement (DBI; based on hepatic background as threshold of positivity) and cytogenetic data using a Chi-squared test. Results The distribution of total metabolic tumour volume (TMTV) and total lesion glycolysis (TLG) values among the three LP score categories was almost stochastic, with no significant association (P=0.70). Additionally, no significant association between TMTV/TLG and any of the six cytogenetic abnormalities included in LP score calculation. A significant association was found between visual high suspicion of DBI and LP score (P=0.036), and between this visual parameter and the presence of 1q gain (P=0.049). Conclusions There is no significant association between quantitative metabolic parameters assessed with 18F-FDG PET/CT and LP score in patients with newly diagnosed MM, suggesting a potential complementarity of these biomarkers for prognostic stratification. A significant association was found between high visual suspicion of DBI and LP score.
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Affiliation(s)
- Yannick Silva
- Department of Nuclear Medicine, Unicancer-Georges François Leclerc Cancer Center, Dijon, France
| | - Jean-Marc Riedinger
- Department of Nuclear Medicine, Unicancer-Georges François Leclerc Cancer Center, Dijon, France
| | | | - Denis Caillot
- Department of Clinical Haematology, François-Mitterrand University Hospital, Dijon, France
| | - Jill Corre
- Unit for Genomics in Myeloma, Institut Universitaire du Cancer-Oncopole, Toulouse, France.,Centre de Recherches en Cancérologie de Toulouse, INSERMU1037, Toulouse, France
| | - Kévin Guillen
- Department of Diagnostic and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Alexandre Cochet
- Department of Nuclear Medicine, Unicancer-Georges François Leclerc Cancer Center, Dijon, France.,ImViA Laboratory-EA 7535, University of Bourgogne/Franche-Comté, Besançon, France
| | - Claire Tabouret-Viaud
- Department of Nuclear Medicine, Unicancer-Georges François Leclerc Cancer Center, Dijon, France
| | - Romaric Loffroy
- Department of Diagnostic and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
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14
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Spinnato P, Filonzi G, Conficoni A, Facchini G, Ponti F, Sambri A, De Paolis M, Cavo M, Salizzoni E, Nanni C. Skeletal Survey in Multiple Myeloma: Role of Imaging. Curr Med Imaging 2021; 17:956-965. [PMID: 33573573 DOI: 10.2174/1573405617666210126155129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/23/2020] [Accepted: 12/18/2020] [Indexed: 11/22/2022]
Abstract
Bone disease is the hallmark of multiple myeloma. Skeletal lesions are evaluated to establish the diagnosis, to choose the therapies and also to assess the response to treatments. Due to this, imaging procedures play a key role in the management of multiple myeloma. For decades, conventional radiography has been the standard imaging modality. Subsequently, advances in the treatment of multiple myeloma have increased the need for an accurate evaluation of skeletal disease. The introduction of new high performant imaging tools, such as whole-body lowdose computed tomography, different types of magnetic resonance imaging studies, and 18F-fluorodeoxyglucose positron emission tomography, replaced the conventional radiography. In this review, we analyze the diagnostic potentials, indications of use, and applications of the imaging tools nowadays available. Whole-body low-dose CT should be considered as the imaging modality of choice for the initial assessment of multiple myeloma lytic bone lesions. MRI is the gold-standard for the detection of bone marrow involvement, while PET/CT is the preferred technique in the assessment of response to therapy. Both MRI and PET/CT are able to provide prognostic information.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alberto Conficoni
- Neuroradiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Sambri
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Michele Cavo
- "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Eugenio Salizzoni
- Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, MNM AOU S.Orsola-Malpighi, Bologna, Italy
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15
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Abstract
Hematologic malignancies are a broad category of cancers arising from the lymphoid and myeloid cell lines. The 2016 World Health Organization classification system incorporated molecular markers as part of the diagnostic criteria and includes more than 100 subtypes. This article focuses on the subtypes for which imaging with positron emission tomography/computed tomography (PET/CT) has become an integral component of the patient's evaluation, that is, lymphoma and multiple myeloma. Leukemia and histiocytic and dendritic cell neoplasms are also discussed as these indications for PET/CT are less common, but increasingly seen in clinic.
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16
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Mesguich C, Latrabe V, Hulin C, Lascaux A, Bordenave L, Hindié E, Marit G. Prospective Comparison of 18-FDG PET/CT and Whole-Body MRI with Diffusion-Weighted Imaging in the Evaluation of Treatment Response of Multiple Myeloma Patients Eligible for Autologous Stem Cell Transplant. Cancers (Basel) 2021; 13:cancers13081938. [PMID: 33923781 PMCID: PMC8074107 DOI: 10.3390/cancers13081938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
To compare the prognostic values of 18-FDG PET/CT (FDG-PET) and Whole-Body MRI with Diffusion-Weighted Imaging (WB-DW-MRI) in the evaluation of treatment response of Multiple Myeloma (MM) patients eligible for ASCT. Thirty patients with newly diagnosed MM prospectively underwent FDG-PET and WB-DW-MRI at baseline, after induction chemotherapy and after ASCT. Response on WB-DW-MRI was evaluated with the MY-RADS criteria. FDG-PET was considered positive if residual uptake was superior to liver uptake. Imaging results were not used for treatment modification. The impact of imaging results on PFS was analyzed. After a median follow-up of 32 months, 10 patients relapsed. With WB-DW-MRI, post-induction examination was positive in 3/25 and post-ASCT examination was positive in 3/27 patients. However, neither study showed prognostic impact on PFS. FDG-PET was positive in 5/22 post-induction and 3/26 patients post-ASCT, respectively. Positivity of FDG-PET, post-induction or post-ASCT, was associated with a shorter PFS (post-induction: median PFS 19 months vs. not reached, log-rank p = 0.0089; post-ASCT: median PFS 18 months vs. not reached, log-rank p = 0.0005). Preliminary results from this small, single-center, prospective study show that, whether performed post-induction or post-ASCT, FDG-PET has a higher prognostic value than WB-DW-MRI for treatment response evaluation of newly diagnosed MM.
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Affiliation(s)
- Charles Mesguich
- Nuclear Medicine Department, CHU Bordeaux, F-33000 Bordeaux, France; (L.B.); (E.H.)
- INSERM U1035, University of Bordeaux, F-33000 Bordeaux, France;
- Correspondence: ; Tel.: +33-5-57656335
| | - Valérie Latrabe
- Radiology Department, CHU Bordeaux, F-33000 Bordeaux, France;
| | - Cyrille Hulin
- Haematology Department, CHU Bordeaux, F-33000 Bordeaux, France; (C.H.); (A.L.)
| | - Axelle Lascaux
- Haematology Department, CHU Bordeaux, F-33000 Bordeaux, France; (C.H.); (A.L.)
| | - Laurence Bordenave
- Nuclear Medicine Department, CHU Bordeaux, F-33000 Bordeaux, France; (L.B.); (E.H.)
| | - Elif Hindié
- Nuclear Medicine Department, CHU Bordeaux, F-33000 Bordeaux, France; (L.B.); (E.H.)
| | - Gerald Marit
- INSERM U1035, University of Bordeaux, F-33000 Bordeaux, France;
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17
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Comparison of [ 18F]FDG PET/CT and MRI for Treatment Response Assessment in Multiple Myeloma: A Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11040706. [PMID: 33920809 PMCID: PMC8071116 DOI: 10.3390/diagnostics11040706] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
The present study was designed to assess the additional value of 2-deoxy-2[18F]fluoro-D-glucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) to magnetic resonance imaging (MRI) in the treatment response assessment of multiple myeloma (MM). We performed a meta-analysis of all available studies to compare the detectability of treatment response of [18F]FDG PET/CT and MRI in treated MM. We defined detecting a good therapeutic effect as positive, and residual disease as negative. We determined the sensitivities and specificities across studies, calculated the positive and negative likelihood ratios (LR), and made summary receiver operating characteristic curves (SROC) using hierarchical regression models. The pooled analysis included six studies that comprised 278 patients. The respective performance characteristics (95% confidence interval (CI)) of [18F]FDG PET/CT and MRI were as follows: sensitivity of 80% (56% to 94%) and 25% (19% to 31%); specificity of 58% (44% to 71%) and 83% (71% to 91%); diagnostic odds ratio (DOR) of 6.0 (3.0-12.0) and 1.7 (0.7-2.7); positive LR of 1.8 (1.3-2.4) and 1.4 (0.7-2.7); and negative LR of 0.33 (0.21-0.53) and 0.81 (0.62-1.1). In the respective SROC curves, the area under the curve was 0.77 (SE, 0.038) and 0.59 (SE, 0.079) and the Q* index was 0.71 and 0.57. Compared with MRI, [18F]FDG PET/CT had higher sensitivity and better DOR and SROC curves. Compared with MRI, [18F]FDG PET/CT had greater ability to detect the treatment assessment of MM.
