Different patterns of technetium-99m sestamibi uptake in multiple myeloma

Abstract

Technetium-99m 2-methoxyisobutylisonitrile (99mTc-MIBI) has been proposed as a potential tracer in patients with multiple myeloma (MM). The aims of this study were to evaluate the incidence of various patterns of diffuse 99mTc-MIBI uptake in patients with MM, to assess their relationship with clinical status and stage of disease, and to try to clarify the meaning of the diffuse bone marrow uptake of 99mTc-MIBI. Thirty-nine consecutive patients with MM were studied. Twenty-nine of these patients had active disease (13 in stage I, ten in stage II, and six in stage III) and ten were in remission after chemotherapy. Anterior and posterior whole-body scans were obtained 10 min after i.v. injection of 555 MBq of 99mTc-MIBI. The scans were classified as showing: pattern N, when only physiological uptake was present; pattern D, when diffuse bone marrow uptake was observed; pattern F, when areas of focal uptake of the radiotracer were evident; or pattern D+F, when both D and F patterns were observed. Diffuse bone marrow uptake was scored according to extension and intensity. Seven of the 39 patients (18%) showed pattern N, 18 (46%) pattern D, 2 (5%) pattern F, and 12 (31%) pattern D+F. Of the 32 patients with a positive 99mTc-MIBI scan (i.e. showing pattern D, F or D+F), 29 (91%) had active disease. Only three patients in remission showed pattern D, but with a very low bone marrow uptake score. Both extension and intensity of diffuse bone marrow uptake correlated with the amount of the monoclonal component and the percentage of bone marrow plasma cells. The distribution of the 99mTc-MIBI uptake patterns differed among patients in different stages of disease. Using as criteria for advanced stage the presence of either focal uptake (pattern F or D+F) or pattern D with a high score, high (90%) diagnostic accuracy was obtained. In conclusion, the patterns of 99mTc-MIBI uptake in patients with MM are related to both the clinical status and the stage of disease. The presence of focal uptake or of intense diffuse bone marrow uptake suggests that the patient has active and advanced stage disease, while a negative scan in a patient with MM clearly indicates remission.

18F-FDG PET/CT, 99mTc-MIBI, and MRI in Evaluation of Patients with Multiple Myeloma

“…The meaning of 18 F-FDG diffuse bone marrow uptake in MM patients must be further investigated, as a mild and diffuse 18 F-FDG uptake in the spine could be also found in young or mildly anemic patients (28,29). On the other hand, previous studies showed that 99m Tc-MIBI concentrates in malignant plasma cells and that diffuse tracer uptake correlates with the percentage of plasma cell infiltration and the amount of a monoclonal component (13,15). Moreover, it has been shown that 99m Tc-MIBI bone marrow uptake is able to identify active myeloma and that the extension and intensity of tracer uptake correlates both with the clinical status and the stage of disease (13).…”

“…On the other hand, previous studies showed that 99m Tc-MIBI concentrates in malignant plasma cells and that diffuse tracer uptake correlates with the percentage of plasma cell infiltration and the amount of a monoclonal component (13,15). Moreover, it has been shown that 99m Tc-MIBI bone marrow uptake is able to identify active myeloma and that the extension and intensity of tracer uptake correlates both with the clinical status and the stage of disease (13). In fact, a previous study showed that moderateto-intense diffuse 99m Tc-MIBI uptake or focal uptake with or without diffuse uptake, in the absence of inflammation or other pathologies, excludes the diagnosis of monoclonal gammopathy of unknown significance (MGUS) and correlates with poor prognosis (19).…”

“…However, the relative contribution of each imaging technique, the specific clinical contexts in which one technique should be preferred over the other, or, eventually, the need to perform both imaging studies have not been fully elucidated. In addition, 99m Tc-MIBI scans showed a high sensitivity and specificity in detecting sites of active disease and bone lesions (13). Despite several reports on the clinical usefulness of this imaging modality (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), it is still unclear whether 99m Tc-MIBI can be fully replaced by 18 F-FDG PET/CT.…”

“…Moreover, previous studies have shown its usefulness in the detection of both osseous and extraosseous myeloma lesions (8)(9)(10). The lipophilic cation 99m Tc-MIBI has been successfully used for the detection of a variety of neoplastic diseases, including multiple myeloma, where it is reported to be useful in the assessment of disease extension both at diagnosis and during follow-up (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). MRI allows a direct high-contrast and sensitive visualization of the bone marrow and its components and, therefore, has become the method of choice for bone marrow imaging (23,24).…”

Value of Tc99m (V) Dmsa Compared to Tc99m Mibi in Evaluation of Bone and Bone Marrow Lesions in Patients with Multiple Myeloma.

“…Tc99m MDP is less sensitive than X-ray in detecting skeletal lesions in patients with MM as it is not capable of evaluating bone marrow disease activity owing to lack of osteoblastic response usually produced in bone 3 . Tc99m Both Tc99m MIBI and Tc99m (V) DMSA have been reported as tumor imaging agents for many neoplasm and bone metastases including multiple myeloma [11][12][13] .…”