Skip to main content
SpringerLink
Log in

Diagnostic performance of 18F-FDG PET/CT and whole-body MRI before and early after treatment of multiple myeloma: a prospective comparative study

  • Original Article
  • Published:
Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine the diagnostic accuracy of WB-MRI and 18F-FDG PET/CT in detecting infiltration pattern, disease activity, and response to treatment in patients with multiple myeloma (MM).

Materials and methods

Fifty-six patients with confirmed MM were included in the present study for pre-treatment evaluation. Among these individuals, 22 patients were available for the post-treatment evaluation of response to therapy. All patients were imaged with both WB-MRI and 18F-FDG PET/CT. All radiographic findings of infiltration pattern, disease activity, and response to therapy were compared. The diagnostic performance of both modalities was estimated using bone marrow aspirate and biopsy as the reference test.

Results

For detection of active myelomatous tissue at diagnosis, WB-MRI achieved higher sensitivity (94%) than 18F-FDG PET/CT (75%) (p = 0.0039), whereas both modalities achieved the same specificity (80%). For detection of residual myelomatous tissue after treatment, 18F-FDG PET/CT achieved higher specificity (86%) than WB-MRI (43%) (p = 0.0081), whereas both modalities achieved the same sensitivity (75%).

Conclusion

WB-MRI is more sensitive than 18F-FDG PET/CT in the diagnosis of MM before treatment; however, 18F-FDG PET/CT is more specific than WB-MRI in detecting residual involvement in treated patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

AUC:

Area under the curve

CI:

Confidence interval

18F-FDG PET/CT:

18F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography

IMWG:

International Myeloma Working Group

IMA:

Inter-modality agreement

MIP:

Maximum-intensity projection

MM:

Multiple myeloma

ROC:

Receiver-operating characteristic

SI:

Signal intensity

STIR:

Short inversion time inversion recovery

SUVmax:

Maximum standardized uptake value

WB-MRI:

Whole-body magnetic resonance imaging

References

  1. Caers J, Withofs N, Hillengass J, et al. The role of positron emission tomography-computed tomography and magnetic resonance imaging in diagnosis and follow up of multiple myeloma. Haematologica. 2014;99(4):629–37.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Rajkumar SV. Multiple myeloma: 2016 update on diagnosis, risk-stratification, and management. Am J Hematol. 2016;91(7):719–34.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Angtuaco EJ, Fassas AB, Walker R, Sethi R, Barlogie B. Multiple myeloma: clinical review and diagnostic imaging 1. Radiology. 2004;231(1):11–23.

    Article  PubMed  Google Scholar 

  4. Lütje S, de Rooy JW, Croockewit S, Koedam E, Oyen WJ, Raymakers RA. Role of radiography, MRI and FDG-18F-FDG PET/CT in diagnosing, staging and therapeutical evaluation of patients with multiple myeloma. Ann Hematol. 2009;88(12):1161.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Derlin T, Weber C, Habermann CR, et al. 18F-FDG 18F-FDG PET/CT for detection and localization of residual or recurrent disease in patients with multiple myeloma after stem cell transplantation. Eur J Nucl Med Mol Imaging. 2012;39(3):493–500.

    Article  PubMed  Google Scholar 

  6. Fonti R, Salvatore B, Quarantelli M, et al. 18F-FDG 18F-FDG PET/CT, 99mTc-MIBI, and MRI in evaluation of patients with multiple myeloma. J Nucl Med. 2008;49(2):195–200.

    Article  PubMed  Google Scholar 

  7. Rajkumar SV, Harousseau JL, Durie B, et al. Consensus recommendations for the uniform reporting of clinical trials: report of the International Myeloma Workshop Consensus Panel 1. Blood. 2011;117(18):4691–5.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Dimopoulos M, Kyle R, Fermand JP, et al. Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel 3. Blood. 2011;117(18):4701–5.

    Article  PubMed  CAS  Google Scholar 

  9. Durie BG. The role of anatomic and functional staging in myeloma: description of Durie/Salmon plus staging system. Eur J Cancer. 2006;42(11):1539–43.