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18
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Spinnato P, Sambri A, Fujiwara T, Ceccarelli L, Clinca R, Medellin MR, Paolis MD, Donati DM, Bianchi G. Myxofibrosarcoma: Clinical and Prognostic Value of MRI Features. Curr Med Imaging 2021; 17:217-224. [PMID: 32729425 DOI: 10.2174/1573405616999200729152135] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/02/2020] [Accepted: 05/13/2020] [Indexed: 12/16/2022]
Abstract
Myxofibrosarcoma is one of the most common soft tissue sarcomas in the elderly. It is characterized by an extremely high rate of local recurrence, higher than other soft tissue tumors, and a relatively low risk of distant metastases.Magnetic resonance imaging (MRI) is the imaging modality of choice for the assessment of myxofibrosarcoma, which plays a key role in the preoperative setting of these patients. MRI features associated with the high risk of local recurrence are: high myxoid matrix content (water-like appearance of the lesions), high grade of contrast enhancement and presence of an infiltrative pattern ("tail sign"). On the other hand, MRI features associated with worse sarcoma specific survival are: large size of the lesion, deep location, high grade of contrast enhancement. Recognizing the above-mentioned imaging features of myxofibrosarcoma may be helpful in stratifying the risk for local recurrence and disease-specific survival. Moreover, the surgical planning should be adjusted according to the MRI features.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Sambri
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tomohiro Fujiwara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Luca Ceccarelli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberta Clinca
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | - Davide M Donati
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Bianchi
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Positron Emission Tomography (PET) Imaging of Multiple Myeloma in a Post-Treatment Setting. Diagnostics (Basel) 2021; 11:diagnostics11020230. [PMID: 33546455 PMCID: PMC7913723 DOI: 10.3390/diagnostics11020230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/23/2021] [Accepted: 01/29/2021] [Indexed: 12/01/2022] Open
Abstract
2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (FDG PET/CT) has an established clinical value in the diagnosis and initial staging of multiple myeloma (MM). In the last ten years, a vast body of literature has shown that this tool can also be of high relevance for monitoring therapy responses, making it the recommended imaging approach in this field. Starting from the strengths and weaknesses of radiological imaging in MM, the present review aims to analyze FDG PET/CT’s current clinical value focusing on therapy response assessment and objective interpretation criteria for therapy monitoring. Given the potential occurrence of patients with MM showing non-FDG-avid bone disease, new opportunities can be provided by non-FDG PET tracers. Accordingly, the potential role of non-FDG PET tracers in this setting has also been discussed.
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20
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Zuo X, Liu D. Progress in the application of minimal residual disease detection in multiple myeloma. J Hematop 2021. [DOI: 10.1007/s12308-020-00436-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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21
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Belgioia L, Vagge S, Tagliafico A, Corvò R. How Can Imaging Help the Radiation Oncologist in Multiple Myeloma Treatment. ACTA ACUST UNITED AC 2020; 57:medicina57010020. [PMID: 33379406 PMCID: PMC7823586 DOI: 10.3390/medicina57010020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 12/16/2022]
Abstract
Multiple myeloma is an incurable malignant tumor of plasma cells of the bone marrow; most patients present a disseminated disease with important bone involvement. Even though a chemotherapy-based approach is the major treatment, radiotherapy often has a supportive role for symptom relief but also a radical role for patients with indolent disease or localized forms. In both cases imaging is the basis for treatment planning and for correct patient classification. This paper aims to describe and summarize how radiation oncologists could use imaging information to personalize the treatment for each patient.
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Affiliation(s)
- Liliana Belgioia
- Health Science Department (DISSAL), University of Genoa, 16132 Genoa, Italy; (A.T.); (R.C.)
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- Correspondence: ; Tel.: +39-010-555-8050
| | - Stefano Vagge
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Alberto Tagliafico
- Health Science Department (DISSAL), University of Genoa, 16132 Genoa, Italy; (A.T.); (R.C.)
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Renzo Corvò
- Health Science Department (DISSAL), University of Genoa, 16132 Genoa, Italy; (A.T.); (R.C.)
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
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Virtual calcium-suppression in dual energy computed tomography predicts metabolic activity of focal MM lesions as determined by fluorodeoxyglucose positron-emission-tomography. Eur J Radiol 2020; 135:109502. [PMID: 33388530 DOI: 10.1016/j.ejrad.2020.109502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/07/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Recent studies showed that dual energy CT (DECT) allows for detection of bone marrow infiltration in multiple myeloma (MM) by obtaining virtual non-calcium (VNCa) images. This feasibility study investigated, if VNCa imaging might discriminate metabolically active, focal lesions in MM against avital lesions in MM patients, considering fluorodeoxyglucose positron-emission-tomography CT (FDG PET/CT) as the standard of reference. METHOD The study included 60 osteolytic lesions in 10 consecutive low-dose whole body CT scans of patients with MM, who underwent both FDG PET/CT and DECT at a tertiary care university hospital. Circular ROI measurements were performed in predefined lesions on the monoenergetic CT (MECT) and VNCa images by three blinded radiologists. Each lesion was rated vital or avital by a blinded specialist of nuclear medicine, based on their FDG metabolism. RESULTS Each of the three readers could separate FDG PET/CT negative and positive MM lesions when analyzing the VNCa images, while MECT did not show a significant difference. Best results were yielded by high calcium suppression with excellent inter-rater reliability (average sensitivity 0.91, specificity 0.88, cutoff -46.9 HU), followed by medium and low calcium suppression. CONCLUSIONS In contrast to MECT imaging, VNCa imaging in DECT appears to be feasible to assess metabolic activity of focal MM lesions as defined by the standard of reference, FDG PET/CT. Considering the higher cost and radiation exposure of FDG PET/CT, DECT VNCa imaging might develop to be the modality of choice to assess metabolic activity of focal MM lesions.
