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Fargette C, Imperiale A, Taïeb D. Molecular imaging of endocrine neoplasms with emphasis on 18F-DOPA PET: a practical approach for well-tailored imaging protocols. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:141-147. [PMID: 35343670 DOI: 10.23736/s1824-4785.22.03450-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
6-[18F]-L-fluoro-L-3, 4-dihydroxyphenylalanine (18F-DOPA) PET/CT can be a useful tool for the detection of different neuroendocrine tumors (NETs). The main determinants of 18F-DOPA uptake and retention by NETs are related to expression of LAT1/LAT2 transporters, expression and activity of AADC and biochemical phenotype, all being intimately inter-connected to their embryological origin. In order to improve sensitivity of 18F-DOPA PET, it is of main importance to perform indivisualized imaging protocols across primaries. This review provides a practical approach for performing well-tailored imaging protocols and describes the clinical value of the recommended radiopharmaceuticals.
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Affiliation(s)
- Christelle Fargette
- Department of Nuclear Medicine, CERIMED, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Alessio Imperiale
- Department of Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), IPHC, UMR 7178, University Hospitals of Strasbourg, CNRS/University of Strasbourg, Strasbourg, France
| | - David Taïeb
- Department of Nuclear Medicine, CERIMED, La Timone University Hospital, Aix-Marseille University, Marseille, France -
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Mesguich C, Latrabe V, Hulin C, Lascaux A, Bordenave L, Hindié E, Marit G. Prospective Comparison of 18-FDG PET/CT and Whole-Body MRI with Diffusion-Weighted Imaging in the Evaluation of Treatment Response of Multiple Myeloma Patients Eligible for Autologous Stem Cell Transplant. Cancers (Basel) 2021; 13:cancers13081938. [PMID: 33923781 PMCID: PMC8074107 DOI: 10.3390/cancers13081938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
To compare the prognostic values of 18-FDG PET/CT (FDG-PET) and Whole-Body MRI with Diffusion-Weighted Imaging (WB-DW-MRI) in the evaluation of treatment response of Multiple Myeloma (MM) patients eligible for ASCT. Thirty patients with newly diagnosed MM prospectively underwent FDG-PET and WB-DW-MRI at baseline, after induction chemotherapy and after ASCT. Response on WB-DW-MRI was evaluated with the MY-RADS criteria. FDG-PET was considered positive if residual uptake was superior to liver uptake. Imaging results were not used for treatment modification. The impact of imaging results on PFS was analyzed. After a median follow-up of 32 months, 10 patients relapsed. With WB-DW-MRI, post-induction examination was positive in 3/25 and post-ASCT examination was positive in 3/27 patients. However, neither study showed prognostic impact on PFS. FDG-PET was positive in 5/22 post-induction and 3/26 patients post-ASCT, respectively. Positivity of FDG-PET, post-induction or post-ASCT, was associated with a shorter PFS (post-induction: median PFS 19 months vs. not reached, log-rank p = 0.0089; post-ASCT: median PFS 18 months vs. not reached, log-rank p = 0.0005). Preliminary results from this small, single-center, prospective study show that, whether performed post-induction or post-ASCT, FDG-PET has a higher prognostic value than WB-DW-MRI for treatment response evaluation of newly diagnosed MM.
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Affiliation(s)
- Charles Mesguich
- Nuclear Medicine Department, CHU Bordeaux, F-33000 Bordeaux, France; (L.B.); (E.H.)
