¹⁸F‑ FDG PET/ CT and ^99mTc‑ MIBI Scintigraphy in Evaluation of Patients with Multiple Myeloma and Monoclonal Gammopathy of Unknown Significance: Comparison of Methods

Česká verzia

Authors: M. Mysliveček ²; J. Bačovský ¹; V. Ščudla ¹; P. Koranda ²; J. Minařík ¹; E. Buriánková ²; R. Formánek ²; J. Zapletalová ³
Authors place of work: III. interní klinika, FN a LF UP Olomouc ¹; Klinika nukleární medicíny, FN a LF UP Olomouc ²; Ústav lékařské biofyziky, LF UP Olomouc ³
Published in the journal: Klin Onkol 2010; 23(5): 325-331
Category: Original Articles

Summary

Backgrounds:
Newer imaging modalities, such as ¹⁸F‑ FDG PET/ CT and ^99mTc‑ MIBI scintigraphy, have been recently introduced to assess the activity and extent of disease in patients with multiple myeloma (MM) and gammopathy of undetermined significance (MGUS). The aim of our study was to compare the impact of these imaging modalities in the evaluation of MM and MGUS patients.

Materials and Methods:
A total of 101 patients with MM (81 patients) and MGUS (20 patients) were enrolled in the study (21 newly diagnosed and 44 relapsed patients with symptomatic MM, 16 with asymptomatic MM and 20 with MGUS). All patients were without therapy and underwent ¹⁸F‑ FDG PET/ CT and ^99mTc‑ MIBI scintigraphy within a maximum interval of 14 days. The scans were classified as normal (N), diffuse (D), and focal or combined (F‑ FD) pattern.

Results:
There was no significant difference in the detection of newly diagnosed MM and relapsed patients between the compared methods. ¹⁸F‑ FDG PET/ CT performed better than ^99mTc‑ MIBI scintigraphy in the detection of focal lesions (p < 0.039), whereas ^99mTc‑ MIBI scintigraphy was superior in the visualization of diffuse disease (p = 0.042). ¹⁸F‑ FDG PET/ CT visualised significantly more focal lesions than ^99mTc‑ MIBI scintigraphy (p = 0.002), both generally in the cohort and when comparing the number of focal lesions per patient. Both the imaging modalities singly or in combination influenced the subsequent clinical management in 17% of patients. In our study, ¹⁸F‑ FDG PET/ CT predicted asymptomatic MM and MGUS transformation into more aggressive forms with the necessity to start therapy more often than ^99mTc‑ MIBI scintigraphy.

Conclusion:
¹⁸F‑ FDG PET/ CT appeared to be a better imaging technique than ^99mTc‑ MIBI scintigraphy in the detection of focal lesions in patients with symptomatic MM. ^99mTc‑ MIBI was superior in the visualization of diffuse disease. On the other hand, despite its limited capacity in detecting focal lesions, ^99mTc‑ MIBI scintigraphy still remains the most rapid and inexpensive technique for whole‑ body evaluation and may be an alternative option when a PET/ CT facility is not available.

Key words:
multiple myeloma – monoclonal gammopathy of undetermined significance – Tc‑ MIBI – scintigraphy – PET scan – CT scan – ¹⁸F‑ FDG

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