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23
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Mesguich C, Hulin C, Latrabe V, Lascaux A, Bordenave L, Hindié E, Marit G. Prospective comparison of 18-FDG PET/CT and whole-body diffusion-weighted MRI in the assessment of multiple myeloma. Ann Hematol 2020; 99:2869-2880. [PMID: 32951093 DOI: 10.1007/s00277-020-04265-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 09/07/2020] [Indexed: 12/21/2022]
Abstract
Magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18FDG 18F-FDG PET-CT) are standard procedures for staging multiple myeloma (MM). Diffusion-weighted sequences applied to whole-body MRI (WB-DWI) improve its sensitivity. We compared the number of MM bone focal lesions (FLs) detected by 18F-FDG PET-CT and WB-DWI and evaluated the diagnostic performance of 18F-FDG PET-CT for diffuse infiltration. Thirty newly diagnosed MM patients prospectively underwent 18F-FDG PET-CT and WB-DWI. The criteria for skeletal region positivity were ≥ 1 focal bone lesions (FLs) and/or diffuse disease. MRI with the MY-RADS criteria was used as a reference standard for the diagnosis of diffuse infiltration. 18F-FDG PET-CT and WB-DWI were both interpreted as positive in 28/30 patients with an agreement of 1.00 (95% CI 0.77-1.00) between the two methods. The mean numbers of FLs were 16.7 detected by 18F-FDG PET-CT and 23.9 detected by WB-DWI (P = 0.028). WB-DWI detected more FLs in the skull (P = 0.001) and spine (P = 0.006). Agreement assessed using the prevalence and bias-corrected kappa index was moderate (0.40-0.60) for the spine, sternum-ribs and upper limbs and substantial (0.60-0.80) for the pelvis and lower limbs. As regards the diagnosis of diffuse bone marrow infiltration, the sensitivity, specificity and accuracy of 18F-FDG PET-CT were 0.75, 0.79 and 0.77, respectively. Although WB-DWI detected more FLs than did 18F-FDG PET-CT, there was no difference in the detection of bone disease on a per-patient basis. 18F-FDG PET-CT showed high performance, including for evaluation of diffuse infiltration.
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Affiliation(s)
- Charles Mesguich
- Nuclear Medicine Department, CHU Bordeaux, 33000, Bordeaux, France. .,INSERM U1035, University of Bordeaux, Bordeaux, France.
| | - Cyrille Hulin
- Haematology Department, CHU Bordeaux, 33000, Bordeaux, France
| | | | - Axelle Lascaux
- Haematology Department, CHU Bordeaux, 33000, Bordeaux, France
| | | | - Elif Hindié
- Nuclear Medicine Department, CHU Bordeaux, 33000, Bordeaux, France
| | - Gerald Marit
- INSERM U1035, University of Bordeaux, Bordeaux, France
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24
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Zhong X, Diao W, Zhao C, Jia Z. Fluorodeoxyglucose-avid focal lesions and extramedullary disease on 18F-FDG PET/computed tomography predict the outcomes of newly diagnosed symptomatic multiple myeloma patients. Nucl Med Commun 2020; 41:950-958. [PMID: 32796484 DOI: 10.1097/mnm.0000000000001242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate whether the number of fluorodeoxyglucose (FDG)-avid focal lesions and the presence of extramedullary disease (EMD) on F-FDG PET/computed tomography (PET/CT) can predict the outcomes of newly diagnosed symptomatic multiple myeloma patients. METHODS We performed a meta-analysis to research the prognostic significance of focal lesions and EMD on F-FDG PET/CT for overall survival (OS) and progression-free survival (PFS) using a fix-effected model. The PubMed, EMBASE and Cochrane Library databases were searched. Manual searches were also conducted. RESULTS Of the 398 citations identified in the original search, 13 original studies with a total of 2823 patients met the inclusion criteria. The pooled hazard ratios of focal lesions were 1.63 [95% confidence interval (CI) 1.41-1.86, P = 0.442, I= 0%] for PFS and 2.15 (95% CI 1.74-2.57, P = 0.615, I= 0%) for OS. The pooled hazard ratios of EMD were 1.89 (95% CI 1.44-2.34, P = 0.497, I= 0%) for PFS and 1.91 (95% CI 1.08-2.73, P = 0.182, I= 29.6%) for OS. The results of the subgroup analysis showed the same trend. No significant heterogeneity was observed among studies. CONCLUSION This meta-analysis demonstrated that patients with a higher number of FDG-avid focal lesions and EMD on PET/CT may experience a higher risk for progression and a shorter survival time than those with a few focal lesions and no EMD.
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Affiliation(s)
- Xiao Zhong
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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25
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Yoon JH, Yu MH, Hur BY, Park CM, Lee JM. Detection of distant metastases in rectal cancer: contrast-enhanced CT vs whole body MRI. Eur Radiol 2020; 31:104-111. [PMID: 32789755 DOI: 10.1007/s00330-020-07149-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/16/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of whole-body MRI (WB-MRI) including contrast-enhanced T1-weighted imaging (T1WI) and WB-DWI in rectal cancer initial staging. METHODS This retrospective study was approved by the IRB and the requirement of informed consent was waived. From September 2013 to Feb 2015, patients who underwent rectal MRI including WB-MRI, as well as chest and abdominopelvic CT for initial staging, were included. WB-MRI consisted of contrast-enhanced T1-weighted imaging and DWI covering neck to the pelvis. Three radiologists reviewed WB-MRI and CECT independently for the M-classification. The diagnostic performance of CECT and WB-MRI was compared using a reference standard incorporating histology, FDG-PET results, and clinical follow-up. RESULTS A total of 139 patients (male:female = 89:50, mean age 63.2 ± 12.4 years) were included and metastasis was observed in 15.2% (21/139). WB-MRI showed significantly higher specificity (96.7% [114/118] vs. 85.6% [101/118], p = 0.001) and positive predictive value (PPV) (80% [16/20] vs. 48.5% [16/33], p < 0.001) than CECT. However, there were no significant differences in sensitivity (76.2% [16/21] for both, p > 0.99) and negative predictive value (95.3% [101/106] at CECT vs. 95.8% [114/119] at WB-MRI, p = 0.77) between CECT and WB-MRI. CONCLUSIONS WB-MRI showed higher specificity and PPV than CECT in newly diagnosed rectal cancer. Adding WB-MRI to standard rectal MRI is a feasible option for initial staging workup of rectal cancer. KEY POINTS • WB-MRI showed a higher specificity and PPV than those of CECT for identifying metastasis at initial staging workup of rectal cancer. • WB-MRI and CECT did not show a significant difference in sensitivity and NPV for the M-classification. • WB-MRI can be used as an alternative to CECT for the initial M-classification modality in newly diagnosed rectal cancer.
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Affiliation(s)
- Jeong Hee Yoon
- Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
| | - Mi Hye Yu
- Radiology, Radiology Department, Konkuk University School of Medicine, Seoul, 05030, Republic of Korea
| | - Bo Yun Hur
- Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, 06236, Republic of Korea
| | - Chang Min Park
- Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
| | - Jeong Min Lee
- Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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26
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Takasu M, Kondo S, Akiyama Y, Takahashi Y, Maeda S, Baba Y, Kawase T, Ichinohe T, Awai K. Assessment of early treatment response on MRI in multiple myeloma: Comparative study of whole-body diffusion-weighted and lumbar spinal MRI. PLoS One 2020; 15:e0229607. [PMID: 32106239 PMCID: PMC7046272 DOI: 10.1371/journal.pone.0229607] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/10/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives To compare remission status at completion of chemotherapy for multiple myeloma (MM) with changes in total diffusion volume (tDV) calculated from whole-body diffusion-weighted imaging (WB-DWI) and fat fraction (FF) of lumbar bone marrow (BM) by modified Dixon Quant (mDixon Quant) soon after induction of chemotherapy, and to assess the predictive value of MRI. Methods Fifty patients (mean age, 66.9 ± 10.5 years) with symptomatic myeloma were examined before and after two cycles of chemotherapy. From WB-DWI data, tDV was obtained with the threshold for positive BM involvement. Mean FF was calculated from lumbar BM using the mDixon Quant sequence. At the completion of chemotherapy, patients were categorized into a CR/very good PR (VGPR) group (n = 15; mean age, 67.6 ± 10.3 years) and a PR, SD or PD group (n = 35; mean age, 69.1 ± 8.6 years). ROC curves were plotted to assess performance in predicting achievement of CR/VGPR. Results At second examination, serum M protein, β2-microglobulin, and tDV were significantly decreased and hemoglobin, mean ADC, and FF were significantly increased in the CR/VGPR group and serum M protein was significantly increased in the PR/SD/PD group. The general linear model demonstrated that percentage changes in FF and M protein contributed significantly to achieving CR/VGPR (P = 0.02, P = 0.04, respectively). AUCs of ROC curves were 0.964 for FF and 0.847 for M protein. Conclusions Early change in FF of lumbar BM and serum M protein soon after induction of chemotherapy contributed significantly to prediction of CR/VGPR.
