Value of 18F-fluorodeoxyglucose uptake in positron emission tomography/computed tomography in predicting survival in multiple myeloma

Haznedar, Rauf; Akı, Şahika Zeynep; Akdemir, Ozgur; Özkurt, Zübeyde Nur; Çeneli̇, Özcan; Yağcı, Münci; Sucak, Gülsan Türköz; Ünlü, Mustafa

doi:10.1007/s00259-011-1738-8

Cited by 81 publications

(49 citation statements)

References 22 publications

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“…However, the new imaging parameter MTV, derived from SUVmax, showed prognostic significance, likely because MTV takes into account the metabolic active volume of all MM lesions, which can vary in size and uptake and be widespread throughout the body. A recent study reported that patients affected by MM at different stages with 18 F-FDG uptake-positive extramedullary lesions showed a shorter survival than patients without 18 F-FDG-positive lesions; the study also found that the SUVmax of the extramedullary lesion with the highest metabolic uptake was significantly associated with overall survival (35). In our study, we enrolled MM patients who were in the same stage.…”

Section: Discussionmentioning

confidence: 84%

Metabolic Tumor Volume Assessed by ¹⁸F-FDG PET/CT for the Prediction of Outcome in Patients with Multiple Myeloma

Fonti

Larobina

Vecchio³

et al. 2012

J Nucl Med

166

117

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18 F-FDG PET/CT allows the direct measurement of metabolic tumor burden in a variety of different malignancies. The aim of this study was to assess whether metabolic tumor volume (MTV) determined by 18 F-FDG PET/CT could be used in the prediction of progression-free and overall survival in multiple myeloma patients. Methods: Forty-seven patients (18 women, 29 men; mean age 6 SD, 63 6 11 y) with stage IIIA disease who had undergone whole-body 18 F-FDG PET/CT were retrospectively evaluated. Images underwent a 3-dimensional region-of-interest analysis including all focal lesions with a maximum standardized uptake value . 2.5. The MTV of each lesion was calculated using an automated contouring program based on the standardized uptake value and developed with a threshold of 40% of the maximum standardized uptake value. The total MTV of each patient was defined as the sum of metabolic volume of all focal lesions. Patients were treated and then subjected to a mean follow-up period of 24 mo. Results: In the 47 patients studied, MTV range was 1.3-316.3 mL, with a median of 23.7 mL. A direct, significant correlation was found between MTV and the percentage of diffuse infiltration of bone marrow by plasma cells (r 5 0.46, P 5 0.006), whereas hemoglobin levels were inversely correlated with MTV (r 5 20.56, P 5 0.0001). At follow-up, patients who developed progressive disease (n 5 18) showed a significantly higher MTV (74.7 6 19.3 vs. 29.8 6 5.1 mL, P 5 0.009) than patients without progressive disease (n 5 29). Furthermore, patients who died of myeloma (n 5 9) had a significantly higher MTV (123.2 6 30.6 vs. 28.9 6 4.2 mL, P 5 0.0001) than survivors (n 5 38). No differences in age, plasma cell infiltration, M protein, albumin, b2-microglobulin, performance status, International Staging System score, and presence or absence of a bone marrow transplant were found between groups. The MTV cutoff level was determined by receiver-operating-characteristic curve analysis, and the best discriminative value found for predicting progression-free and overall survival was 42.2 and 77.6 mL, respectively. By Kaplan-Meier analysis and log-rank testing, progression-free and overall survival at follow-up were significantly better in patients showing an MTV lower than the cutoff than in those having an MTV higher than the cutoff (x 2 5 3.9, P 5 0.04, and x 2 5 56.3, P , 0.0001, respectively). Conclusion: The direct measurement of tumor burden obtained by calculating MTV on 18 F-FDG PET/CT images may be used in the prediction of progression-free and overall survival in myeloma patients.

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Section: Discussionmentioning

confidence: 84%

Metabolic Tumor Volume Assessed by ¹⁸F-FDG PET/CT for the Prediction of Outcome in Patients with Multiple Myeloma

Fonti

Larobina

Vecchio³

et al. 2012

J Nucl Med

166

117

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“…On the contrary, the PET parameter SUV has rarely been connected to baseline clinical characteristics. Although there were several studies suggesting that SUV at diagnosis has a prognostic impact, there was no unifying definition of SUV used in these studies; the mean value of SUV [31] or SUV max [33] was arbitrarily cited. In our study, we evaluated the correlation between SUV max at diagnosis and baseline clinical characteristics and observed no significant relationship.…”

Section: Discussionmentioning

confidence: 99%

“…As reported in the literature, an X-ray is less sensitive than other imaging modalities at detecting both medullary and extramedullary lesions as well as at identifying bone marrow (BM) involvement [20,21,22,23,24]; therefore, it serves as a less accurate modality for staging MM [25,26,27,28,29]. In addition to staging at the time of initial diagnosis, newer imaging techniques allow for improved understanding of the prognosis of a disease [17,30,31,32,33]. In brief, radiological imaging goes beyond simply detecting ‘morphological' findings but reflects disease aggressiveness and prognosis.…”

Section: Introductionmentioning

confidence: 99%

Positive Correlation between Baseline PET or PET/CT Findings and Clinical Parameters in Multiple Myeloma Patients