- INSERM U1035, University of Bordeaux, F-33000 Bordeaux, France;
- Correspondence: ; Tel.: +33-5-57656335
| | - Valérie Latrabe
- Radiology Department, CHU Bordeaux, F-33000 Bordeaux, France;
| | - Cyrille Hulin
- Haematology Department, CHU Bordeaux, F-33000 Bordeaux, France; (C.H.); (A.L.)
| | - Axelle Lascaux
- Haematology Department, CHU Bordeaux, F-33000 Bordeaux, France; (C.H.); (A.L.)
| | - Laurence Bordenave
- Nuclear Medicine Department, CHU Bordeaux, F-33000 Bordeaux, France; (L.B.); (E.H.)
| | - Elif Hindié
- Nuclear Medicine Department, CHU Bordeaux, F-33000 Bordeaux, France; (L.B.); (E.H.)
| | - Gerald Marit
- INSERM U1035, University of Bordeaux, F-33000 Bordeaux, France;
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Ravikanth R, Singh JK. Semi-quantitative analysis of 18F fluorodeoxyglucose uptake in the assessment of disease activity and therapeutic response in rheumatoid arthritis: An institutional experience. World J Nucl Med 2021; 19:347-352. [PMID: 33623503 PMCID: PMC7875038 DOI: 10.4103/wjnm.wjnm_12_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/05/2020] [Accepted: 03/18/2020] [Indexed: 11/04/2022] Open
Abstract
18F fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) can be used to image synovial inflammation in patients with rheumatoid arthritis (RA). Recently, clinical application of novel therapies for RA, such as tumor necrosis factor-α (TNF-α) inhibitor and anti-interleukin-6 receptor antibody, has been introduced. The radiological assessment of disease activity changes of patients who underwent these therapies will help the clinicians to obtain more information about the patients and to decide drug withdrawal or change of medication. It is considered that 18F-FDG PET scan is generally very expensive; however, the information from 18F-FDG PET about patients during biological treatments helps discontinuation of these treatments with incomplete response despite its high costs and with possible side effects such as malignant lymphoma. In this study, we evaluated if the 18F-FDG uptake of the affected joints represented by standardized uptake value (SUV) correlated with the clinical assessment of patients with RA. In addition, we would like to evaluate if there was a correlation between the difference of SUV and improvement of clinical findings in RA patients undergoing anti TNF therapies. RA patients who underwent anti-TNFα therapies in a tertiary care hospital were assessed using whole-body 18F-FDG PET/computed tomography (CT). PET assessments were performed on hip joints, knees, shoulders, wrists, ankles, MCP, and PIP for a total of 28 joints in each patient. The 18F-FDG uptake was then quantified using the maximum SUV (SUVmax) prior to, and 6 months after the initiation of treatment with anti-TNF-α drugs. Disease activity score (DAS28 and DAS28-C-reactive protein [CRP]) were recorded and white blood cell, matrix metalloproteinases (MMP-3) and rheumatoid factor (RF) were examined in all patients. The average of SUVmax among measured joints, or the sum of these joints (total SUVmax), correlated with DAS28 (r = 0.671, P < 0.001), DAS28-CRP (r = 0.623, P < 0.001), ESR (r = 0.542, P < 0.001), CRP (r = 0.411, P = 0.002), MMP-3 (r = 0.399, P = 0.006), and RF (r = 0.447, P = 0.002). There were correlations between ΔSUV and ΔDAS28 (r = 0.651, P < 0.001), ΔSUV and ΔDAS28-CRP (r = 0.682, P < 0.001), ΔSUV and ΔESR (r = 0.449, P = 0.023), and ΔSUV and ΔMMP-3 (r = 0.457, P = 0.027), respectively. The number of PET-positive joints and the cumulative SUV significantly correlated with the DAS28, which is a composite disease activity score (DAS) that combines the swollen and tender joint counts, the erythrocyte sedimentation rate (DAS28-ESR) or CRP serum levels (DAS28 - CRP) or RF (DAS28 - RF) or metalloproteinases-3 (DAS28-MMP-3). At baseline and at 6 months' post-treatment with anti-TNFα drugs, there was a significant correlation between the PET results, either visual, the cumulative SUVs or the composite SUV index, and the comprehensive clinical assessment (DAS28), the CRP levels and the number of joints positive for RA, and cumulative synovial thickness. By reflecting inflammatory activity, 18F-FDG PET may enhance the diagnostic performance and expectation of disease prognosis in RA, especially with early synovial inflammation. The intensity of uptake varied from mild to intense (SUVmax values from 3.10 to 6.0). Overall, these values correlated well with the clinical evaluation of involved joints. 18F-FDG PET imaging data provided a distribution of joint involvement with varying degrees of severity and phase of disease activity (moderate, low, and remission) in the same patient. PET/CT imaging with 18F-FDG shows better image quality, provides more confirmative diagnostic information, and will be promising imaging modality in diagnosis and management of RA.
