Clinical value of 11C-methionine PET/CT in patients with plasma cell malignancy: comparison with 18F-FDG PET/CT

Abstract

MET revealed an equal or greater number of lesions in PCM than FDG. MET may be especially useful when negative or inconclusive findings are obtained by FDG despite highly suspicious indications of recurrence.

18F-fluorocholine versus 18F-fluorodeoxyglucose for PET/CT imaging in patients with suspected relapsing or progressive multiple myeloma: a pilot study

“…Those results that were obtained using a fluorinated analogue of choline are entirely consistent with the higher detection rate and greater uptake intensity (SUVmax) for MM bone lesions previously observed using other tracers of lipid metabolism, either 11 C-choline or 11 C-acetate, in comparison with FDG [24][25][26]. Similar results were also reported when comparing the uptake in the skeletal lesions of MM patients of an amino acid for PET imaging, 11 C-methionine, with that of FDG [23] or with the 11 C-methionine uptake in the skeleton of control patients with hyperparathyroidism [22].…”

“…This was not tested by Nanni et al They might correspond to lesions detected early and/or at a less aggressive stage when glucose metabolism was not yet substantially enhanced, whereas choline turnover was already enhanced but not as intensely as in more advanced lesions. This hypothesis seems to be supported by the corresponding aspect of those foci on CT which was osteolytic only in a minority of lesions (35 %), whereas Nakamoto et al [23] found osteolytic CT pattern in 56 % of PET/CT-positive foci, regardless whether they tookup one or both tracers (Chi-square test p < 0.001). The proportion of PET/CT foci that did not correspond to a definite morphological abnormality on CT was 39 % in their series, similar to 35 % of unmatched foci in our series.…”

“…Although they gave consistent results concerning the detection of a greater number of foci with a more intense uptake using the non-FDG tracer, the other pilot studies recruited all patients at an earlier phase of MM management, staging, or initial treatment evaluation, and used non-choline tracers, either 11 C-methionine [22,23] or 11 C-acetate [24,25]. A review of their main results has been recently published [35].…”

“…According to Machida et al [37], FDG does not accumulate in bone marrow lesions of IgD-λ type MM, whereas Nakamoto et al [23] observed non-FDG avid myelomas other than IgD-λ type MM. Our study found no relationship between MM type and number of visible lesions regardless of which tracer was used.…”

“…These include 11 C-methionine [22,23], 11 Cacetate [24,25], and 11 C-choline [26]. However, because of its short half-life (20 min), 11 C use is restricted to PET centers with an on-site cyclotron, whereas 18 F can be produced and delivered industrially.…”