Bone marrow immunoscintigraphy using technetium-99m anti-granulocyte antibody in multiple myeloma

Abstract

Conventional skeletal radiography and bone scan have certain limitations in the initial evaluation of bone and bone marrow lesions in multiple myeloma (MM). In this study we investigated the value of bone marrow immunoscintigraphy (BMIS) using anti-granulocyte monoclonal antibody (AGA) for the diagnosis of bone involvement of MM, in comparison with bone scan and skeletal radiography. Whole-body BMIS using technetium-99m-labelled AGA was performed in 22 MM patients (15 male, 7 female) and the imaging findings compared with those of skeletal radiography and (99m)Tc-methylene diphosphonate bone scan. The findings of bone marrow aspiration and serum biochemical findings were also compared with BMIS findings. Abnormal findings of BMIS were defined as presence of a focal photon defect in the axial skeleton or expansion of peripheral bone marrow. A total of 124 focal lesions were detected in 19 subjects (86%) by skeletal radiography, bone scan or BMIS. BMIS detected 92 lesions (74%) in 19 subjects, whereas skeletal radiography detected 58 focal lesions (47%) in 14 and bone scan 40 lesions (32%) in 11. Fifty-one (41%) of the 124 lesions were only seen on BMIS. Spine and pelvic lesions were better visualised by BMIS, whereas skull lesions were better seen with skeletal radiography, and bone scan detected more lesions in the ribs. Marrow expansion was noted in 15 subjects (68%) on BMIS, and its grade correlated with marrow cellularity and myeloma cell percentage in bone marrow aspirates ( P=0.0055 and P=0.0541, respectively). BMIS revealed abnormal lesions in one of three stage II patients and 17 out of 19 stage III patients. The number of lesions of the thoracolumbar vertebrae on BMIS was correlated with cellularity ( P=0.0393), but not with myeloma cell percentage ( P=0.1262). These findings suggest that the results of BMIS with (99m)Tc-labelled AGA correlate with clinical stage, and thus reflect the functional status of bone marrow in MM patients. BMIS might be useful for the detection of bone involvement of MM when skeletal radiography or bone scan is inconclusive, especially for vertebral lesions.

Imaging techniques used in the diagnosis, staging, and follow-up of patients with myeloma

“…The future will see the development of monoclonal antibody imaging. Some of these agents have already been developed and are undergoing testing (29).…”

Nonsecretory multiple myeloma in a horse

“…Images produced with this technique can be used not only for diagnosis, but also for prognosis and for determining the response to treatment (Alexandrakis et al 2001(Alexandrakis et al , 2002. Immunoscintigraphy using technetium-99m-anti-granulocyte antibodies has also been shown to be more sensitive than conventional radiographs or 99m Tc-MDP, picking up 74% vs. 47 and 32% of myeloma lesions, respectively (Sohn et al 2002). Magnetic resonance imaging (MRI) remains the gold standard for diagnosis of myeloma in human patients (Mirzaei et al 2003), but this modality is not easily translated to the horse, due to the lack of availability of imaging centres, cost and the need for general anaesthesia in most cases.…”

Besilesomab for imaging inflammation and infection in peripheral bone in adults with suspected osteomyelitis

“…29,34,47,59,[62][63][64][65][66][67][68][69][70][71][72][73] These studies have also been the subject of review 20,33,51,74,75 and retrospective data analysis, 29,76 and 80 inflammatory bowel disease, [81][82][83] and septic loosening of knee 84 or hip 85 endoprosthesis, although a detailed discussion of such uses extends beyond the scope of this report. Beyond diagnosis of infection and inflammation, bone marrow scintigraphy has been used to track bone metastases in cancer patients 86,87 and has also been considered for radiotherapeutic applications. 88 Recently, an assessment report from the EMEA, in response to CIS Bio International's application for marketing authorization, summarizes data from 59 In this most recent and pivotal phase III trial involving 119 patients with suspected osteomyelitis, the agreement rate between the 2 methods was estimated to be 83% (lower 95% confidence interval limit: 80%); however, there was no adequate standard of truth (or acceptable surrogate) used in this trial, and so diagnostic parameters like sensitivity and specificity could not be calculated.…”