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Affiliation(s)
- Reddy Ravikanth
- Department of Radiology, St. John's Hospital, Kattappana, Kerala, India
| | - Jyotin Kshitiz Singh
- Department of Internal Medicine, Diana Princess of Wales Hospital, Grimsby, United Kingdom
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Li Q, Ma J, Li H, Xu W, Cao Z, Liu S, Chen L, Gao S, Yan T, Li D, Wang X, Yue Y, Zhao Z, Wang X, Yang H, Zhao H, Yu Y, Zhang Y, Fan F, Wang Y. Correlation Between Uptake of 18F-FDG During PET/CT and Ki-67 Expression in Patients Newly Diagnosed With Multiple Myeloma Having Extramedullary Involvement. Technol Cancer Res Treat 2019; 18:1533033819849067. [PMID: 31092140 PMCID: PMC6535751 DOI: 10.1177/1533033819849067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to evaluate the relationship of prognosis of patients with multiple myeloma having extramedullary involvement (EMM) with the 18F- fluorodeoxyglucose(18F-FDG) maximum standardized uptake value and the expression of Ki-67 in biopsy samples. Sixty-five patients were newly diagnosed with multiple myeloma presenting with EMM at our hospital from January 2005 to January 2015. Of these 65 patients, 20 were enrolled in this study. Over the last decade, both the maximum standardized uptake value and Ki-67 expression in these extramedullary lesions significantly correlated with progression-free survival, respectively (P= .039, P =.009). After combining—the maximum standardized uptake value and the Ki-67 expression as an integral—there was a significant correlation between both the overall survival (P = .027) and progression-free survival (P= .014). Patients have poor outcomes when EMM is detected at presentation. Both the maximum standardized uptake value and Ki-67 expression could aid in accurately evaluating EMM patient prognosis.
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Affiliation(s)
- Qian Li
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,2 Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China.,They are co-first authors and have contributed equally to this article
| | - Jing Ma
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,They are co-first authors and have contributed equally to this article
| | - Han Li
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Wengui Xu
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Zeng Cao
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Su Liu
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Lin Chen
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Shuang Gao
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Tinghui Yan
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Dongying Li
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xue Wang
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Yuanfang Yue
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Zhigang Zhao
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xiaofang Wang
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Hongliang Yang
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Haifeng Zhao
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Yong Yu
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Yizhuo Zhang
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Feiyue Fan
- 3 Institute of Laboratory Animal Sciences, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yafei Wang
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
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Abstract
The primary hurdle in the path to curing multiple myeloma (MM) is defining a validated minimal residual disease (MRD) and its utility in the therapeutic decision making. A better definition of MRD will aid in tailoring MM therapy further to address the clonal heterogeneity and genomic instability and overcome patient's ineffective immune surveillance. MRD analysis can define the logical endpoint for maintenance therapy, in addition also aids in providing a better clinical end point for studies comparing novel agents in myeloma. MRD is a surrogate for the survival in MM. Guidelines for global incorporation of MRD in myeloma are fraught with lack of standardization, universal availability and abridged physicians' understanding of MRD modalities. We aimed at addressing some of the frequently asked questions in the MRD assessment and will also place in perspective some arguments in favor of MRD assessment in routine practice and clinical trial scenario.