Park

Lee²,

Chang

et al. 2013

Acta Haematol

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Recently, positron emission tomography (PET) has been incorporated into a series of prospective studies as a predictor of outcomes in multiple myeloma (MM), and the number of ¹⁸F-fluorodeoxuglucose (FDG)-avid focal lesions (FLs) and the intensity of tumor metabolism have been designated as important surrogate markers for predicting prognosis. Here, we compared initial clinical characteristics of MM patients with baseline PET parameters: the number of FLs and the maximum standardized uptake value (SUV_max). A total of 59 patients diagnosed with MM between August 2004 and February 2012 were reviewed. At diagnosis, 23 patients (40.0%) had ≤3 FLs, 11 patients (18.6%) 4-9 FLs, and 25 patients (42.4%) ≥10 FLs. The median SUV_max was 5.3 (range 0-24.3), and 40 patients (67.8%) showed a SUV_max >4. No clinical characteristics were significantly different between groups with a SUV_max ≤4 and a SUV_max >4. However, there were significant differences in several clinical indices between the FLs ≤3 and FLs >3 groups; elevated β₂-microglobulin, elevated lactate dehydrogenase, anemia and more advanced disease by the Durie-Salmon stage corresponded to FLs >3 at baseline PET. Adverse baseline PET findings are positively correlated with prognostically relevant clinical parameters. Regarding PET parameters, FLs are more likely to be well correlated with disease aggressiveness and pathophysiology compared to SUV_max.

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“…PET/CT has the highest detection rates for extramedullary disease (EMD; ref. 34) compared with other imaging techniques, which is critical, since EMD has been found to confer a poor prognosis (24,27,35,36). Only one study examined the prognostic value of lesions found on CT, and showed no correlation between the number of lesions and prognosis (30).…”

Section: Imaging For Surveillance and Prognosticationmentioning

confidence: 99%

“…The most significant advantage in the use of PET/CT is through detection of disease activity as it can distinguish between active and inactive disease (22). PET results correlate with clinical and hematologic parameters in patients with multiple myeloma (23), and can predict survival (24). Limitations of PET imaging include poor specificity to small lytic lesions less than 0.5 cm in size and false-positive results.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Whole-Body Low-Dose Computed Tomography and Advanced Imaging Techniques for Multiple Myeloma Bone Disease

Pianko

Terpos

Roodman

et al. 2014

Clinical Cancer Research

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Detection of lytic bone lesions is crucial in the workup for multiple myeloma and very often dictates the decision to start treatment. Conventional radiography, despite decades of use, is often insufficient for detection of bone disease in multiple myeloma. Modern imaging techniques such as MRI, PET, and CT offer superior detection of myeloma bone disease and extramedullary manifestations of plasma cell dyscrasias. Novel whole-body low-dose computed tomography (WBLDCT) protocols allow for collection of superior image detail of the skeleton at doses of radiation similar to those used for conventional planar radiography. Several studies have shown that WBLDCT has a superior detection rate for lytic bone lesions compared with whole-body X-ray (WBXR), potentially leading to restaging and changes in therapy. MRI and PET provide imaging data important for assessing disease activity and prognostication. Because of several advantages over WBXR, WBLDCT is already the standard imaging technique for use in patients with multiple myeloma in many European institutions. However, the radiographic skeletal survey or WBXR is still the initial study of choice used to screen for myeloma bone disease in many institutions. In this review, we aim to explore the changing landscape of imaging for myeloma bone disease through use of modern imaging techniques. Clin Cancer Res; 20(23); 5888-97. Ó2014 AACR.

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Value of 18F-fluorodeoxyglucose uptake in positron emission tomography/computed tomography in predicting survival in multiple myeloma

Abstract: PET/CT allows identification of high-risk myeloma patients, and extramedullary lesions with the highest SUV(max) independently predict inferior OS.

Cited by 81 publications

References 22 publications

Metabolic Tumor Volume Assessed by ¹⁸F-FDG PET/CT for the Prediction of Outcome in Patients with Multiple Myeloma

Metabolic Tumor Volume Assessed by ¹⁸F-FDG PET/CT for the Prediction of Outcome in Patients with Multiple Myeloma

Positive Correlation between Baseline PET or PET/CT Findings and Clinical Parameters in Multiple Myeloma Patients

Whole-Body Low-Dose Computed Tomography and Advanced Imaging Techniques for Multiple Myeloma Bone Disease

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Value of 18F-fluorodeoxyglucose uptake in positron emission tomography/computed tomography in predicting survival in multiple myeloma

Abstract: PET/CT allows identification of high-risk myeloma patients, and extramedullary lesions with the highest SUV(max) independently predict inferior OS.

Cited by 81 publications

References 22 publications

Metabolic Tumor Volume Assessed by 18F-FDG PET/CT for the Prediction of Outcome in Patients with Multiple Myeloma

Metabolic Tumor Volume Assessed by 18F-FDG PET/CT for the Prediction of Outcome in Patients with Multiple Myeloma

Positive Correlation between Baseline PET or PET/CT Findings and Clinical Parameters in Multiple Myeloma Patients

Whole-Body Low-Dose Computed Tomography and Advanced Imaging Techniques for Multiple Myeloma Bone Disease

Contact Info

Product

Resources

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Metabolic Tumor Volume Assessed by ¹⁸F-FDG PET/CT for the Prediction of Outcome in Patients with Multiple Myeloma

Metabolic Tumor Volume Assessed by ¹⁸F-FDG PET/CT for the Prediction of Outcome in Patients with Multiple Myeloma