    Article  PubMed  Google Scholar 

  10. Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia. 2014;28(4):980.

    Article  Google Scholar 

  11. Palumbo A, Rajkumar SV. Treatment of newly diagnosed myeloma. Leukemia. 2009;23(3):449–56.

    Article  PubMed  CAS  Google Scholar 

  12. Breyer RJ, Mulligan ME, Smith SE, Line BR, Badros AZ. Comparison of imaging with FDG PET/CT with other imaging modalities in myeloma. Skeletal Radiol. 2006;35(9):632–40.

    Article  PubMed  Google Scholar 

  13. Shortt CP, Gleeson TG, Breen KA, et al. Whole-body MRI versus PET in assessment of multiple myeloma disease activity. Am J Roentgenol. 2009;192(4):980–6.

    Article  Google Scholar 

  14. Schmidt GP, Kramer H, Reiser MF, Glaser C. Whole-body magnetic resonance imaging and positron emission tomography-computed tomography in oncology. Top Magn Reson Imaging. 2007;18(3):193–202.

    Article  PubMed  Google Scholar 

  15. Nanni C, Zamagni E, Farsad M, et al. Role of 18F-FDG 18F-FDG PET/CT in the assessment of bone involvement in newly diagnosed multiple myeloma: preliminary results. Eur J Nucl Med Mol Imaging. 2006;33(5):525–31.

    Article  PubMed  Google Scholar 

  16. Zamagni E, Nanni C, Patriarca F, et al. A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma. Haematologica. 2007;92(1):50–5.

    Article  PubMed  Google Scholar 

  17. Dimopoulos M, Terpos E, Comenzo RL, et al. International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple Myeloma. Leukemia. 2009;23(9):1545–56.

    Article  PubMed  CAS  Google Scholar 

  18. Cascini GL, Falcone C, Console D, et al. Whole-body MRI and 18F-FDG PET/CT in multiple myeloma patients during staging and after treatment: personal experience in a longitudinal study. Radiol Med (Torino). 2013;118(6):930–48.

    Article  Google Scholar 

  19. Weininger M, Lauterbach B, Knop S, et al. Whole-body MRI of multiple myeloma: comparison of different MRI sequences in assessment of different growth patterns. Eur J Radiol. 2009;69(2):339–45.

    Article  PubMed  Google Scholar 

  20. Ghanem N, Lohrmann C, Engelhardt M, et al. Whole-body MRI in the detection of bone marrow infiltration in patients with plasma cell neoplasms in comparison to the radiological skeletal survey. Eur Radiol. 2006;16(5):1005–14.

    Article  PubMed  Google Scholar 

  21. Falcone C, Cipullo S, Sannino P, Restuccia A. Whole body magnetic resonance and CT-PET in patients affected by multiple myeloma during staging before treatment. Recenti Prog Med. 2012;103(11):444–9.

    PubMed  Google Scholar 

  22. Moulopoulos LA, Gika D, Anagnostopoulos A, et al. Prognostic significance of magnetic resonance imaging of bone marrow in previously untreated patients with multiple myeloma. Ann Oncol. 2005;16(11):1824–8.

    Article  PubMed  CAS  Google Scholar 

  23. Moreau P, Attal M, Caillot D, et al. Prospective evaluation of magnetic resonance imaging and [18F] fluorodeoxyglucose positron emission tomography-computed tomography at diagnosis and before maintenance therapy in symptomatic patients with multiple myeloma included in the IFM/DFCI 2009 trial: results of the IMAJEM study. J Clin Oncol. 2017;35(25):2911–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bredella MA, Steinbach L, Caputo G, Segall G, Hawkins R. Value of FDG PET in the assessment of patients with multiple myeloma. Am J Roentgenol. 2005;184(4):1199–204.

    Article  Google Scholar 

  25. Zamagni E, Patriarca F, Nanni C, et al. Prognostic relevance of 18-F FDG 18F-FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation. Blood. 2011;118(23):5989–95.

