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

Czech version

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‘ workplace: 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: Klin Onkol 2010; 23(5): 325-331
Category: Original Articles

Overview

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

Sources

1. Hallek M, Bergsagel PL, Anderson KC et al. Multiple myeloma: increasing evidence for a multistep transformation process. Blood 1998; 91(1): 3– 21.

2. Klein B, Bataille R. Cytokine network in human multiple myeloma. Hematol Oncol Clin North Am 1992; 6(2): 273– 284.

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

4. Durie BG, Salmon SE. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment and survival. Cancer 1975; 36(3): 842– 854.

5. Durie BG, Waxman AD, D’Agnolo A et al. Whole‑ body ¹⁸F‑ FDG PET identifies high‑risk myeloma. J Nucl Med 2002; 43(11): 1457– 1463.

6. 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– 1543.

7. D’Sa S, Abildgaard N, Tighe J et al. Guidelines for the use of imaging in the management of myeloma. Br J Haematol 2007; 137(1): 49– 63.

8. Tirovola EB, Biassoni L, Britton KE et al. The use of ^99mTc‑ MIBI scanning in multiple myeloma. Br J Cancer 1996; 74(11): 1815– 1820.

9. el‑ Shirbiny AM, Yeung H, Imbriaco M et al. Technetium‑ ^99m‑ MIBI versus fluorine‑ ¹⁸- FDG in diffuse multiple myeloma. J Nucl Med 1997; 38(8): 1208– 1210.

10. Pace L, Catalano L, Pinto A et al. Different patterns of technetium‑ ^99m sestamibi uptake in multiple myeloma. Eur J Nucl Med 1998; 25(7): 714– 720.

11. Catalano L, Pace L, Califano C et al. Detection of focal myeloma lesions by technetium‑^99m‑ sestamibi scintigraphy. Haematologica 1999; 84(2): 119– 124.

12. Fonti R, Del Vecchio S, Zannetti et al. Bone marrow uptake of ^99mTc‑ MIBI in patients with multiple myeloma. Eur J Nucl Med 2001; 28(2): 214– 220.

13. Mileshkin L, Blum R, Seymour JF et al. A comparison of fluorine‑¹⁸fluoro‑deoxyglucose PET and technetium‑ ^99m sestamibi in assessing patients with multiple myeloma. Eur J Haematol 2004; 72(1): 32– 37.

14. Pace L, Catalano L, Del Vecchio S et al. Washout of (^99mTc) sestamibi in predicting response to chemotherapy in patients with multiple myeloma. Q J Nucl Med Mol Imaging 2005; 49(3): 281– 285.

15. Hung GU, Tsai CC, Tsai SC et al. Comparison of Tc‑ ^99m sestamibi and F‑ ¹⁸ FDG PET in the assessment of multiple myeloma. Anticancer Res 2005; 25(6C): 4737– 4741.

16. Martín MG, Romero Colás MS, Dourdil Sahún MV et al. Baseline Tc‑ 99- MIBI scanning predicts survival in multiple myeloma and helps to differentiate this disease from monoclonal gammopathy of unknown significance. Haematologica 2005; 90(8): 1141– 1143.

17. Nandurkar D, Kalff V, Turlakow A et al. Focal MIBI uptake is better indicator of active myeloma than diffuse uptake. Eur J Haematol 2006; 76(2): 141– 146.

18. Mele A, Offidani M, Visani G et al. Technetium‑ ^99m sestamibi scintigraphy is sensitive and specific for the staging and the follow‑up of patients with multiple myeloma: a multicentre study on 397 scans. Br J Haematol 2007; 136(5): 729– 735.

19. Erten N, Saka B, Berberoglu K et al. Technetium‑ ^99m 2-methoxy‑ isobutyl‑ isonitrile uptake scintigraphy in detection of bone marrow infiltration in multiple myeloma: correlation with MRI and other prognostic factors. Ann Haematol 2007; 86(11): 805– 813.

20. Mysliveček M, Bačovský J, Kamínek M et al. Scintigrafie pomocí ^99mTc‑ MIBI v diagnostice mnohočetného myelomu: senzitivní ukazatel biologické aktivity choroby. Klin Onkol 2004; 17(1): 13– 17.

21. Mysliveček M, Bačovský J, Kamínek M et al. Prediktivní cena ^99mTc‑ MIBI scintigrafie u nemocných s mnohočetným myelomem a potenciální úloha metody při jejich sledování po terapii. Klin Onkol 2005; 18(2): 46– 50.

22. 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 assessment of bone disease in newly diagnosed multiple myeloma. Haematologica 2007; 92(1): 50– 55.

23. Mulligan ME, Badros AZ. PET/ CT and MR imaging in myeloma. Skeletal Radiol 2007; 36(1): 5– 16.

24. Breyer RJ 3rd, Mulligan ME, Smith SE et al. Comparison of imaging with FDG PET/ CT with other imaging modalities in myeloma. Skeletal Radiol 2006; 35(9): 632– 640.

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

26. Schmidt GP, Schoenberg SO, Reiser MF et al. Whole‑ body MR imaging of bone marrow. Eur J Radiol 2005; 55(1): 33– 40.

27. Lucignani G. Bone and marrow imaging: do we know what we see and do we see what we want to know? Eur J Nucl Med Mol Imaging 2007; 34(7): 1123– 1126.

28. Villa G, Balleari E, Carletto M et al. Staging and therapy monitoring of multiple myeloma by ^99mTc‑ MIBI scintigraphy: a five year single center experience. J Exp Clin Cancer Res 2005; 24(3): 355– 361.

29. Bredella MA, Steinbach L, Caputo G et al. Value of FDG PET in the assessment of patients with multiple myeloma. AJR Am J Roentgenol 2005; 184(4): 1199– 1204.

30. Nanni C, Zamagni E, Farsad M et al. Role of 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– 531.

31. Wakasugi S, Noguti A, Katuda T et al. Potential of (^99m)Tc- MIBI for detecting bone marrow metastases. J Nucl Med 2002; 43(5): 596– 602.

32. Giovanella L, Taborelli M, Ceriani L et al. ^99mTc‑ sestamibi imaging and bone marrow karyotyping in the assessment of multiple myeloma and MGUS. Nucl Med Commun 2008; 29(6): 535– 541.

33. Hillner BE, Siegel AF, Liu D et al. Relationship between cancer type and impact of PET and PET/ CT on intended management: findings of the National Oncologic PET Registry. J Nucl Med 2008; 49(12): 1928– 1935.