Osseous involvement defined by lytic bone lesions is shown by skeletal survey in multiple myeloma (MM). This technique has limitations because it detects only lesions with more than 30% trabecular bone loss. In addition, lesions persist after chemotherapy, thereby limiting its usefulness at relapsing disease. Alternative techniques to detect new bone lesions are somatostatin receptor scintigraphy (SRS) and F-fluordeoxyglucose (FDG) PET so far predominantly studied in patients with newly diagnosed MM. Malignant plasma cells can have a high expression of somatostatin receptors and an elevated metabolic activity. Therefore, these techniques might be useful in patients with relapsing MM because they are not hampered by preexisting skeletal defects. The purpose of this study was to demonstrate which technique is most optimal to detect skeletal lesions in patients with relapsing MM.
In patients with relapsing MM (n = 21), 3 separate methods were used (skeletal survey, SRS, and FDG PET) for detecting new skeletal lesions.
Of all patients, 55% had new lesions on the skeletal survey [mean (SD), 1.45 (1.76); range, 0-5], 52% had new SRS lesions [mean (SD), 1.43 (0.38); range, 0-5], and 71% demonstrated new lesions on the FDG PET-scan [mean (SD), 4.05 (0.9); range, 0-12]. The lesions on skeletal survey and SRS corresponded with FDG PET. The number of lesions was higher with the FDG PET versus that with SRS (P = 0.01) and with FDG PET versus that with skeletal survey (P = 0.01).
The results demonstrate that FDG PET is more valuable than skeletal survey and SRS to detect disease activity in relapsing MM.
[Show abstract][Hide abstract] ABSTRACT: Multiple myeloma cells express somatostatin receptors, and somatostatin receptor scintigraphy with 111In-pentetreotide has been used for imaging multiple myeloma with variable success. We here present 68Ga-DOTANOC somatostatin receptor PET-CT findings in a 57-year-old man with multiple myeloma. PET-CT showed 2 expansile lytic lesions with increased 68Ga-DOTANOC. This case highlights the potential use of 68Ga-DOTANOC PET-CT as an alternative imaging modality in multiple myeloma.
Clinical nuclear medicine 05/2013; 39(4). DOI:10.1097/RLU.0b013e31828e9722 · 3.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE:
The current study was performed to evaluate the impact of Tc-EDDA-tricine-HYNIC-Tyr-octreotate in the differentiation of active from inactive pulmonary tuberculosis lesions.
PATIENTS AND METHODS:
Ten consecutive patients (six male and four female, age range 24-83 years) with proven pulmonary tuberculosis (with a positive smear or culture) were enrolled in the study. At 120 min after injection of 740 MBq of Tc-EDDA-tricine-HYNIC-Tyr-octreotate, planar and single-photon emission computed tomography (SPECT) images of the thorax were taken. A semiquantitative evaluation of lesion and nonlesion areas was performed. The scan was repeated following the same protocol after standard treatment for tuberculosis after a negative sputum culture.
Semiquantitative evaluation of the lesions showed a statistically significant higher uptake before treatment in both planar and SPECT images (P=0.005 and 0.007, respectively). Lesion-to-nonlesion ratios were also higher in the pretreatment sets on both planar and SPECT images (1.4±0.2 vs. 1.19±0.15, P=0.001, for planar images and 2.32±0.55 vs. 1.32±0.32, P=0.0001, for SPECT images).
Tc-EDDA-tricine-HYNIC-Tyr-octreotate scintigraphy may help to differentiate between active and inactive pulmonary tuberculosis. SPECT imaging and semiquantitative evaluation are indispensable for increasing the diagnostic yield of this method. Larger studies are needed to corroborate our results.
Nuclear Medicine Communications 09/2014; 35(12). DOI:10.1097/MNM.0000000000000206 · 1.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Whole-body x-ray (WBX) is used for detecting skeleton abnormalities in patients with multiple myeloma (MM). An alternative might be F-FDG-PET, which makes use of metabolic changes of malignant cells. The aims of this study were to evaluate whether F-FDG-PET detects more lesions compared with WBX in patients with relapsing MM and to define its prognostic value. In addition 1-α-D: -(5-deoxy-5-[F]-fluoroarabinofuranosyl)-2-nitroimidazole (F-FAZA) scan and immunohistochemical staining on bone marrow were performed to define whether FDG uptake coincides with angiogenesis-related tumor hypoxia.
F-FDG-PET (n = 44) and F-FAZA-PET (n = 5) were performed in patients with relapsed MM. Bone marrow biopsies (n = 20) were evaluated for hypoxia inducible factors (HIF) 1α and 2α, vascular endothelial growth factor, glucose transport proteins 1 and 3, and the microvessel density.
New lesions were more frequently demonstrated on F-FDG-PET than on WBX (P = 0.000001). F-FDG-PET was not predictive for progression-free survival and overall survival. Immunohistochemical staining on bone marrow biopsies demonstrated a significant increase in microvessel density and elevated expression of vascular endothelial growth factor, HIF-2α, and glucose transport protein 3 by the malignant plasma cells. However, HIF-1α expression and F-FAZA scan results were negative.
Our results demonstrate that F-FDG-PET is relevant for diagnostic purposes compared with WBX in relapsing MM. The enhanced uptake of F-FDG-PET is likely related to the activation of the HIF-2α signaling pathway but probably independent of hypoxia-induced signaling in view of the negative findings on both F-FAZA-PET and HIF-1α expression.
Clinical Nuclear Medicine 12/2014; 40(4). DOI:10.1097/RLU.0000000000000629 · 3.93 Impact Factor
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