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Affiliation(s)
- Uday Yanamandra
- Department of Hematology and Stem Cell Transplant, Army Hospital - Research and Referral, New Delhi, Delhi, IN 110010
| | - Shaji K. Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA 55905
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Affiliation(s)
- Yun Young Choi
- Department of Nuclear Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Ji Young Kim
- Department of Nuclear Medicine, Hanyang University Medical Center, Seoul, Korea
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Simplified response monitoring criteria for multiple myeloma in patients undergoing therapy with novel agents using computed tomography. Eur J Radiol 2016; 85:2195-2199. [PMID: 27842666 DOI: 10.1016/j.ejrad.2016.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/24/2016] [Accepted: 10/14/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Multiple myeloma is a malignant hematological disorder of the mature B-cell lymphocytes originating in the bone marrow. While therapy monitoring is still mainly based on laboratory biomarkers, the additional use of imaging has been advocated due to inaccuracies of serological biomarkers or in a-secretory myelomas. Non-enhanced CT and MRI have similar sensitivities for lesions in yellow marrow-rich bone marrow cavities with a favourable risk and cost-effectiveness profile of CT. Nevertheless, these methods are still limited by frequently high numbers of medullary lesions and its time consumption for proper evaluation. OBJECTIVE To establish simplified response criteria by correlating size and CT attenuation changes of medullary multiple myeloma lesions in the appendicular skeleton with the course of lytic bone lesions in the entire skeleton. Furthermore to evaluate these criteria with respect to established hematological myeloma-specific parameters for the prediction of treatment response to bortezomib or lenalidomide. MATERIALS AND METHODS Non-enhanced reduced-dose whole-body CT examinations of 78 consecutive patients (43 male, 35 female, mean age 63.69±9.2years) with stage III multiple myeloma were retrospectively re-evaluated. On per patient basis, size and mean CT attenuation of 2-4 representative lesions in the limbs were measured at baseline and at a follow-up after a mean of 8 months. Results were compared with the course of lytical bone lesions as well with that of specific hematological biomarkers. Myeloma response was assessed according to the International Myeloma Working Group (IMWG) uniform response criteria. Testing for correlation between response of medullary lesions (Respmed) and response of all myeloma manifestations including osteolyses (Resptotal) was performed using the corrected contingency coefficient (Ccorr). RESULTS The correlation between Respmed based on length diameter and transverse diameter and Resptotal was perfect (Ccorr=1.0; p<0.0001) whereas the correlation based on density was moderate (Ccorr=0.54; p<0.0001). The evaluation of simplified response criteria with a measurement of only 2 medullary lesions yielded the best sensitivity and specificity valued for treatment-induced changes for the length diameter evaluation with 94.4%/95.7% for prediction of progressive disease and 78.6%/93.3% for prediction of therapy response. There were no significant differences between patients treated with bortezomib and lenalidomide (p>0.05). CONCLUSION Measurements of size of a minimum of two medullary lesions is sufficient for response assessment and correlates very well with the course of lytic bone lesions and that of hematologic parameters.
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Agrawal K, Marafi F, Gnanasegaran G, Van der Wall H, Fogelman I. Pitfalls and Limitations of Radionuclide Planar and Hybrid Bone Imaging. Semin Nucl Med 2016; 45:347-72. [PMID: 26278850 DOI: 10.1053/j.semnuclmed.2015.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The radionuclide (99m)Tc-MDP bone scan is one of the most commonly performed nuclear medicine studies and helps in the diagnosis of different pathologies relating to the musculoskeletal system. With its increasing utility in clinical practice, it becomes more important to be aware of various limitations of this imaging modality to avoid false interpretation. It is necessary to be able to recognize various technical, radiopharmaceutical, and patient-related artifacts that can occur while carrying out a bone scan. Furthermore, several normal variations of tracer uptake may mimic pathology and should be interpreted cautiously. There is an important limitation of a bone scan in metastatic disease evaluation as the inherent mechanism of tracer uptake is not specific for tumor but primarily relies on an osteoblastic response. Thus, it is crucial to keep in mind uptake in benign lesions, which can resemble malignant pathologies. The utility of a planar bone scan in benign orthopedic diseases, especially at sites with complex anatomy, is limited owing to lack of precise anatomical information. SPECT/CT has been significantly helpful in these cases. With wider use of PET/CT and reintroduction of the (18)F-fluoride bone scan, increasing knowledge of potential pitfalls on an (18)F-fluoride bone scan and (18)F-FDG-PET/CT will help in improving the accuracy of clinical reports.
