Interpretation criteria for FDG PET/CT in multiple myeloma (IMPeTUs): final results. IMPeTUs (Italian myeloma criteria for PET USe)

  • Cristina Nanni
  • Annibale Versari
  • Stephane Chauvie
  • Elisa Bertone
  • Andrea Bianchi
  • Marco Rensi
  • Marilena Bellò
  • Andrea Gallamini
  • Francesca Patriarca
  • Francesca Gay
  • Barbara Gamberi
  • Pietro Ghedini
  • Michele Cavo
  • Stefano Fanti
  • Elena Zamagni
Original Article

Abstract

FDG PET/CT (18F-fluoro-deoxy-glucose positron emission tomography/computed tomography) is a useful tool to image multiple myeloma (MM). However, simple and reproducible reporting criteria are still lacking and there is the need for harmonization. Recently, a group of Italian nuclear medicine experts defined new visual descriptive criteria (Italian Myeloma criteria for Pet Use: IMPeTUs) to standardize FDG PET/CT evaluation in MM patients. The aim of this study was to assess IMPeTUs reproducibility on a large prospective cohort of MM patients.

Materials and methods

Patients affected by symptomatic MM who had performed an FDG PET/CT at baseline (PET0), after induction (PET-AI), and the end of treatment (PET-EoT) were prospectively enrolled in a multicenter trial (EMN02)(NCT01910987; MMY3033). After anonymization, PET images were uploaded in the web platform WIDEN® and hence distributed to five expert nuclear medicine reviewers for a blinded independent central review according to the IMPeTUs criteria. Consensus among reviewers was measured by the percentage of agreement and the Krippendorff’s alpha. Furthermore, on a patient-based analysis, the concordance among all the reviewers in terms of positivity or negativity of the FDG PET/CT scan was tested for different thresholds of positivity (Deauville score (DS 2, 3, 4, 5) for the main parameters (bone marrow, focal score, extra-medullary disease).

Results

Eighty-six patients (211 FDG PET/CT scans) were included in this analysis. Median patient age was 58 years (range, 35–66 years), 45% were male, 15% of them were in stage ISS (International Staging System) III, and 42% had high-risk cytogenetics. The percentage agreement was superior to 75% for all the time points, reaching 100% of agreement in assessing the presence skull lesions after therapy. Comparable results were obtained when the agreement analysis was performed using the Krippendorff’s alpha coefficient, either in every single time point of scanning (PET0, PET-AI or PET-EoT) or overall for all the scans together. DS proved highly reproducible with the highest reproducibility for score 4.

Conclusions

IMPeTUs criteria proved highly reproducible and could therefore be considered as a base for harmonizing PET interpretation in multiple myeloma. A prospective clinical validation of IMPeTUs criteria is underway.

Keywords

Multiple myeloma FDG PET/CT Interpretation criteria Standardization IMPeTUs 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

All the patients signed a specific informed consent.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Cristina Nanni
    • 1
  • Annibale Versari
    • 2
  • Stephane Chauvie
    • 3
  • Elisa Bertone
    • 3
  • Andrea Bianchi
    • 4
  • Marco Rensi
    • 5
  • Marilena Bellò
    • 6
  • Andrea Gallamini
    • 7
  • Francesca Patriarca
    • 8
  • Francesca Gay
    • 9
  • Barbara Gamberi
    • 10
  • Pietro Ghedini
    • 1
  • Michele Cavo
    • 11
  • Stefano Fanti
    • 1
  • Elena Zamagni
    • 11
  1. 1.Medicina Nucleare Metropolitana, Bld 30, AOU Policlinico S. Orsola-MalpighiBolognaItaly
  2. 2.Nuclear Medicine, IRCSS Reggio EmiliaS. Maria Nuova HospitalReggio EmiliaItaly
  3. 3.Medical Physics DivisionSanta Croce e Carle HospitalCuneoItaly
  4. 4.Nuclear MedicineSanta Croce e Carle HospitalCuneoItaly
  5. 5.Nuclear MedicineAOU S. Maria della MisericordiaUdineItaly
  6. 6.Nuclear MedicineAO Città della Salute e della ScienzaTorinoItaly
  7. 7.Research, Innovation and Statistics Department. A. Lacassagne Cancer CenterNiceFrance
  8. 8.Hematologic ClinicUdine UniversityUdineItaly
  9. 9.Myeloma Unit, Division of HematologyUniversity of TorinoTorinoItaly
  10. 10.Hematology Unit, IRCCS, Reggio EmiliaS. Maria Nuova HospitalReggio EmiliaItaly
  11. 11.Hematology, AOU Policlinico S. Orsola-MalpighiBolognaItaly

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