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. 2015 Oct 12;5(5):469-78.
eCollection 2015.

Comparison of (18)F-FDG PET/CT and PET/MRI in patients with multiple myeloma

Christos Sachpekidis  1 , Jens Hillengass  2 , Hartmut Goldschmidt  2 , Jennifer Mosebach  3 , Leyun Pan  1 , Heinz-Peter Schlemmer  3 , Uwe Haberkorn  4 , Antonia Dimitrakopoulou-Strauss  1
Affiliations

Comparison of (18)F-FDG PET/CT and PET/MRI in patients with multiple myeloma

Christos Sachpekidis et al. Am J Nucl Med Mol Imaging. .

Abstract

PET/MRI represents a promising hybrid imaging modality with several potential clinical applications. Although PET/MRI seems highly attractive in the diagnostic approach of multiple myeloma (MM), its role has not yet been evaluated. The aims of this prospective study are to evaluate the feasibility of (18)F-FDG PET/MRI in detection of MM lesions, and to investigate the reproducibility of bone marrow lesions detection and quantitative data of (18)F-FDG uptake between the functional (PET) component of PET/CT and PET/MRI in MM patients. The study includes 30 MM patients. All patients initially underwent (18)F-FDG PET/CT (60 min p.i.), followed by PET/MRI (120 min p.i.). PET/CT and PET/MRI data were assessed and compared based on qualitative (lesion detection) and quantitative (SUV) evaluation. The hybrid PET/MRI system provided good image quality in all cases without artefacts. PET/MRI identified 65 of the 69 lesions, which were detectable with PET/CT (94.2%). Quantitative PET evaluations showed the following mean values in MM lesions: SUVaverage=5.5 and SUVmax=7.9 for PET/CT; SUVaverage=3.9 and SUVmax=5.8 for PET/MRI. Both SUVaverage and SUVmax were significantly higher on PET/CT than on PET/MRI. Spearman correlation analysis demonstrated a strong correlation between both lesional SUVaverage (r=0.744) and lesional SUVmax (r=0.855) values derived from PET/CT and PET/MRI. Regarding detection of myeloma skeletal lesions, PET/MRI exhibited equivalent performance to PET/CT. In terms of tracer uptake quantitation, a significant correlation between the two techniques was demonstrated, despite the statistically significant differences in lesional SUVs between PET/CT and PET/MRI.

Keywords: Multiple myeloma; PET/CT; PET/MRI; SUV.

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Figures

Figure 1
Figure 1
Multiple intensity projection (MIP) images of a 78-year old patient with newly diagnosed stage III MM, derived from PET/CT 60 min p.i. (left) and PET/MRI 120 min p.i. (right). The patient demonstrates intense diffuse 18F-FDG bone marrow uptake along the spinal column demonstrated with both PET/CT and PET/MRI. Moreover, a big focal lesion in the right os ilium that infiltrates the soft tissues is depicted with both techniques (arrow). Mixed pattern of 18F-FDG uptake. The values of the scale bar refer to g/ml. (Lt: lower threshold; Ut: upper threshold).
Figure 2
Figure 2
Transaxial PET/CT (upper row) and PET/MRI (lower row) images of a MM patient referred to our department for initial evaluation of extent of bone involvement. A MM-suspicious lesion is depicted in the right iliac bone in both systems. The lesion has the following values in PET/CT: SUVaverage=5.5 and SUVmax=7.1. The respective SUVs in PET/MRI are: SUVaverage=4.2 and SUVmax=6.5. The values of the scale bar refer to Bq/ml.
Figure 3
Figure 3
Transaxial PET/CT (upper row) and PET/MRI (lower row) images of the same patient as in Figure 2. The patient has a myeloma-indicative site of enhanced 18F-FDG uptake in the 7th thoracic vertebrae seen with both hybrid imaging systems. The lesion has the following values in PET/CT: SUVaverage=4.1 and SUVmax=6.7. The respective SUVs in PET/MRI are: SUVaverage=3.6 and SUVmax=5.9. The values of the scale bar refer to Bq/ml.
Figure 4
Figure 4
Transaxial PET/CT (upper row) and PET/MRI (lower row) images of the same patient as in Figure 2. A MM-suspicious lesion is delineated in the 10th left rib dorsally involving the costovertebral joint (arrow). The lesion has the following values in PET/CT: SUVaverage=4.4 and SUVmax=6.9. The respective SUVs in PET/MRI are: SUVaverage=4.3 and SUVmax=7.1. The values of the scale bar refer to Bq/ml.
Figure 5
Figure 5
Transaxial PET/CT (upper row) and PET/MRI (lower row) images of a pre-treated stage III MM patient. PET/CT reveals a myeloma-suspicious lesion in the 11th rib right dorsolaterally, while PET/MRI shows no pathological tracer uptake in the respective anatomical site. The values of the scale bar refer to Bq/ml.
Figure 6
Figure 6
Transaxial PET/CT (upper row) and PET/MRI (lower row) images of a pre-treated stage III MM patient. On PET/CT a myeloma-suspicious lesion in the right 5th rib ventrally is depicted. PET/MRI shows no pathologically enhanced 18F-FDG uptake. Same patient as in Figure 5.
Figure 7
Figure 7
Scatter plot of the results of correlation analysis between lesional SUVaverage derived from PET/CT and PET/MRI (r=0.744, p<0.0001).
Figure 8
Figure 8
Scatter plot of the results of correlation analysis between lesional SUVmax derived from PET/CT and PET/MRI (r=0.855, p<0.0001).
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