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Affiliation(s)
- Kanhaiyalal Agrawal
- Department of Nuclear Medicine, Guy׳s & St Thomas׳ NHS Foundation Trust, London, UK.
| | - Fahad Marafi
- Department of Nuclear Medicine, Kuwait Cancer Control Center (KCCC), King's College, London
| | | | - Hans Van der Wall
- Department of Nuclear Medicine, Concord Nuclear Imaging, Concord West, New South Wales, Australia
| | - Ignac Fogelman
- Department of Nuclear Medicine, Kuwait Cancer Control Center (KCCC), King's College, London
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Abstract
A 67-year-old man with newly diagnosed multiple myeloma underwent both FDG and C-acetate PET/CT sequentially on different days. There was increased FDG activity only in L1 vertebral body, but there was diffuse abnormal C-acetate activity throughout the skeletal system. After the successful therapy, the patient who was on remission clinically underwent follow-up PET/CT scans. Interestingly, L1 remained to have elevated FDG, although with less intensity. In contrast, there was no abnormal C-acetate activity anywhere in the body. The patient remained in remission clinically.
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Patriarca F, Carobolante F, Zamagni E, Montefusco V, Bruno B, Englaro E, Nanni C, Geatti O, Isola M, Sperotto A, Buttignol S, Stocchi R, Corradini P, Cavo M, Fanin R. The Role of Positron Emission Tomography with 18F-Fluorodeoxyglucose Integrated with Computed Tomography in the Evaluation of Patients with Multiple Myeloma Undergoing Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2015; 21:1068-73. [DOI: 10.1016/j.bbmt.2015.03.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/02/2015] [Indexed: 01/06/2023]
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Gertz MA. Advanced skeletal imaging redefines the management of plasma cell disorders. J Clin Oncol 2015; 33:537-9. [PMID: 25605847 DOI: 10.1200/jco.2014.59.5066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Mesguich C, Fardanesh R, Tanenbaum L, Chari A, Jagannath S, Kostakoglu L. State of the art imaging of multiple myeloma: comparative review of FDG PET/CT imaging in various clinical settings. Eur J Radiol 2014; 83:2203-2223. [PMID: 25308249 DOI: 10.1016/j.ejrad.2014.09.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 09/19/2014] [Indexed: 12/24/2022]
Abstract
18-Flurodeoxyglucose Positron Emission Tomography with computed tomography (FDG PET/CT) and Magnetic Resonance Imaging (MRI) have higher sensitivity and specificity than whole-body X-ray (WBXR) survey in evaluating disease extent in patients with multiple myeloma (MM). Both modalities are now recommended by the Durie-Salmon Plus classification although the emphasis is more on MRI than PET/CT. The presence of extra-medullary disease (EMD) as evaluated by PET/CT imaging, initial SUVmax and number of focal lesions (FL) are deemed to be strong prognostic parameters at staging. MRI remains the most sensitive technique for the detection of diffuse bone marrow involvement in both the pre and post-therapy setting. Compression fractures are best characterized with MRI signal changes, for determining vertebroplasty candidates. While PET/CT allows for earlier and more specific evaluation of therapeutic efficacy compared to MRI, when signal abnormalities persist years after treatment. PET/CT interpretation, however, can be challenging in the vertebral column and pelvis as well as in cases with post-therapy changes. Hence, a reading approach combining the high sensitivity of MRI and superior specificity of FDG PET/CT would be preferred to increase the diagnostic accuracy. In summary, the established management methods in MM, mainly relying on biological tumor parameters should be complemented with functional imaging data, both at staging and restaging for optimal management of MM.