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Affiliation(s)
- Miyuki Takasu
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
- * E-mail:
| | - Shota Kondo
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Akiyama
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Takahashi
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Maeda
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Takakazu Kawase
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Pan Q, Cao X, Luo Y, Li J, Feng J, Li F. Chemokine receptor-4 targeted PET/CT with 68Ga-Pentixafor in assessment of newly diagnosed multiple myeloma: comparison to 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging 2019; 47:537-546. [PMID: 31776631 DOI: 10.1007/s00259-019-04605-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/07/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE 18F-FDG PET/CT has some limitations in the evaluation of multiple myeloma (MM). Since chemokine receptor-4 is overexpressed in MM, we perform a prospective cohort study to compare the performance of 68Ga-Pentixafor and 18F-FDG PET/CT in newly diagnosed MM. METHODS Thirty patients with newly diagnosed MM were recruited. All patients underwent 68Ga-Pentixafor and18F-FDG PET/CT within 1 week after enrollment. A positive PET/CT was defined as the presence of focal PET-positive lesions in bone marrow or diffuse bone marrow patterns (uptake > liver). Bone marrow uptake values in 68Ga-Pentixafor and18F-FDG PET/CT (total bone marrow glycolysis [TBmGFDG], total bone marrow uptake with 68Ga-Pentixafor [TBmUCXCR4], total bone marrow volume [TBmV], SUVmean, and SUVmax) were obtained by drawing total bone marrow volume of interest on PET/CT. The positive rates of the PET/CT scans were statistically compared, and the correlation between quantitative bone marrow uptake values and clinical characteristics, laboratory findings, and staging was analyzed. RESULTS 68Ga-Pentixafor PET/CT had a higher positive rate than 18F-FDG PET/CT in recruited patients (93.3 vs. 53.3%, p = 0.0005). In quantitative analysis, bone marrow uptake values in 68Ga-Pentixafor (TBmUCXCR4, SUVmax, and SUVmean) were positively correlated with end organ damage, staging, and laboratory biomarkers related to tumor burden including serum β2-microglobulin, serum free light chain, and 24-h urine light chain (p < 0.05). In 18F-FDG PET/CT, only the SUVmean of total bone marrow was positively correlated with serum free light chain and 24-h urine light chain (p < 0.05). CONCLUSIONS 68Ga-Pentixafor PET/CT is promising in assessment of newly diagnosed MM. TRIAL REGISTRATION NUMBER NCT03436342.
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Affiliation(s)
- Qingqing Pan
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China
| | - Xinxin Cao
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China
| | - Yaping Luo
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China. .,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China.
| | - Jian Li
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China
| | - Jun Feng
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China
| | - Fang Li
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China
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28
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Detappe A, Reidy M, Yu Y, Mathieu C, Nguyen HVT, Coroller TP, Lam F, Jarolim P, Harvey P, Protti A, Nguyen QD, Johnson JA, Cremillieux Y, Tillement O, Ghobrial IM, Ghoroghchian PP. Antibody-targeting of ultra-small nanoparticles enhances imaging sensitivity and enables longitudinal tracking of multiple myeloma. NANOSCALE 2019; 11:20485-20496. [PMID: 31650133 DOI: 10.1039/c9nr06512a] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Monitoring malignant progression and disease recurrence post-therapy are central challenges to improving the outcomes of patients with multiple myeloma (MM). Whereas current detection methods that rely upon bone marrow examination allow for precise monitoring of minimal residual disease and can help to elucidate clonal evolution, they do not take into account the spatial heterogeneity of the tumor microenvironment. As such, they are uninformative as to the localization of malignant plasma cells and may lead to false negative results. With respect to the latter challenge, clinically-available imaging agents are neither sufficiently sensitive nor specific enough to detect minute plasma cell populations. Here, we sought to explore methods by which to improve detection of MM cells within their natural bone marrow environment, using whole-animal magnetic resonance imaging to longitudinally monitor early-stage disease as well as to enhance tumor detection after systemic therapy. We conducted a proof-of-concept study to demonstrate that ultra-small (<5 nm) gadolinium-containing nanoparticles bound to full-length antibodies against the B-cell maturation antigen (BCMA) exhibit rapid tumor uptake followed by renal clearance, improving the signal-to-noise ratio for MM detection beyond levels that are currently afforded by other FDA-approved clinical imaging modalities. We anticipate that when combined with bone marrow or blood biopsy, such imaging constructs could help to augment the effective management of patients with MM.
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Affiliation(s)
- Alexandre Detappe
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA. and Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA. and Centre Paul Strauss, 3 rue de la porte de l'hôpital, 67000 Strasbourg, France
| | - Mairead Reidy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA. and Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Yingjie Yu
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA.
| | - Clelia Mathieu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA. and Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Hung V-T Nguyen
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Thibaud P Coroller
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA and Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Fred Lam
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA. and Clinical Scholar Program, Division of Neurosurgery, McMaster University, 237 Barton St East, Hamilton General Hospital, Hamilton ON, L8L 2X2, Canada
| | - Petr Jarolim
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA and Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - Peter Harvey
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Andrea Protti
- Lurie Family Imaging Center, Department of Radiology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Quang-De Nguyen
- Lurie Family Imaging Center, Department of Radiology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Jeremiah A Johnson
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Yannick Cremillieux
- Institut des Sciences Moléculaires, Université de Bordeaux, UMR CNRS 5255, 33076 Bordeaux, France
| | - Olivier Tillement
- Institut Lumière Matière, UMR 5306 Université Lyon1-CNRS, Université de Lyon, 69622 Villeurbanne Cedex, France
| | - Irene M Ghobrial
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA. and Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - P Peter Ghoroghchian
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA. and Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA.
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29
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Takahashi MES, Mosci C, Souza EM, Brunetto SQ, Etchebehere E, Santos AO, Camacho MR, Miranda E, Lima MCL, Amorim BJ, de Souza C, Pericole FV, Lorand-Metze I, Ramos CD. Proposal for a Quantitative 18F-FDG PET/CT Metabolic Parameter to Assess the Intensity of Bone Involvement in Multiple Myeloma. Sci Rep 2019; 9:16429. [PMID: 31712729 PMCID: PMC6848137 DOI: 10.1038/s41598-019-52740-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022] Open
Abstract
Many efforts have been made to standardize the interpretation of 18F-FDG PET/CT in multiple myeloma (MM) with qualitative visual analysis or with quantitative metabolic parameters using various methods for lesion segmentation of PET images. The aim of this study was to propose a quantitative method for bone and bone marrow evaluation of 18F-FDG PET/CT considering the extent and intensity of bone 18F-FDG uptake: Intensity of Bone Involvement (IBI). Whole body 18F-FDG PET/CT of 59 consecutive MM patients were evaluated. Compact bone tissue was segmented in PET images using a global threshold for HU of the registered CT image. A whole skeleton mask was created and the percentage of its volume with 18F-FDG uptake above hepatic uptake was calculated (Percentage of Bone Involvement - PBI). IBI was defined by multiplying PBI by mean SUV above hepatic uptake. IBI was compared with visual analysis performed by two experienced nuclear medicine physicians. IBI calculation was feasible in all images (range:0.00–1.35). Visual analysis categorized PET exams into three groups (negative/mild, moderate and marked bone involvement), that had different ranges of IBI (multi comparison analysis, p < 0.0001). There was an inverse correlation between the patients’ hemoglobin values and IBI (r = −0.248;p = 0.02). IBI score is an objective measure of bone and bone marrow involvement in MM, allowing the categorization of patients in different degrees of aggressiveness of the bone disease. The next step is to validate IBI in a larger group of patients, before and after treatment and in a multicentre setting.
