New Approaches to Molecular Imaging of Multiple Myeloma

Abstract

Molecular imaging plays an important role in detection and staging of hematologic malignancies. Multiple myeloma (MM) is an age-related hematologic malignancy of clonal bone marrow plasma cells characterized by destructive bone lesions and is fatal in most patients. Traditional skeletal survey and bone scans have sensitivity limitations for osteolytic lesions manifested in MM. Progressive biomedical imaging technologies such as low-dose CT, molecularly targeted PET, MRI, and the functional–anatomic hybrid versions (PET/CT and PET/MRI) provide incremental advancements in imaging MM. Imaging with PET and MRI using molecularly targeted probes is a promising precision medicine platform that might successfully address the clinical ambiguities of myeloma spectrum diseases. The intent of this focus article is to provide a concise review of the present status and promising developments on the horizon, such as the new molecular imaging biomarkers under investigation that can either complement or potentially supersede existing standards.

Multimodal PET Imaging of Amyloid and Tau Pathology in Alzheimer Disease and Non–Alzheimer Disease Dementias

“…46 Subsequently, it was also shown in larger samples that the topographic distribution of [ 18 F] AV-1451 in amnesic MCI or AD dementia, compared with normal aging, was consistent with Braak staging, with more prominent tracer binding in inferior and lateral temporoparietal cortices, parieto-occipital cortices, posterior cingulate cortices, and precuneus and less in frontal regions and primary sensorimotor cortices. 47,48 Similar results have been observed in AD dementia patients using other tau PET tracers, including [ 18 F]THK5351 49 and [ 11 C]PBB3. 50 …”

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

“…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]. They are not directly comparable to the present study.…”

“…There was no significant difference between the readers in mean SUVmax or T/NT values for a given tracer (Wilcoxon's tests all p > 0. 35). The correlation coefficients between the values measured by the two readers for a given tracer were all highly significant (all p < 0.005).…”

Evaluating Acetate Metabolism for Imaging and Targeting in Multiple Myeloma

“…Metabolic imaging can differentiate metabolically active tumor lesions from large osteolytic areas where tumor cells may have been cleared by therapy but bone regeneration has not yet occurred as seen by standard radiographic imaging. Functional PET imaging of MM tumor-metabolism using 18 F-FDG has been widely used in the clinic for staging, treatment planning, and monitoring of response (39, 40). Despite the impressive results of 18 F-FDG on prognosis and treatment response, studies have suggested that other metabolic tracers are needed to complement 18 F-FDG (38).…”