    Article  PubMed  CAS  Google Scholar 

  26. Moulopoulos LA, Dimopoulos MA, Kastritis E, et al. Diffuse pattern of bone marrow involvement on magnetic resonance imaging is associated with high risk cytogenetics and poor outcome in newly diagnosed, symptomatic patients with multiple myeloma: a single center experience on 228 patients. Am J Hematol. 2012;87(9):861–4.

    Article  PubMed  Google Scholar 

  27. Filonzi G, Mancuso K, Zamagni E, et al. A comparison of different staging systems for multiple myeloma: can the MRI pattern play a prognostic role? Am J Roentgenol. 2017;209(1):152–8.

    Article  Google Scholar 

  28. Derlin T, Peldschus K, Münster S, et al. Comparative diagnostic performance of 18F-FDG 18F-FDG PET/CT versus whole-body MRI for determination of remission status in multiple myeloma after stem cell transplantation. Eur Radiol. 2013;23(2):570–8.

    Article  PubMed  Google Scholar 

  29. Weber C, Peldschus K, Klutmann S, Derlin T. F-18-FDG 18F-FDG PET/CT vs whole-body mr imaging in the evaluation of multiple myeloma after stem cell transplantation. Conference: radiological society of North America scientific assembly and annual meeting. November 2010.

  30. Dankerl A, Liebisch P, Glatting G, et al. Multiple myeloma: molecular imaging with 11 C-methionine PET/CT—initial experience. Radiology. 2007;242(2):498–508.

    Article  PubMed  Google Scholar 

  31. Okasaki M, Kubota K, Minamimoto R, et al. Comparison of 11 C-4′-thiothymidine, 11 C-methionine, and 18 F-FDG PET/CT for the detection of active lesions of multiple myeloma. Ann Nucl Med. 2015;29(3):224–32.

    Article  PubMed  CAS  Google Scholar 

  32. Nakamoto Y. Clinical contribution of PET/CT in myeloma: from the perspective of a radiologist. Clin Lymphoma Myeloma Leuk. 2014;14(1):10–1.

    Article  PubMed  Google Scholar 

  33. Sachpekidis C, Hillengass J, Goldschmidt H, et al. Comparison of 18F-FDG PET/CT and PET/MRI in patients with multiple myeloma. Am J Nucl Med Mol Imaging. 2015;5(5):469–78.

    PubMed  PubMed Central  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, Zagazig University, Zagazig, Egypt

    Mohammad Abd Alkhalik Basha, Maged Abdel Gelil Hamed, Mohamad Zakarya AlAzzazy, Manar A. Bessar, Elshaimaa Mohamed Mohamed, Ayman F. Ahmed, Heba Fathy Tantawy & Khaled Mohamed Altaher

  2. Department of Diagnostic Radiology, Ain Shams University, Cairo, Egypt

    Rania Refaat

  3. Department of Clinical Oncology, Zagazig University, Zagazig, Egypt

    Ahmed Ali obaya

  4. Department of Clinical Pathology, Zagazig University, Zagazig, Egypt

    Amira Hamed Mohamed Afifi

Authors
  1. Mohammad Abd Alkhalik Basha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maged Abdel Gelil Hamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rania Refaat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamad Zakarya AlAzzazy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Manar A. Bessar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elshaimaa Mohamed Mohamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ayman F. Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Heba Fathy Tantawy
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Khaled Mohamed Altaher
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ahmed Ali obaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Amira Hamed Mohamed Afifi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohammad Abd Alkhalik Basha.

Ethics declarations

Conflict of interest

The author of this manuscript declares no relevant conflicts of interest, and no relationships with any companies, whose products or services may be related to the subject matter of the article.

Ethical approval

Institutional review board approval was obtained.

Informed consent

Written informed consent was obtained from all patients.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Basha, M.A.A., Hamed, M.A.G., Refaat, R. et al. Diagnostic performance of 18F-FDG PET/CT and whole-body MRI before and early after treatment of multiple myeloma: a prospective comparative study. Jpn J Radiol 36, 382–393 (2018). https://doi.org/10.1007/s11604-018-0738-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-018-0738-z

Keywords

Search

Navigation