Comparison of [18F]fluciclovine and [18F]FDG PET/CT in Newly Diagnosed Multiple Myeloma Patients

Abstract

Purpose [18F]FDG PET/CT in multiple myeloma (MM) is currently the best technology to demonstrate patchy and extramedullary disease. However, [18F]FDG PET has some limitations, and imaging with alternative tracers should be explored. In this study, we aimed to evaluate the performance of [18F]fluciclovine PET compared to [18F]FDG PET in newly diagnosed MM patients. Procedures Thirteen newly diagnosed transplant eligible MM patients were imaged both with [18F]FDG PET/CT and [18F]fluciclovine PET/CT within 1 week in a prospective study. The subjects were visually assessed positive or negative for disease. The number of lesions and the SUVmax of selected lesions were measured for both tracers. Furthermore, tracer uptake ratios were obtained by dividing lesion SUVmax by blood or bone marrow SUVmax. Between-group differences and correlations were assessed with paired t-tests and Pearson tests. Bone marrow SUVs were compared to bone marrow plasma cell percentage in biopsy samples. Results Nine subjects were assessed positively by [18F]FDG PET (69%) and 12 positives by [18F]fluciclovine PET (92%). All positive subjects had [18F]fluciclovine scans that were qualitatively scored as easier to interpret visually than the [18F]FDG scans. The number of lesions was also higher; seven of nine subjects with distinct hot spots on [18F]fluciclovine PET had fewer or no visible lesions on [18F]FDG PET. The mean lesion SUVmax values were 8.2 and 3.8 for [18F]fluciclovine and [18F]FDG, respectively. The mean tumour to blood values were 6.4 and 2.0 for [18F]fluciclovine and [18F]FDG, and the mean ratios between tumour and bone marrow were 2.1 and 1.5 for [18F]fluciclovine and [18F]FDG. The lesion SUVmax and ratios were significantly higher for [18F]fluciclovine (all p < 0.01). Local [18F]fluciclovine SUVmax or SUVmean values in os ilium and the percentage of plasma cells in bone marrow biopsies were linearly correlated (p = 0.048). There were no significant correlations between [18F]FDG SUVs and plasma cells (p = 0.82). Conclusions Based on this pilot study, [18F]fluciclovine is a promising tracer for MM. The visual and semi-quantitative evaluations indicate that [18F]fluciclovine PET/CT can out-perform [18F]FDG PET/CT at diagnosis.

Metabolic features of myeloma cells in the context of bone microenvironment: Implication for the pathophysiology and clinic of myeloma bone disease

“…All 18 F-fluciclovine-positive PET/CT MM patients exhibited a satisfactory response to treatment three months post-ASCT. Interestingly, a correlation between the uptake of 18 F-fluciclovine PET and the percentage of neoplastic PCs in BM biopsies was found, which was not observed with 18 F-FDG ( 115 ).…”

“…Compared with 18 F-FDG PET, 18 F-fluciclovine showed significantly higher uptake, detecting more lesions in seven of the thirteen patients. Moreover, three patients who were negative for 18 F-FDG PET were positive for 18 F-fluciclovine PET/CT ( 115 ). All 18 F-fluciclovine-positive PET/CT MM patients exhibited a satisfactory response to treatment three months post-ASCT.…”

Head-to-Head Comparison between FDG and 11C-Methionine in Multiple Myeloma: A Systematic Review

“…Fourth, MET accumulates in normal bone marrow, and in the liver and pancreas, thus limiting the accuracy in case of faint or mild invasion. In this regard, a synthetic amino-acid labeled with 18 F-fluorine, namely 18 F-fluciclovine or 18 F-FACBC [25], recently implemented in clinical practice for the imaging of prostate cancer recurrence, provided promising results in a preliminary study carried out in patients with newly diagnosed MM [26]. On the same path, Czy ż and coworkers assessed the potential of 18 F-ethyl-tyrosine ( 18 F-FET), another amino-acid tracer used in neuro-oncology, in 32 MM patients; although it was not compared to FDG, 18 F-FET showed good diagnostic performance, detecting a greater number of lesions with respect to CT in subjects with a newly diagnosed disease [27].…”

New Developments in Myeloma Treatment and Response Assessment

“…The presence of diffuse bone marrow uptake, more than 10 FLs, and an SUV max of more than 6.0 for FLs by 11 C-acetate PET/CT predicted a higher probability of disease progression and shorter PFS. Other tracers, such as 18 Fsodium fluoride, 18 F-fluciclovine, 18 F-fluoroethyltyrosine, and 18 Ffluorothymidine, have also been proposed; however, these are very preliminary studies (122)(123)(124)(125)(126). Another promising tracer is the ligand of prostate-specific membrane antigen, a characteristic biomarker for prostate cancer cells and with increased expression in the tumor vasculature.…”