Thibaut Cassou-Mounat1,2,3, Sona Balogova4,5, Valérie Nataf4,6, Marie Calzada4,7, Virginie Huchet4, Khaldoun Kerrou4, Jean-Yves Devaux7,8, Mohamad Mohty8,9,10, Jean-Noël Talbot4,8, Laurent Garderet8,9,10. 1. Department of Nuclear Medicine, Hôpital Tenon, AP-HP, 4 rue de la Chine, Paris, 75020, France. thibaut.cassou-mounat@aphp.fr. 2. Department of Nuclear Medicine, Hôpital Saint Antoine, AP-HP, 184 rue du Fg St Antoine, Paris, 75012, France. thibaut.cassou-mounat@aphp.fr. 3. Université Pierre et Marie Curie (UPMC), Paris, France. thibaut.cassou-mounat@aphp.fr. 4. Department of Nuclear Medicine, Hôpital Tenon, AP-HP, 4 rue de la Chine, Paris, 75020, France. 5. Department of Nuclear Medicine, Comenius University & St. Elisabeth Oncology Institute, Bratislava, Slovakia. 6. Radiopharmacy, Hôpital Tenon, AP-HP, 4 rue de la Chine, Paris, 75020, France. 7. Department of Nuclear Medicine, Hôpital Saint Antoine, AP-HP, 184 rue du Fg St Antoine, Paris, 75012, France. 8. Université Pierre et Marie Curie (UPMC), Paris, France. 9. INSERM, UMR_S 938, Proliferation and Differentiation of Stem Cells, 75012, Paris, France. 10. Département d'hématologie et de thérapie cellulaire, Hôpital Saint Antoine, AP-HP, 184 rue du Fg St Antoine, 75012, Paris, France.
Abstract
PURPOSE: Hybrid positron emission tomography/computed tomography (PET/CT) has now become available, as well as whole-body, low-dose multidetector row computed tomography (MDCT) or magnetic resonance imaging (MRI). The radioactive glucose analogue 18F-fluorodeoxyglucose (FDG) is the most widely used tracer but has a relatively low sensitivity in detecting multiple myeloma (MM). We compared FDG with a more recent metabolic tracer, 18F-fluorocholine (FCH), for the detection of MM lesions at time of disease relapse or progression. METHODS: We analyzed the results of FDG and FCH imaging in 21 MM patients undergoing PET/CT for suspected relapsing or progressive MM. For each patient and each tracer, an on-site reader and a masked reader independently determined the number of intraosseous and extraosseous foci of tracer and the intensity of uptake as measured by their SUVmax and the corresponding target/non-target ratio (T/NT). RESULTS: In the skeleton of 21 patients, no foci were found for two cases, uncountable foci were observed in four patients, including some mismatched FCH/FDG foci. In the 15 patients with countable bone foci, the on-site reader detected 72 FDG foci vs. 127 FCH foci (+76 %), whereas the masked reader detected 69 FDG foci vs. 121 FCH foci (+75 %), both differences being significant. Interobserver agreement on the total number of bone foci was very high, with a kappa coefficient of 0.81 for FDG and 0.89 for FCH. Measurement of uptake in the matched foci that took up both tracers revealed a significantly higher median SUVmax and T/NT for FCH vs. FDG. Almost all unmatched foci were FCH-positive FDG-negative (57/59 = 97 % on-site and 56/60 = 93 % on masked reading); they were more frequently observed than matched foci in the head and neck region. CONCLUSIONS: These findings suggest that PET/CT performed for suspected relapsing or progressive MM would reveal more lesions when using FCH rather than FDG.
PURPOSE: Hybrid positron emission tomography/computed tomography (PET/CT) has now become available, as well as whole-body, low-dose multidetector row computed tomography (MDCT) or magnetic resonance imaging (MRI). The radioactive glucose analogue 18F-fluorodeoxyglucose (FDG) is the most widely used tracer but has a relatively low sensitivity in detecting multiple myeloma (MM). We compared FDG with a more recent metabolic tracer, 18F-fluorocholine (FCH), for the detection of MM lesions at time of disease relapse or progression. METHODS: We analyzed the results of FDG and FCH imaging in 21 MM patients undergoing PET/CT for suspected relapsing or progressive MM. For each patient and each tracer, an on-site reader and a masked reader independently determined the number of intraosseous and extraosseous foci of tracer and the intensity of uptake as measured by their SUVmax and the corresponding target/non-target ratio (T/NT). RESULTS: In the skeleton of 21 patients, no foci were found for two cases, uncountable foci were observed in four patients, including some mismatched FCH/FDG foci. In the 15 patients with countable bone foci, the on-site reader detected 72 FDG foci vs. 127 FCH foci (+76 %), whereas the masked reader detected 69 FDG foci vs. 121 FCH foci (+75 %), both differences being significant. Interobserver agreement on the total number of bone foci was very high, with a kappa coefficient of 0.81 for FDG and 0.89 for FCH. Measurement of uptake in the matched foci that took up both tracers revealed a significantly higher median SUVmax and T/NT for FCH vs. FDG. Almost all unmatched foci were FCH-positive FDG-negative (57/59 = 97 % on-site and 56/60 = 93 % on masked reading); they were more frequently observed than matched foci in the head and neck region. CONCLUSIONS: These findings suggest that PET/CT performed for suspected relapsing or progressive MM would reveal more lesions when using FCH rather than FDG.
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