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Affiliation(s)
- Maria E S Takahashi
- School of Medical Sciences, University of Campinas, Campinas, Brazil.,Gleb Wataghin Physics Institute, University of Campinas, Campinas, Brazil
| | - Camila Mosci
- Division of Nuclear Medicine, University of Campinas, Campinas, Brazil
| | - Edna M Souza
- Division of Nuclear Medicine, University of Campinas, Campinas, Brazil.,Center of Biomedical Engineering, University of Campinas, Campinas, Brazil
| | - Sérgio Q Brunetto
- Division of Nuclear Medicine, University of Campinas, Campinas, Brazil.,Center of Biomedical Engineering, University of Campinas, Campinas, Brazil
| | - Elba Etchebehere
- Division of Nuclear Medicine, University of Campinas, Campinas, Brazil
| | - Allan O Santos
- Division of Nuclear Medicine, University of Campinas, Campinas, Brazil
| | - Mariana R Camacho
- School of Medical Sciences, University of Campinas, Campinas, Brazil.,Division of Nuclear Medicine, University of Campinas, Campinas, Brazil
| | - Eliana Miranda
- Center of Hematology and Hemotherapy, University of Campinas, Campinas, Brazil
| | - Mariana C L Lima
- Division of Nuclear Medicine, University of Campinas, Campinas, Brazil
| | - Barbara J Amorim
- Division of Nuclear Medicine, University of Campinas, Campinas, Brazil
| | - Carmino de Souza
- School of Medical Sciences, University of Campinas, Campinas, Brazil.,Center of Hematology and Hemotherapy, University of Campinas, Campinas, Brazil
| | - Fernando V Pericole
- Center of Hematology and Hemotherapy, University of Campinas, Campinas, Brazil
| | - Irene Lorand-Metze
- School of Medical Sciences, University of Campinas, Campinas, Brazil.,Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Celso D Ramos
- School of Medical Sciences, University of Campinas, Campinas, Brazil. .,Division of Nuclear Medicine, University of Campinas, Campinas, Brazil.
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30
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Kogan F, Broski SM, Yoon D, Gold GE. Applications of PET-MRI in musculoskeletal disease. J Magn Reson Imaging 2019; 48:27-47. [PMID: 29969193 DOI: 10.1002/jmri.26183] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/19/2018] [Indexed: 12/26/2022] Open
Abstract
New integrated PET-MRI systems potentially provide a complete imaging modality for diagnosis and evaluation of musculoskeletal disease. MRI is able to provide excellent high-resolution morphologic information with multiple contrast mechanisms that has made it the imaging modality of choice in evaluation of many musculoskeletal disorders. PET offers incomparable abilities to provide quantitative information about molecular and physiologic changes that often precede structural and biochemical changes. In combination, hybrid PET-MRI can enhance imaging of musculoskeletal disorders through early detection of disease as well as improved diagnostic sensitivity and specificity. The purpose of this article is to review emerging applications of PET-MRI in musculoskeletal disease. Both clinical applications of malignant musculoskeletal disease as well as new opportunities to incorporate the molecular capabilities of nuclear imaging into studies of nononcologic musculoskeletal disease are discussed. Lastly, we discuss some of the technical considerations and challenges of PET-MRI as they specifically relate to musculoskeletal disease. LEVEL OF EVIDENCE 5 TECHNICAL EFFICACY: Stage 3 J. Magn. Reson. Imaging 2018;48:27-47.
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Affiliation(s)
- Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California, USA
| | | | - Daehyun Yoon
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA.,Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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31
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Evolving Roles of Fluorodeoxyglucose and Sodium Fluoride in Assessment of Multiple Myeloma Patients. PET Clin 2019; 14:341-352. [DOI: 10.1016/j.cpet.2019.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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32
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Madduri D, Barlogie B. PET-Computed Tomography in Myeloma. PET Clin 2019; 14:411-418. [DOI: 10.1016/j.cpet.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders. Lancet Oncol 2019; 20:e302-e312. [DOI: 10.1016/s1470-2045(19)30309-2] [Citation(s) in RCA: 211] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 02/08/2023]
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34
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Raynor WY, Zadeh MZ, Kothekar E, Yellanki DP, Alavi A. Evolving Role of PET-Based Novel Quantitative Techniques in the Management of Hematological Malignancies. PET Clin 2019; 14:331-340. [PMID: 31084773 DOI: 10.1016/j.cpet.2019.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
"The role of 18F-fluorodeoxyglucose PET/computed tomography in hematological malignancies continues to expand in disease diagnosis, staging, and management. A key advantage of PET over other imaging modalities is its ability to quantify tracer uptake, which can be used to determine degree of disease activity. Although tracer uptake with PET is conventionally measured in focal lesions, novel quantitative techniques are being investigated that set objective protocols and produce robust parameters that represent total disease activity portrayed by PET. This article discusses recent advances in PET quantification that can improve reliability and accuracy of characterizing hematological malignancies."
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Affiliation(s)
- William Y Raynor
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Drexel University College of Medicine, 2900 W Queen Lane, Philadelphia, PA 19129, USA
| | - Mahdi Zirakchian Zadeh
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Esha Kothekar
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Dani P Yellanki
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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35
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Withofs N, Beguin Y, Cousin F, Tancredi T, Simoni P, Alvarez-Miezentseva V, De Prijck B, Hafraoui K, Bonnet C, Baron F, Hustinx R, Caers J. Dual-tracer PET/CT scan after injection of combined [ 18 F]NaF and [ 18 F]FDG outperforms MRI in the detection of myeloma lesions. Hematol Oncol 2019; 37:193-201. [PMID: 30821017 DOI: 10.1002/hon.2600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/05/2019] [Accepted: 02/26/2019] [Indexed: 12/16/2022]
Abstract
The detection rates of whole-body combined [18 F]NaF/[18 F]FDG positron emission tomography combined with computed tomography (PET/CT), CT alone, whole-body magnetic resonance imaging (WB-MRI), and X-ray were prospectively studied in patients with treatment-requiring plasma cell disorders The detection rates of imaging techniques were compared, and focal lesions were classified according to their anatomic location. Twenty-six out of 30 initially included patients were assessable. The number of focal lesions detected in newly diagnosed patients (n = 13) and in relapsed patients (n = 13) were 296 and 234, respectively. The detection rate of PET/CT was significantly higher than those of WB-MRI (P < 0.05) and CT (P < 0.0001) both in patients with newly diagnosed and in those with relapsed multiple myeloma (MM). The X-ray detection rate was significantly lower than those of all other techniques, while CT detected more lesions compared with WB-MRI at diagnosis (P = 0.025). With regard to the infiltration patters, relapsed patients presented more diffuse patterns, and more focal lesions located in the limbs compared with newly diagnosed patients. In conclusion, the detection rate of [18 F]NaF/[18 F]FDG PET/CT was significantly higher than those of CT, MRI, and X-ray, while the detection rate of X-rays was significantly lower than those of all other imaging techniques except for focal lesions located in the skull.