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Affiliation(s)
- Charles Mesguich
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Reza Fardanesh
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Lawrence Tanenbaum
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ajai Chari
- Department of Medicine Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sundar Jagannath
- Department of Medicine Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Lale Kostakoglu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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Chakravarty R, Hong H, Cai W. Positron emission tomography image-guided drug delivery: current status and future perspectives. Mol Pharm 2014; 11:3777-97. [PMID: 24865108 PMCID: PMC4218872 DOI: 10.1021/mp500173s] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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Positron
emission tomography (PET) is an important modality in
the field of molecular imaging, which is gradually impacting patient
care by providing safe, fast, and reliable techniques that help to
alter the course of patient care by revealing invasive, de facto procedures
to be unnecessary or rendering them obsolete. Also, PET provides a
key connection between the molecular mechanisms involved in the pathophysiology
of disease and the according targeted therapies. Recently, PET imaging
is also gaining ground in the field of drug delivery. Current drug
delivery research is focused on developing novel drug delivery systems
with emphasis on precise targeting, accurate dose delivery, and minimal
toxicity in order to achieve maximum therapeutic efficacy. At the
intersection between PET imaging and controlled drug delivery, interest
has grown in combining both these paradigms into clinically effective
formulations. PET image-guided drug delivery has great potential to
revolutionize patient care by in vivo assessment
of drug biodistribution and accumulation at the target site and real-time
monitoring of the therapeutic outcome. The expected end point of this
approach is to provide fundamental support for the optimization of
innovative diagnostic and therapeutic strategies that could contribute
to emerging concepts in the field of “personalized medicine”.
This review focuses on the recent developments in PET image-guided
drug delivery and discusses intriguing opportunities for future development.
The preclinical data reported to date are quite promising, and it
is evident that such strategies in cancer management hold promise
for clinically translatable advances that can positively impact the
overall diagnostic and therapeutic processes and result in enhanced
quality of life for cancer patients.
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Affiliation(s)
- Rubel Chakravarty
- Department of Radiology, University of Wisconsin-Madison , Madison, Wisconsin 53705-2275, United States
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Solitary Plasmacytoma of the Sternum Mimicking Bone Metastasis in a Patient with a History of Breast Cancer Evaluated by F-18-FDG PET/CT. Nucl Med Mol Imaging 2014; 48:169-70. [PMID: 24900161 PMCID: PMC4028481 DOI: 10.1007/s13139-013-0257-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/19/2013] [Accepted: 11/26/2013] [Indexed: 11/17/2022] Open
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Kuroda J, Shimura Y, Ohta K, Tanaka H, Shibayama H, Kosugi S, Fuchida S, Kobayashi M, Kaneko H, Uoshima N, Ishii K, Nomura S, Taniwaki M, Takaori-Kondo A, Shimazaki C, Tsudo M, Hino M, Matsumura I, Kanakura Y. Limited value of the international staging system for predicting long-term outcome of transplant-ineligible, newly diagnosed, symptomatic multiple myeloma in the era of novel agents. Int J Hematol 2014; 99:441-9. [PMID: 24584872 DOI: 10.1007/s12185-014-1539-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/12/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
Abstract
We retrospectively investigated clinical outcomes and prognostic factors of 131 patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM) who received melphalan and prednisolone (MP) as first-line therapy from 2006 to 2013. Eighty-one patients received salvage therapies incorporating bortezomib, lenalidomide, and/or thalidomide. The overall response rate to MP was 54.2 %, including 9.2 % of better than very good partial response. With a median follow-up period of 30.2 months, median overall survival (OS) and median time to next treatment (TNT) were 54.4 and 19.0 months, respectively. Univariate analysis revealed that performance status and serum calcium level significantly associated with both OS and TNT, and multivariate analysis revealed that the higher serum calcium level had a significantly unfavorable impact on OS and TNT. Importantly, staging informed by the international staging system (ISS) was not predictive for OS or TNT in the analyzed cohort. Our study revealed that, in the context of first-line MP therapy for NDMM, the salvage therapy incorporating novel agents produced a survival period of >30 months after the initiation of second-line therapy, suggesting that the predictive value of ISS for OS and TNT may be limited in the era of novel agents.
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Affiliation(s)
- Junya Kuroda
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan,
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