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Affiliation(s)
- Nadia Withofs
- Division of Nuclear Medicine and Oncological Imaging, Medical Physics Department, CHU of Liège, Liège, Belgium
| | - Yves Beguin
- Department of Clinical Hematology, CHU of Liège, Liège, Belgium.,Laboratory of Hematology, GIGA-I3, University of Liège, Liège, Belgium
| | - François Cousin
- Division of Nuclear Medicine and Oncological Imaging, Medical Physics Department, CHU of Liège, Liège, Belgium
| | - Tino Tancredi
- Division of Nuclear Medicine and Oncological Imaging, Medical Physics Department, CHU of Liège, Liège, Belgium
| | - Paolo Simoni
- Division of Diagnostic Imaging, Medical Physics Department, CHU of Liège, Liège, Belgium
| | | | | | | | | | - Frédéric Baron
- Department of Clinical Hematology, CHU of Liège, Liège, Belgium.,Laboratory of Hematology, GIGA-I3, University of Liège, Liège, Belgium
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, Medical Physics Department, CHU of Liège, Liège, Belgium
| | - Jo Caers
- Department of Clinical Hematology, CHU of Liège, Liège, Belgium.,Laboratory of Hematology, GIGA-I3, University of Liège, Liège, Belgium
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36
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Spinnato P, Bazzocchi A, Facchini G, Filonzi G, Nanni C, Rambaldi I, Rimondi E, Fanti S, Albisinni U. Vertebral Fractures of Unknown Origin: Role of Computed Tomography-Guided Biopsy. Int J Spine Surg 2018; 12:673-679. [PMID: 30619670 DOI: 10.14444/5084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background We performed a retrospective evaluation of histological and imaging results of patients submitted to computed tomography (CT)-guided biopsy for vertebral fractures (VFs) of unknown etiology to evaluate the pathological causes of fractures and also to observe the diagnostic results of imaging studies available. Methods We retrospectively reviewed all the CT-guided vertebral biopsies performed in our institution in the last 2 years, selecting patients with VF of unknown etiology. We reviewed clinical records, imaging studies, and histological examination results. We compared diagnostic performance of the 2 most sensitive imaging modalities for detection of malignancy on the collapsed vertebral body: magnetic resonance imaging (MRI) and positron emission tomography-CT (PET-CT). Anatomopathological results have been considered the gold standard to assess the diagnostic performance of imaging studies. Age stratification has been performed to understand the distribution of different anatomopathological diagnoses in age groups. Results Among 282 CT-guided vertebral biopsies, 36 (12.8%) have been performed to diagnose the etiology of VF of unknown origin. In 26/32 (81.3%), the vertebral biopsy was diagnostic: 8 osteopenia, 6 multiple myelomas, 4 osteomyelitis, 2 eosinophilic granuloma, 3 metastases, 1 mastocytosis, 1 Paget's disease, and 1 dysmielopoiesis. In 6 cases, the anatomopathological diagnosis was normal bone structure, most likely excluding malignancy. There were no statistically significance differences between MRI and PET-CT results (P = 1.0000). Conclusions Multiple myeloma and osteopenia represent the most frequent causes of this condition in adult patients, while eosinophilic granuloma and osteomyelitis in pediatric patients. Computed tomography-guided biopsy permits one to reach diagnosis in most of cases. Both PET and MRI could be insufficient to discriminate benign from malignant causes of fractures. Computed tomography-guided biopsy is needed when the etiology of fracture remains unclear.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Instituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Instituto Ortopedico Rizzoli, Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Instituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Filonzi
- Diagnostic and Interventional Radiology, IRCCS Instituto Ortopedico Rizzoli, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Ilaria Rambaldi
- Nuclear Medicine Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Eugenio Rimondi
- Diagnostic and Interventional Radiology, IRCCS Instituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Ugo Albisinni
- Diagnostic and Interventional Radiology, IRCCS Instituto Ortopedico Rizzoli, Bologna, Italy
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37
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Abstract
OBJECTIVE The purpose of this article is to provide an update on clinical PET/MRI, including current and developing clinical indications and technical developments. CONCLUSION PET/MRI is evolving rapidly, transitioning from a predominant research focus to exciting clinical practice. Key technical obstacles have been overcome, and further technical advances promise to herald significant advancements in image quality. Further optimization of protocols to address challenges posed by this hybrid modality will ensure the long-term success of PET/MRI.
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38
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Tsang RW, Campbell BA, Goda JS, Kelsey CR, Kirova YM, Parikh RR, Ng AK, Ricardi U, Suh CO, Mauch PM, Specht L, Yahalom J. Radiation Therapy for Solitary Plasmacytoma and Multiple Myeloma: Guidelines From the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2018; 101:794-808. [PMID: 29976492 DOI: 10.1016/j.ijrobp.2018.05.009] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/16/2018] [Accepted: 05/02/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE To develop guidelines for the work-up and radiation therapy (RT) management of patients with plasma cell neoplasms. METHODS AND MATERIALS A literature review was conducted covering staging, work-up, and RT management of plasma cell neoplasms. Guidelines were developed through consensus by an international panel of radiation oncologists with expertise in these diseases, from the International Lymphoma Radiation Oncology Group. RT volume definitions are based on the International Commission on Radiation Units and Measurements. RESULTS Plasma cell neoplasms account for approximately one-fifth of mature B-cell neoplasms in the United States. The majority (∼95%) are diagnosed as multiple myeloma, in which there has been tremendous progress in systemic therapy approaches with novel drugs over the last 2 decades, resulting in improvements in disease control and survival. In contrast, a small proportion of patients with plasma cell neoplasms present with a localized plasmacytoma in the bone, or in extramedullary (extraosseous) soft tissues, and definitive RT is the standard treatment. RT provides long-term local control in the solitary bone plasmacytomas and is potentially curative in the extramedullary cases. This guideline reviews the diagnostic work-up, principles, and indications for RT, target volume definition, treatment planning, and follow-up procedures for solitary plasmacytoma. Specifically, detailed recommendations for RT volumes and dose/fractionation are provided, illustrated with specific case scenarios. The role of palliative RT in multiple myeloma is also discussed. CONCLUSIONS The International Lymphoma Radiation Oncology Group presents a standardized approach to the use and implementation of definitive RT in solitary plasmacytomas. The modern principles outlining the supportive role of palliative RT in multiple myeloma in an era of novel systemic therapies are also discussed.
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Affiliation(s)
- Richard W Tsang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Belinda A Campbell
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jayant S Goda
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Chris R Kelsey
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Youlia M Kirova
- Department of Radiation Therapy, Institut Curie, Paris, France
| | - Rahul R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Andrea K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts
| | - Umberto Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Peter M Mauch
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
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Stecco A, Buemi F, Iannessi A, Carriero A, Gallamini A. Current concepts in tumor imaging with whole-body MRI with diffusion imaging (WB-MRI-DWI) in multiple myeloma and lymphoma. Leuk Lymphoma 2018; 59:2546-2556. [PMID: 29431555 DOI: 10.1080/10428194.2018.1434881] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Whole-body MRI (WB-MRI) with diffusion-weighted imaging (DWI) can now be used to stage and restage multiple myeloma (MM) and lymphoma. Magnetic resonance imaging (MRI) is the standard tool to detect BM involvement (BMI). The 2016 diagnostic criteria of the International Myeloma Working Group identify WB-MRI and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) as the most sensitive imaging techniques for detecting skeletal and extra-skeletal MM invasion, respectively. Preliminary findings have also shown that WB-MRI is better than CT and equal to PET/CT in staging aggressive lymphoma and Hodgkin lymphoma, whereas MRI is better for diagnosing BMI in patients with low-grade lymphoma. Signal intensity (SI) and the apparent diffusion coefficient (ADC) are useful metrics to quantify the chemotherapy response in WB-MRI.
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Affiliation(s)
- Alessandro Stecco
- a Services Diagnosis and Therapies Department - Radiology , Azienda Ospedaliero-Universitaria Maggiore della Carita , Novara , Italy
| | - Francesco Buemi
- b Radiologic Department , L'Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte , Messina , Italy
| | - Antoine Iannessi
- c Radiology Department , Centre Antoine-Lacassagne , Nice , France
| | - Alessandro Carriero
- a Services Diagnosis and Therapies Department - Radiology , Azienda Ospedaliero-Universitaria Maggiore della Carita , Novara , Italy
| | - Andrea Gallamini
- d Research, Innovation and Statistics Department , Centre Antoine-Lacassagne , Nice , France
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40
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Morone M, Bali MA, Tunariu N, Messiou C, Blackledge M, Grazioli L, Koh DM. Whole-Body MRI: Current Applications in Oncology. AJR Am J Roentgenol 2017; 209:W336-W349. [PMID: 28981354 DOI: 10.2214/ajr.17.17984] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this article is to review current image acquisition and interpretation for whole-body MRI, clinical applications, and the emerging roles in oncologic imaging, especially in the assessment of bone marrow diseases. CONCLUSION Whole-body MRI is an emerging technique used for early diagnosis, staging, and assessment of therapeutic response in oncology. The improved accessibility and advances in technology, including widely available sequences (Dixon and DWI), have accelerated its deployment and acceptance in clinical practice.
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Affiliation(s)
- Mario Morone
- 1 Prima Radiologia Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Piazzale Spedali Civili, 1, Brescia, BS 25123, Italy
| | | | - Nina Tunariu
- 2 Radiology Department, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Christina Messiou
- 2 Radiology Department, Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Luigi Grazioli
- 1 Prima Radiologia Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Piazzale Spedali Civili, 1, Brescia, BS 25123, Italy
| | - Dow-Mu Koh
- 2 Radiology Department, Royal Marsden NHS Foundation Trust, Sutton, UK
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Krebs S, Ganly I, Ghossein R, Yang J, Yahalom J, Schöder H. Solitary Extramedullary Plasmacytoma of the Cricoid Cartilage-Case Report. Front Oncol 2017; 7:284. [PMID: 29230383 PMCID: PMC5711767 DOI: 10.3389/fonc.2017.00284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/10/2017] [Indexed: 01/07/2023] Open
Abstract
Solitary plasmacytoma (SP) is an extremely rare form of hematologic malignancy that can be classified as solitary bone plasmacytoma or solitary extramedullary plasmacytoma. Here, we report a patient who presented with progressive shortness of breath and foreign body sensation in his throat. Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) demonstrated an abnormal FDG-avid soft tissue mass arising from the larynx involving the cricoid cartilage without additional suspicious lesions. Histology revealed an abundance of plasma cells; immunohistochemistry was positive for CD138 expression and lambda chains, and negative for CD20. Comprehensive imaging studies and panendoscopy of the ENT tract confirmed solitary disease involvement. Following additional systemic work-up, a diagnosis of extramedullary plasmacytoma was rendered. The patient underwent definitive radiotherapy using intensity-modulated radiation therapy (total dose of 46 Gy, divided in 23 fractions of 200 cGy). Serial PET/CT showed the stepwise resolution of abnormal FDG uptake and resolution of the cricoid cartilage lesion. With 22 months of follow-up, the patient remains free of disease. We describe the rare case of SP presenting as a FDG-avid hypermetabolic soft tissue mass in the cricoid cartilage, which should be considered in the differential diagnosis of laryngeal tumors. Of note, SP is radiosensitive; favorable outcome can be expected once treated with doses of 40–50 Gy. FDG PET/CT is helpful in diagnosis and response assessment for this disease.
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Affiliation(s)
- Simone Krebs
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Ronald Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Joanna Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Heiko Schöder
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, United States
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Brandelik SC, Krzykalla J, Hielscher T, Hillengass J, Kloth JK, Kauczor HU, Weber MA. [Focal lesions in whole-body MRI in multiple myeloma : Quantification of tumor mass and correlation with disease-related parameters and prognosis]. Radiologe 2017; 58:72-78. [PMID: 28905085 DOI: 10.1007/s00117-017-0299-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES In this study, we evaluated methods of quantification of tumor mass in whole-body MRI (wb-MRI) in multiple myeloma and correlated these with disease-related parameters in serum and bone marrow. MATERIALS AND METHODS We retrospectively evaluated wb-MRIs of 52 patients with focal infiltration pattern and a total of 700 focal lesions (subsequently called lesions). We determined the longest diameter (LD), the segmented volume (SV), and the morphology (spherical or non-spherical). We correlated total number/volume of the lesions with clinical parameters and prognosis and furthermore LD with SV. After that we analyzed the agreement of SV and estimated volume (EV) using the volume formula of a sphere based on LD. RESULTS Results showed no significant correlations of total number/volume with prognosis or clinical parameters. The latter were situated predominantly in the normal range. Furthermore, 10% of lesions were spherical. SV and LD correlated significantly in single lesions and on patient level. SV was in lesions <6 cm3 systematically larger and in lesions ≥6 cm3 smaller than EV. In 95%, we found in small lesions a deviation of EV versus SV from +0.9 cm3 to -4.6 cm3 and in large lesions from +160 cm3 to -111 cm3 (EV-SV). CONCLUSIONS Quantification of tumor mass in the focal infiltration pattern is performed more accurately by volumetry than LD due to the predominant existence of non-spherical lesions. The patient cohort with clinical parameters predominantly in the normal range is distributed to ISS stage I and partly pretreated, a fact that makes interpretation of absent correlations more difficult. Consider also a variation in activitiy of lesions and a diffuse infiltration not detectable by MRI.
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Affiliation(s)
- S C Brandelik
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - J Krzykalla
- Biostatistik, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - T Hielscher
- Biostatistik, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - J Hillengass
- Hämatologie und Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - J K Kloth
- Radiologie Löbau, Löbau, Deutschland
| | - H U Kauczor
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - M A Weber
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
- Diagnostische und Interventionelle Radiologie, Universitätsmedizin Rostock, Rostock, Deutschland
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Filonzi G, Mancuso K, Zamagni E, Nanni C, Spinnato P, Cavo M, Fanti S, Salizzoni E, Bazzocchi A. A Comparison of Different Staging Systems for Multiple Myeloma: Can the MRI Pattern Play a Prognostic Role? AJR Am J Roentgenol 2017; 209:152-158. [DOI: 10.2214/ajr.16.17219] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Giacomo Filonzi
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
- Diagnostic and Interventional Radiology, The “Rizzoli” Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy
- Ospedale di Porretta Terme, UOC Radiologia O. Bellaria e Area Sud-Est, Ausl Bologna, Bologna, Italy
| | - Katia Mancuso
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Elena Zamagni
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Cristina Nanni
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, The “Rizzoli” Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy
| | - Michele Cavo
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Fanti
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Eugenio Salizzoni
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, The “Rizzoli” Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy
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Cavo M, Terpos E, Nanni C, Moreau P, Lentzsch S, Zweegman S, Hillengass J, Engelhardt M, Usmani SZ, Vesole DH, San-Miguel J, Kumar SK, Richardson PG, Mikhael JR, da Costa FL, Dimopoulos MA, Zingaretti C, Abildgaard N, Goldschmidt H, Orlowski RZ, Chng WJ, Einsele H, Lonial S, Barlogie B, Anderson KC, Rajkumar SV, Durie BGM, Zamagni E. Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol 2017; 18:e206-e217. [PMID: 28368259 DOI: 10.1016/s1470-2045(17)30189-4] [Citation(s) in RCA: 315] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/21/2016] [Accepted: 11/29/2016] [Indexed: 12/26/2022]
Abstract
The International Myeloma Working Group consensus aimed to provide recommendations for the optimal use of 18fluorodeoxyglucose (18F-FDG) PET/CT in patients with multiple myeloma and other plasma cell disorders, including smouldering multiple myeloma and solitary plasmacytoma. 18F-FDG PET/CT can be considered a valuable tool for the work-up of patients with both newly diagnosed and relapsed or refractory multiple myeloma because it assesses bone damage with relatively high sensitivity and specificity, and detects extramedullary sites of proliferating clonal plasma cells while providing important prognostic information. The use of 18F-FDG PET/CT is mandatory to confirm a suspected diagnosis of solitary plasmacytoma, provided that whole-body MRI is unable to be performed, and to distinguish between smouldering and active multiple myeloma, if whole-body X-ray (WBXR) is negative and whole-body MRI is unavailable. Based on the ability of 18F-FDG PET/CT to distinguish between metabolically active and inactive disease, this technique is now the preferred functional imaging modality to evaluate and to monitor the effect of therapy on myeloma-cell metabolism. Changes in FDG avidity can provide an earlier evaluation of response to therapy compared to MRI scans, and can predict outcomes, particularly for patients who are eligible to receive autologous stem-cell transplantation. 18F-FDG PET/CT can be coupled with sensitive bone marrow-based techniques to detect minimal residual disease (MRD) inside and outside the bone marrow, helping to identify those patients who are defined as having imaging MRD negativity.
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Affiliation(s)
- Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Cristina Nanni
- Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Philippe Moreau
- Haematology Department, University Hospital of Nantes, Nantes, France
| | | | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
| | - Jens Hillengass
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Monika Engelhardt
- Department of Medicine, Hematology, Oncology & Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Saad Z Usmani
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - David H Vesole
- John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ, USA
| | | | - Shaji K Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Paul G Richardson
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joseph R Mikhael
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Fernando Leal da Costa
- Myeloma Clinic, Hematology Department, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | | | | | - Niels Abildgaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Wee Joo Chng
- National University Cancer Institute, National University Health System, Singapore
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Bart Barlogie
- Tisch Cancer Institute/Multiple Myeloma Program, Mt. Sinai Cancer Institute, New York, NY, USA
| | - Kenneth C Anderson
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - S Vincent Rajkumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brian G M Durie
- Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Elena Zamagni
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
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Nanni C, Zamagni E. Therapy assessment in multiple myeloma with PET. Eur J Nucl Med Mol Imaging 2017; 44:111-117. [DOI: 10.1007/s00259-017-3730-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 01/03/2023]
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Whole-body MRI, dynamic contrast-enhanced MRI, and diffusion-weighted imaging for the staging of multiple myeloma. Skeletal Radiol 2017; 46:733-750. [PMID: 28289855 DOI: 10.1007/s00256-017-2609-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 02/02/2023]
Abstract
Magnetic resonance imaging (MRI) is the most sensitive imaging technique for the detection of bone marrow infiltration, and has therefore recently been included in the new diagnostic myeloma criteria, as proposed by the International Myeloma Working Group. Nevertheless, conventional MRI only provides anatomical information and is therefore only of limited use in the response assessment of patients with multiple myeloma. The additional information from functional MRI techniques, such as diffusion-weighted imaging and dynamic contrast-enhanced MRI, can improve the detection rate of bone marrow infiltration and the assessment of response. This can further enhance the sensitivity and specificity of MRI in the staging of multiple myeloma patients. This article provides an overview of the technical aspects of conventional and functional MRI techniques with practical recommendations. It reviews the diagnostic performance, prognostic value, and role in therapy assessment in multiple myeloma and its precursor stages.
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Ippolito D, Talei Franzesi C, Spiga S, Besostri V, Pezzati S, Rossini F, Sironi S. Diagnostic value of whole-body ultra-low dose computed tomography in comparison with spinal magnetic resonance imaging in the assessment of disease in multiple myeloma. Br J Haematol 2017; 177:395-403. [PMID: 28233900 DOI: 10.1111/bjh.14545] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/23/2016] [Indexed: 02/05/2023]
Abstract
This study compared the diagnostic value of Whole-Body Ultra Low-Dose computed tomography (WBULDCT) with that of Spinal Magnetic Resonance Imaging (SMRI) in identification of spinal bone marrow involvement in patients with Multiple Myeloma (MM). Thirty-five patients with histologically proven MM underwent WBULDCT and dedicated SMRI. Unenhanced WBULDCT was performed on a 256-slice scanner, with 120 kV and 40 mAs. SMRI was performed on a 1·5T magnet, with T1-turbo spin echo and T2-short tau inversion recovery sequences on sagittal plane. WBULDCT was compared with SMRI in terms of lesion detection, pattern and bone marrow involvement. The overall concordance between WBULDCT and SMRI in lesion detection was 76·7%, detecting (25/35) or excluding (8/35) involvement of the axial skeleton, while in 2/35 patients WBULDCT and SMRI were discordant in terms of axial skeleton involvement. The concordance in spinal distribution of lesions was 61·6% on cervical, 71·5% on dorsal, 86·4% on lumbar and 94·4% on sacral, while for the pattern of disease, it was 56·1% for the focal and 88·7% for the combined pattern. Cohen's kappa index was 0·85 (P < 0·001) assessing an excellent agreement. WBULDCT represents a useful diagnostic tool in the detection of spinal involvement of MM patients, offering detailed information about extra-axial involvement, which could be potentially missed with dedicated SMRI.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Sara Spiga
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Valeria Besostri
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Sara Pezzati
- Department of Haematology, San Gerardo Hospital, Monza, MB, Italy
| | - Fausto Rossini
- Department of Haematology, San Gerardo Hospital, Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
- Department of Diagnostic Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol 2017. [DOI: 10.1016/s1470-2045%2817%2930189-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
PET-magnetic resonance (MR) is a hybrid imaging modality that combines PET and MR. Evidence for this new modality is in the process of being developed, but both component modalities are well tested in the diagnosis and management of multiple myeloma. It allows advanced bimodality imaging of the whole body with an adaptable field of view and it can be used for monitoring plasma cell dyscrasias for progression to multiple myeloma, for assessing disease burden in patients with known multiple myeloma, for assessing response to therapy and relapse after remission, and for radiation therapy treatment planning.
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Affiliation(s)
- Shetal N Shah
- Abdominal Imaging Section and Nuclear Medicine Department, Imaging Institute and Taussig Cancer Institute, Cleveland Clinic Main Campus, Mail Code JB3, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Jorge D Oldan
- Nuclear Medicine, Department of Radiology, 2006 Old Clinic, CB# 7510, Chapel Hill, NC 27599, USA
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Terpos E, Dimopoulos MA, Moulopoulos LA. The Role of Imaging in the Treatment of Patients With Multiple Myeloma in 2016. Am Soc Clin Oncol Educ Book 2017; 35:e407-17. [PMID: 27249748 DOI: 10.1200/edbk_159074] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The novel criteria for the diagnosis of symptomatic multiple myeloma have revealed the value of modern imaging for the management of patients with myeloma. Whole-body low-dose CT (LDCT) has increased sensitivity over conventional radiography for the detection of osteolytic lesions, and several myeloma organizations and institutions have suggested that whole-body LDCT should replace conventional radiography for the work-up of patients with myeloma. MRI is the best imaging method for the depiction of marrow infiltration by myeloma cells. Whole-body MRI (or at least MRI of the spine and pelvis if whole-body MRI is not available) should be performed for all patients with smoldering multiple myeloma with no lytic lesions to look for occult disease, which may justify treatment. In addition, MRI accurately illustrates the presence of plasmacytomas, spinal cord, and/or nerve compression for surgical intervention or radiation therapy; it is also recommended for the work-up of solitary bone plasmacytoma, and it may distinguish malignant from benign fractures (which is very important in cases of patients in biochemical remission with no other signs of progression). Diffusion weighted imaging (DWI) seems to improve MRI diagnosis in patients with myeloma. PET/CT is a functional imaging technique, more sensitive than conventional radiography for the detection of lytic lesions, which probably allows better definition of complete response and minimal residual disease compared with all other imaging methods. PET/CT has shown the best results in the follow-up of patients with myeloma and has an independent prognostic value both at diagnosis and following treatment. PET/CT can also be used for the work-up of solitary bone plasmacytoma and nonsecretory myeloma.
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Affiliation(s)
- Evangelos Terpos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Meletios A Dimopoulos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Lia A Moulopoulos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
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